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GYNECOLOGICAL ONCOLOGY . . . CONT.

Notes

• burning • atrophic vulva with fusion of labia • not associated with increased incidence of malignancy • treated with testosterone cream or progesterone cream in petroleum lichen sclerosis with epithelial hyperplasia (mixed dystrophy) • burning • pruritus • dyspareunia • increased incidence of cellular atypia • treated with corticosteroid cream followed by testosterone cream papillary hidradenoma • sharply circumscribed nodule, usually on labia majora or interlabial folds • tendency to ulcerate (gets confused with carcinoma) • identical in appearance to intraductal papillomas of breast condylomata acuminatum (3 forms) (see Gynecological Infections Section)

Malignant Vulvar Lesions characteristics

  • 3-4% of genital tract malignancies

  • most commonly squamous cell carcinoma

  • 50% of invasive lesions are associated with current or previous vulvar dystrophy

  • usually post-menopausal women

  • patient usually presents late or is biopsied late

  • 5% are VDRL positive

    • occurs at younger age and has a worse prognosis

  • etiological association with HPV

    • VIN = precancerous change which presents as multicentric white or pigmented plaques on vulva

    • 90% of VIN contain HPV DNA, specifically types 16, 18

    • increased incidence associated with obesity, hypertension, diabetes, atherosclerosis, long-term steroid treatment

sites of origin

  • labia minora (40-45%)

  • labia majora (35-40%)

  • clitoris (10-15%)

  • perineum, anus (3%)

  • Bartholin gland (1%)

  • multifocal (5%)

spread

  • locally

  • ipsilateral groin nodes

  • superficial inguinal —> pelvic nodes

clinical features

  • localized pruritus, pain

  • raised red, white or pigmented plaque

  • ulcer

  • bleeding, discharge

  • dysuria

diagnosis

  • physical examination

  • ALWAYS biopsy

  • +/– colposcopy

Gynecology 36

MCCQE 2000 Review Notes and Lecture Series

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