A wide spectrum of benign, premalignant, and malignant lesions may occur on the vulva. If you would like a large, unwatermarked image for your web page or. Rapidly progressive nephritic syndrome with focal glomerulonephritis. Guttate lesions may herald the onset of plaquetype psoriasis. Vin is an intraepithelial neoplasia, and can disappear without treatment. Papular lesions may be condyloma, bowenoid papulosis, multiple syringoma, or multiple cysts. Accurate diagnosis in vulvar dermatology is facilitated by accurate description of skin lesions.
Vulvar cancer was reported in 3,200 women in 1998, resulting in 800 deaths. A gynecologic examination revealed multiple large papillomatous. After history, physical examination, and morphologic classification see tables, the information in this topic can be used to begin differential diagnosis of the lesion. Examination of the vulva requires good lighting, and a magnlfymg glass may assist close inspection. Although pyogenic granulomas pg are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. But if they arent treated, there is a chance that these abnormal changes may become vulvar cancer.
Patients with hpvrelated squamous intraepithelial lesions are usually in their thirties or forties, frequently smokers, and frequently have a history of, or concurrent, multifocal vulvar lesions andor multicentric oncogenic hpvrelated disease, or other sexually transmitted diseases. Rapidly progressive nephritic syndrome, focal and segmental glomerular lesions. This classic finding almost is pathognomonic for paget disease. Pdf spectrum of vulvar lesions in an obstetrics and. The type of lesion can usually be diagnosed with a pelvic exam and a biopsy. Erythroplasia of queyrat, typically found on the penis may affect the vulvae in females staging. A 16yearold with multiple, pink, umbilicated 2 to 3mm papules on the labia majora has molluscum contagiosum.
You may not embed one of our images on your web page without a link back to our site. Most of these processes are asymptomatic and found incidentally requiring. This topic will discuss the diagnostic evaluation of women with vulvar lesions. Classification of vulvar dystrophies and premalignant squamous lesions. On the contrary, vulvoscopy has to be regarded as a valid tool, especially in complicated clinical presentations and in. The white appearance of dystrophic lesions is due to excessive keratin, at times deep pigmentation, and relative avascularity. Premalignant lesions of the vulva and vagina request pdf. Candidiasis vulva2 candida vulva and thigh candidiasis vulva lichen simplex chronicus lichen simplex chronicus1 lichen simplex chronicus2 lichen simplex chronicus3 vulvar psoriasis contact derm vulva contact derm vulva2 wickhams striae on plaque lichen planus oral wickham striae tinea cruris buttocks red macular high grade squamous intraepithelial lesion of vulva. Vulvar intraepithelial neoplasia vin is a precancerous skin disorder of the vulva. Vulvar pyogenic granuloma in a postmenopausal woman. Precancerous conditions of the vulva canadian cancer society.
Although the first, nonsurgical approach consists of culture of the drainage for a variety of microorganisms including fungi, diagnosis may be difficult. Localized vulvar pemphigus has been reported due to topical tacrolimus therapy. Information and treatment options for benign vulvar lesions. There are two main categories of vaginal neoplasms cystic tumors and solid lesions, as well as a few related conditions that will be discussed here briefly. The primary lesions are flat, ivorycoloured spots, which may merge together into. Anatomical staging supplemented preclinical staging starting in 1988. The most common presenting sign of vulvar cancer is a vulvar lump or mass. Rapidly progressive nephritic syndrome with focal and segmental hyalinosis.
The appearance of the vulva is highly variable see womens health victoria site, the labia library proliferative lesions affecting the vulva may originate from skin, mucosa or underlying connective tissue skin lesions are mainly typical of those found elsewhere on the body, and are found on the outer aspects of the vulva, the labia majora, extending to the groin. All 3 of these characteristics are present in the spectrum of vulvar dystrophies. The detection of hpv in vulvar cancer is much lower than that of cervical carcinoma. Benign vulvar lesions, or neoplasms, of the vagina are fairly rare. If you continue browsing the site, you agree to the use of cookies on this website. Rapidly progr neph synd w focal and seg glomerular lesions. Vulvar squamous intraepithelial lesions low grade squamous intraepithelial lesion flat condyloma or hpv effect high grade squamous intraepithelial lesion vin usual type intraepithelial neoplasia, differentiatedtype treatment for condyloma hsil in this patient should be. The vulvar skin may be thick, leading to the impression of leukoplakia with the cake icing effect. Anatomical consideration vulvar skin comprises stratified squamous epithelium as in other parts of body.
On the contrary, vulvoscopy has to be regarded as a valid tool, especially in complicated clinical presentations and in situations where there is a risk of intraepithelial neoplasia or. Diseases of vulva slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Precancerous conditions of the vulva are changes to vulvar cells that make them more likely to develop into cancer. The most frequent hpv type in vulvar cancer is hpv type 16, although hpv types 18, 21, 31, 33 and 34 have also been detected in. The vulva is a rich vascularized organ of the lower genital tract. The detection of hpv in lesions of vulvar squamous cell carcinomas ranges from 30% to 70%. The lesion usually is superficial and is considered an. Vulvar intraepithelial neoplasia is defined as an abnormal growth of vulvar epithelium exhibiting lack of cell maturation and crowding of cells within the epithelium. There may also be dystrophies, dermatoses and infections. Rapidly progressive nephritic syndrome with focal and segmental sclerosis. The challenge to the clinician is to differentiate between normal variants, benign findings, and potentially serious diseases. Des exposure sequelae structural changes transverse vaginal and cervical ridges cocks combs, collars, and pseudopolyps abnormally shaped uterine cavity uterine hypoplasia vaginal adenosis shows columnar epithelium on or beneath the vaginal mucosa.
Designed for quick, easy reference in the office or clinic, atlas of vulvar disease is a robust pictorial and textual guide to the diagnosis, treatment, and management of vulvar diseases. Draining vulvar lesions cause a variety of pathologies, including venereal lesions and sinus tracts fig. Biopsy of the affected skin is the key to accurate diagnosis and successful therapy. Surgery for other benign lesions of the vulva clinical gate. Med faculty of medicine, misurata university, libya 2. These disorders include vulvar atrophy, benign tumors, hamartomas and cysts, infectious disorders, and nonneoplastic epithelial disorders. Ulcers and erosions of the vulva clinical examination a general assessment of all slun surfaces including the mouth should be carried out, as vulval ulceration can be one manifestation of systemic disease. The trunk, buttocks, and periphery of the extremities are usually affected. Treatment typically includes excision and lymph node dissection or sentinel lymph node mapping. Even if the diagnosis is not readily apparent, a precise description may lead the way. The etiology of ls, the most well recognized vulvar dermatosis, has not yet been adequately explained, but there is increasing evidence that autoimmune mechanisms play a pathogenetic role 2. Vulvar involvement is rare, and lesions limited to the vulva would be exceptional. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions.
It is currently classified on the basis of histological findings as vin1. Vins are benign but if the changes become more severe, there is a chance of cancer developing after many years, and so it is referred to as a precancerous condition. Benign vulvar disorders are a significant issue for patients. Seborrheic keratoses appear as single or multiple verrucous, roundish, yellowishbrown, sharply circumscribed papules ranging in diameter from 210 mm and covered with a greasy friable scale. Even though in some cases vulvar lesions may go undetected because they are asymptomatic, it is a general rule that a woman must have at least one symptom such as pruritus itchy sensation, dysuria painful urination or. Vulvar lesions usually are hyperemic, and they may be demarcated sharply and thickened with foci of excoriation and induration.
Vulvar cancer gynecology and obstetrics merck manuals. Recent evidence suggests that vulvar cancer comprises two separate. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more. A familiarity with these lesions is necessary for the. Vulvar cancer is usually a squamous cell skin cancer, most often occurring in elderly women.
The bartholin gland is a rare malignancy and usually occurs in women in their midsixties. Whats fake and truth about coronavirus covid19 how people live duration. They can appear anywhere on the vulva and may go undetected until a gynecologic examination. Lamellar eosinophilic fibroplasia of papillary dermis is present. Mucocutaneous vulvar lesions can be classified using the morphologic definitions described in the table. Features overlap with atypical genital nevi j cutan pathol 2008. Vulvar intraepithelial neoplasia vin refers to particular changes that can occur in the skin that covers the vulva. Keith stone, md, a professor of obstetrics and gynecology, this atlas is a musthave resource for both. Rarely, patients present with a large, fungating mass.
Most vulvar lesions are symptomatic, and vulva is accessible to observation. Mayeaux, md, dabfp, dabpm, faafp colleen stockdale, md, ms. Wilkinson, md, a professor of pathology and expert in gynecologic pathology, and i. Usually, however, the patient notices the lesions because of associated symptoms, such as pruritus, dysuria, or dyspareunia. As a consequence, vulvar cytology development has a minor place, if any. Epidermal inclusion cyst located in the middle portion of the labium majus. The objectives of this clinical approach to the diagnosis of vulvar dermatological disorders were 5fold, 1 to accurately describe vulvar lesions. Vulvar lesions range from benign growths to malignant tumors. Common, palpable, nonpigmented lesions of the vulvavagina include bartholin cyst, condylomata acuminata, skin tags achrochordons, and vaginal wall cysts. Abstract the clitoris may become involved by vulvar lesions. The differential diagnosis varies whether the lesions are papular or patchplaque. Clinically, the lesions are characterized by a wrinkled cigarettepaper or parchmentlike shiny, delicate, pale appearance of the skin that commonly extends around the anal area in a figure8 or keyhole configuration. The symptom information on this page attempts to provide a list of some possible signs and symptoms of vulvar lesions.
Vulvar lesions are cutaneous lumps, nodules, papules, vesicles, or ulcers that result from benign or malignant tumors, dystrophies, dermatoses, or infection. In a study done on 77 females with pv, genital lesions were observed in 39 51% patients. The diagnosis of vulvar disorders depends upon clinical history, physical examination, and, in some instances, confirmation with laboratory evaluation. Indeed, vulvar cancer is ten times less frequent than cervical one. Identifying the type of lesion and the appropriate treatment course is an important role of the gp. This signs and symptoms information for vulvar lesions has been gathered from various sources, may not be fully accurate, and may not be the full list of vulvar lesions signs or vulvar lesions symptoms. Review article vulvar skin disorders throughout lifetime.
404 277 23 1201 1171 667 511 989 807 1212 1240 474 616 552 777 76 1406 605 436 1196 1388 1418 1450 835 717 218 1301 740 869 759 836 938 1078 1392 506 1444 388 977 1436 134 359 1342 74 1079 1045