OneNote 22/06/2020, 09(49
Vulva & vagina
Thursday, 4 June 2020 15:08
Lichen sclerosis LS
Pathology Diagnostics
Chronic (auto-immune) Histology shows thinned epidermis
Mostly prepubertal or postmenopausal Punch biopsy
Anatomical changes: Treatment
• Labia minora resorbs Topical super potent corticosteroid
• Clitoris buried under scarred + fused clitoral prepuce ointment
• Introitus narrowed Skin moisturizer
Clinical picture
Pruritus, soreness, pain, burning, urinary + defecation
problems *, bleeding, blistering
*common in prepubertal due to soreness and itch
10-20% white papules on body
Differentiated vulvar intraepithelial neoplasia DNIV High grade squamous intraepithelial lesion
Precursor lesion of HPV negative SCC HSIL
Grey-white discolorations with roughed surface Pre/perimenopausal <50
Ulcerative lesions Rare premalignant HPV-induced disorder
Punch biopsy Pruritus, pain, dyspareunia
Surgery Lesions (warts)
Punch biopsy
Topical imiquimod, surgical excision, laser
ablation
Squamous cell carcinoma SCC
1. Elderly women due to LS
2. Younger women due to HPV 16/18 which results to HSIL
Most common malignant vaginal tumors in cervical carcinoma
spreading. Primary vaginal lesions rare
All primary vaginal carcinomas (1% of ♀ cancers)
Vulvar cancer spreads to inguinofemoral lymph nodes
Clinical picture
Grey-white discolorations with roughed surface
Vulvar mass (+pruritus)
Bleeding, discharge, dysuria
Invasive tumors affect mainly upper vagina
Incision or punch biopsy
Excision surgery
Basal cell carcinoma BCC
2nd most common vulvar malignancies
75 years
Rarely metastasize - Good prognosis
Wide local excision
Embryonal rhabdomyosarcoma
< 5 years
Invade locally and fatal due to penetration into the peritoneal cavity or obstruction of urinary tract
"grapelike" polypoid, rounded, bulky
Conservative surgery with chemo
https://onenote.officeapps.live.com/o/onenoteframe.aspx?ui=en-US&rs=en-U…b-4a3a-81f5-38904f9331e5&sftc=1&wdredirectionreason=Force_SingleStepBoot Page 1 of 2
Vulva & vagina
Thursday, 4 June 2020 15:08
Lichen sclerosis LS
Pathology Diagnostics
Chronic (auto-immune) Histology shows thinned epidermis
Mostly prepubertal or postmenopausal Punch biopsy
Anatomical changes: Treatment
• Labia minora resorbs Topical super potent corticosteroid
• Clitoris buried under scarred + fused clitoral prepuce ointment
• Introitus narrowed Skin moisturizer
Clinical picture
Pruritus, soreness, pain, burning, urinary + defecation
problems *, bleeding, blistering
*common in prepubertal due to soreness and itch
10-20% white papules on body
Differentiated vulvar intraepithelial neoplasia DNIV High grade squamous intraepithelial lesion
Precursor lesion of HPV negative SCC HSIL
Grey-white discolorations with roughed surface Pre/perimenopausal <50
Ulcerative lesions Rare premalignant HPV-induced disorder
Punch biopsy Pruritus, pain, dyspareunia
Surgery Lesions (warts)
Punch biopsy
Topical imiquimod, surgical excision, laser
ablation
Squamous cell carcinoma SCC
1. Elderly women due to LS
2. Younger women due to HPV 16/18 which results to HSIL
Most common malignant vaginal tumors in cervical carcinoma
spreading. Primary vaginal lesions rare
All primary vaginal carcinomas (1% of ♀ cancers)
Vulvar cancer spreads to inguinofemoral lymph nodes
Clinical picture
Grey-white discolorations with roughed surface
Vulvar mass (+pruritus)
Bleeding, discharge, dysuria
Invasive tumors affect mainly upper vagina
Incision or punch biopsy
Excision surgery
Basal cell carcinoma BCC
2nd most common vulvar malignancies
75 years
Rarely metastasize - Good prognosis
Wide local excision
Embryonal rhabdomyosarcoma
< 5 years
Invade locally and fatal due to penetration into the peritoneal cavity or obstruction of urinary tract
"grapelike" polypoid, rounded, bulky
Conservative surgery with chemo
https://onenote.officeapps.live.com/o/onenoteframe.aspx?ui=en-US&rs=en-U…b-4a3a-81f5-38904f9331e5&sftc=1&wdredirectionreason=Force_SingleStepBoot Page 1 of 2
