Path Block 3 (Vulva)

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Path Block 3 (Vulva)
2010-11-03 16:50:33
Path Block Vulva

Path Block 3 (Vulva)
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  1. Patient comes in and presents with:
    Blateral Abdominal Pain and tenderness
    Adnexal & and cervical tenderness (cervical discharge and Urinary frequency)
    Possible Fever
    What does she have?
    What are some sequella?
    • PID
    • Fever with Gonococcal infections
    • Ectopic pregnancys and Infertility.
    • Recurrent infections
  2. What are some complications of PID
    • Peritonitus, endocaritus, meningitus, arthritus
    • Infertility
    • Ectopic pregs
    • Intestinal OPbstructions and adhesions
  3. What are the Malignant neoplasms of the Vagina?
    • SCC
    • Adenocarcinoma
    • Rabdomyosarcoma
    • Malignant melanoma
  4. What is Vaginal Adenosis associated with?
    What is a maligant tumore of the vagina that has this same association?
    What is it?
    • DES exposure
    • Adenocarcinoma

    It is when the squamus cells are transformed to Columnar cells.
  5. What is VaIN?
    What is is associated with?
    it is Disordered growth confined to the epithelium

  6. What is the most common malignancy of the Vagina?
    What age is affected?
    What will you see clinically?
    What is it assocaited with?
    • SCC
    • 60-70yoa
    • Spotting,Dischange,Urinary tract fistulas

    HPV 16 and 18
  7. Grape like lesions
    Hemorrhage with Myxoid change
    What is it?
    Where is it from?
    how does it spread?
    What do you see histologically?
    • This is Rabdomyosarcoma
    • a tumor of mesenchymal cells
    • Local invasion
    • See Rhabdomyoblasts
  8. What is Lichen Sclerosis?
    Who is effected?
    is it cancerous?
    what do you see hystologically?
    • it is atrophic change
    • Elderly and post menopausal patients
    • Non-neoplastic
    • thinning of the epidermal Layer and loss of the Rete ridges
  9. What is Lichen Simplex Chronicus?

    Will you see atypia? what if you do?
    • It is Thickening of the Epithelial layer (acanthosis) and hyperkeratosis.
    • You will not see atypia, but if you do it is not LSC, it is VIN1
  10. LSC
  11. What are the Vulvular Tumors? (6)
    Which are Benein?
    • Papillary hidradenoma
    • Condyloma acuminotum
    • VIN
    • SCC
    • Extramammary Paget disease
    • Malignant melanoma
    • Fibroadenoma
  12. Venerial Warts
    HPV 6,11
    see Koliocytosis, Mitosis
    What is it?
    Does it regress?
    How do you treat it?
    • Condyloma Accuminata
    • Frequently regresses
    • Cryotheropy, Chemical/ Excision
  13. Condyloma Accuminata

    See Koliocytes
  14. What is the most common Malignancy of the Vulvus?
    What ages?
    What is it associated with (risk factors)
    • SCC
    • Older women but now getting younger

    • –HPV & VIN
    • –Vulvar dystrophy
    • –Immunodeficiency
    • syndromes
    • –Smoking
    • –Diabetes mellitus
    • –Granulomatous diseases (LGV, GI)
  15. VIN
    What ages?
    Associated with?
    Can it progress? if so to what? What %
    See in <40 and >60

    Associated with HPV 16,18

    Can progress to SCC 10% of the time
    • VIN
    • See Hyperkeratosis and Thickened Epithelium
  16. What is Bowmens disease?
    it is VIN when it goes the full thickness
  17. What are the Two types of Vulvular Cancer? and %
    • Basaloid or warty (30%)
    • and Keratinizing Squamus (70%)
  18. Basaloid or Warty

    What age?
    Is it HPV associated?
    What do you see?
    • Uusually reproductive age
    • HPV related
    • Immature basal like cells (basaloid)
    • exophytic (warty)
  19. Keratinizing squamous
    Where is it from?
    Is it HPV associated?
    —mean age = 76

    • from lichen sclerosis or squamous hyperplasia
    • Non HPV
  20. On Gross examination see a Solitary, Exophytic Mass in the Labia Majora(could be menora)

    What is it?
    What if it is assocaited with Condyloma?

    Then 10% are Multifocal (multible masses)
  21. What is this?
    Verricous Carcinoma of the Vulva= This is a Non-HPV associated subtype of SCC
  22. What are the two tumors of the Vulva that are from the breast?
    • Pagets disease
    • Papillary hidradinoma
  23. What is this? Where is it from?
    • This is a Papillary hidradenoma
    • From the Breast tissure (sweat glands), seen as a Small descrete nodule that is Beneign
  24. What is Pagets disease?
    What will you see Hystologically?
    Where is the most likley place to see this?
    What ethnicity and age?
    • - It is a breast associated cancer in the Vulvus
    • -see paget (halo) cells
    • - In is PAS,Mucin, EMA, CEA positive
    • -Perianal is most common
    • - See in 70 year old Caucasion women
    • -Wide excision.
  25. What is this
    • This is Pagets Disease
    • See Halo (paget) Cells