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Chapter: Pathology: Female Genital Pathology

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Vulva - Pathology

Lichen sclerosis is caused by epidermal thinning and dermal changes which cause pale skin in postmenopausal women.

VULVA

 

Non-Neoplastic Disorders

      Lichen sclerosis is caused by epidermal thinning and dermal changes which cause pale skin in postmenopausal women. There is a small risk of progression to squamous cell carcinoma (SCC).

      In lichen simplex chronicus, a chronic scratch/itch cycle produces the white plaques seen clinically. These plaques are characterized microscopically by squamous cell hyperplasia and dermal inflammation.

 

Infections

      Human papillomavirus (HPV) causes warty lesions (condylomata acuminata) and precursor dysplastic lesions of squamous cell carcinoma called vulvar intraepithelial neoplasia (VIN). Vulvar HPV is commonly subtype 6 and 11 and therefore has low oncogenic potential.

      Herpes simplex virus (HSV). Most cases of vulvar herpes are caused by HSV-2. Painless vesicles progress to pustules and painful ulcers.

     Syphilis is a sexually transmitted disease caused by Treponema pallidum. The primary lesion is a chancre, a painless ulcer that does not scar after healing.

        Molluscum contagiosum is a viral disease caused by a DNA poxvirus. It pres-ents as smooth papules and has characteristic cytoplasmic viral inclusions.

         Bartholin gland abscess is a polymicrobial infection requiring drainage or excision.


Tumors

 

         Papillary hidradenoma is a benign tumor of modified apocrine sweat glands of the labia majora or interlabial folds. It occurs along the milk line and may ulcerate, mimicking carcinoma. Papillary hidradenoma is histologically simi-lar to an intraductal papilloma of the breast.

 

         Extramammary Paget disease of the vulva usually involves the labia majora, and it causes an erythematous, crusted rash that is characterized microscopi-cally by intraepidermal malignant cells with pagetoid spread. This form of Paget disease is not usually associated with underlying tumor.

 

         Squamous cell carcinoma is the most common malignancy of the vulva. The most common form occurs in women age >60. The less common form occurs in younger women with HPV serotypes 16 and 18.

 

         Melanoma can occur on the vulva, and must be differentiated from lentigo simplex which is more common.

 

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