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VULVA - Coggle Diagram

- - - - Leukoplakia with thick,
        leathery vulvar skin
        
        Benign; no increased risk of
        squamous cell carcinoma
      - Thick vulvar skin with
        enhanced skin markings
  - - - White patch (leukoplakia) +
        parchment-like vulvar skin
        
        MOST LIKELY: Postmenopausal women but ↑ incidence in prepubertal; childs, possible autoimmune etiology
        
        Benign; associated increased risk for squamous cell carcinoma
        
        May extend to anus producing figure-eight appearance
        
        CLINICAL: intense pruritus,dyspareunia, dysuria, dyschezia
      - Porcelain-white plaques
        
        Can be hemorrhagic,
        eroded, or ulcerated
  - - - Bartholin gland on each side →produces mucus-like fluid →drains via ducts into the lower vestibule
      - Women of reproductive age
        
        Unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal
  - - - -Sexually transmitted: Areas that undergo frequent
        friction and abrasion, including cervix, and anus.
        -Birth canal: true vocal cords(Laryngeal papillomatosis)
        
        Koilocytes hallmark of HPV-infected cells:
        
        Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia (Epidermal hyperplasia, hyperkeratosis)
        
        Soft, tan-colored, cauliflower-like papules / verrucous,
        
        Skin-colored, white, or grey verrucous and filiform papules.
        
        Skin-colored, cauliflower-like masse
        
        Nonpainful, nonpruritic skin bump (if it is in other parts of the body like skin of the knee, nail folds, palms/soles, etc.
        Tx: Imiquimod→topical immunomodulator→induces local cytokine (interferon-alpha, interleukin-6) production against the virus.
- - - - Presents with leukoplakia
        
        Etiology:
        
        HPV related 16 & 18 types
        
        Risk factors:
        
        Multiple partners
        
        Early first age of intercourse
        
        MOST LIKELY women of reproductive age
        
        From vulvar intraepithelial neoplasia:
        koilocytic change, disordered cellular
        maturation, nuclear atypia, and
        increased mitotic activity
        
        Non-HPV related
        
        Long-standing
        lichen sclerosis
        
        Elderly women
        (aver. age > 70 years)
      - Biopsy to distinguish carcinoma
        from other causes
  - - - Carcinoma in situ with no
        underlying carcinoma
        
        Must be distinguished
        from melanoma
        
        Rarely occur in vulva
        
        Paget cells are PAS+, keratin+, and S-100-.
        
        Melanoma is PAS-, keratin-, and S-100+.
      - Paget nipple also epidermis
        BUT with underlying carcinoma