Vulva Conditions

Study Notes

Basic Principles: The vulva encompasses the external female genitalia, including the labia, clitoris, and vestibule, lined with squamous epithelium.
Bartholin Cysts: These are cystic dilations of Bartholin glands, located on either side of the vaginal canal. They produce mucus and typically arise from inflammation and gland obstruction, often in reproductive-aged women. Present as unilateral, painful cysts near the vaginal canal.
Condyloma: A wart-like vulvar skin growth, frequently large, typically caused by HPV types 6 or 11 (condyloma acuminatum). It's sexually transmitted. Microscopically, koilocytes (distinctive HPV-infected cells) are present. This condition rarely progresses to cancer.
Lichen Sclerosis: Characterized by epidermal thinning and dermal fibrosis, presenting as a white, parchment-like vulvar patch. Common in postmenopausal women, though autoimmune factors may play a role. Slightly increased risk of squamous cell carcinoma.
Lichen Simplex Chronicus: This condition involves vulvar squamous epithelium hyperplasia, often appearing as leukoplakia (white patches) related to chronic irritation or scratching. Benign, with no increased risk of squamous cell carcinoma.
Vulvar Carcinoma: A cancer arising from the vulvar squamous epithelium. Relatively uncommon. Often presents as leukoplakia, requiring biopsy to differentiate from other causes. Etiology can be HPV-related (high-risk types 16 and 18) or non-HPV related.

Characteristics: Maligned epithelial cells within the vulva epidermis, presenting as erythematous, itchy, ulcerated vulvar skin. Typically carcinoma in situ (no underlying cancer). Distinguished from other leukoplakic conditions via biopsy.
Differentiating from Melanoma: Paget disease cells stain positive for PAS, keratin, and S100, while melanoma cells are PAS-, keratin-, and S100-. This characteristic distinguishes Paget disease from potential melanoma, which occasionally affects the vulva.