Premalignant and Malignant

• Urethral caruncle


  Small fleshy outgrowth of the distal urethra
• Urethral caruncle


  • Soft, smooth, friable, and bright red and initially appears as an eversion of the urethra
  • Small, single, and sessile but may be pedunculated
  • Size: 1-2cm
  • Mostly postmenopausal woman
  • Growth secondary to chronic irritation or infection
• Urethral caruncle histology


  Transitional and stratified squamous epithelium
• Appearance of urethral caruncle

  • Papillomatous, granulomatous, angiomatous
• Urethral prolapse


  Annular rosette of friable, edematous prolapsed mucosa; ulcerated with necrosis; grossly edematous
• Bartholin's cyst


  Cystic dilatation of an obstructed bartholin's cyst
• Wolffian duct cyst


  Thin walled and contain serous fluid
• Epidermal inclusion/sebaceous cyst


  Most common small vulvar cyst, located intermediately below the epidermis on the anterior half of the labia majora, usually multiple, freely movable, round, slow growing, and non tender, white or yellow with caseous contents
• Inclusion cyst


  Develop following trauma when an infolding of squamous epithelium has occurred beneath the epidermis in the site of an episiotomy or OB laceration, epithelial lining of keratinized stratified squamous epithelium with a center of cellular debris that grossly resembles sebaceous material
• Nevus


  Localized nest or cluster of melanocytes, vulvar nevi: most common benign neoplasms in female, size: few mm to 2 cm, depth of color: blue, dark brown, to black, amelanotic, glossy: flat, elevated, or pedunculated
• Hemangioma


  Rare malformations of blood vessels rather than true neoplasms, usually single, 1-2cm in diameter, flat and soft, color: brown to red or purple, multiple channels of thin-walled capillaries arranged randomly and separated by connective tissue septa, not encapsulated, change in size with compression
• Types of hemangioma


  • Strawberry, cavernous, senile or cherry, angiokeratomas, pyogenic granulomas
• Fibroma


  Most common benign solid tumors of the vulva, occur in all age groups and most common on the labia majora, size: few cm to 250 lbs; majority (1-10 cm), firm or cystic with smooth surface and distinct contours, cut surface = gray-white, micro: flat or muscle cells with interlacing fibroblasts
• Lipoma


  Benign slow growing circumscribed tumors of fat cells arising from the subcutaneous tissue fo the vulva, softer and usually alrger than fibromas, usually less than 3cm, second most common benign vulvar mesenchymal tumor, location: labia majora, cut section: soft, yellow, lobulated surface
• Hidradenoma


  Rare, small benign tumor originating from apocrine sweat gland, age incidence: 30-70 yo, most commonly 40 yo, grossly: well defined, sessile, pinkish gray nodules not greater than 2cm with well defined capsules
• Syringoma


  Rare cystic asymptomatic benign tumor that is an adenoma of the eccrine sweat glands, appears as small, subcutaneous papules, less than 5 mm in diameter, that are skin colored or yellow, may coalese to form cords of firm tissue, usually located in labia majora
• Endometriosis


  Rare in the vulva, small firm nodules; cystic or solid and vary from a few mm to a few cm, usually found at the site of an old healed obstetric laceration, pathology: metaplasia, retrograde lymphatic spread, potential implantation of tissue during operation
• Glanular cell myoblastoma


  Rare slow growing vulvar tumor, originates from neural sheath (schwanomma), 7% found in the subcutaneous tissue of the vulva, located in the labia majora, clitoris, gross: subcutaneous nodules, suually 1-5 cm in diameter, slow growing but may cause ulceration of the skin
• Von Recklinghausen's disease


  Benign neural sheath tumor sometimes involved the vulva, characterized by generalized neurofibromatosis and café-au-lait spots, vulvar lesions: fleshy, brownish red, polypoid tumors
• Hematoma


  Usually secondary to blunt trauma such as straddle injury from a fall, an automobile accident or assult, also recreational activities
• Dermatologic diseases of the vulva

  • Contact dermatitis
  • Neurodermatitis
  • Psoriasis
  • Seborrheic dermatitis
  • Cutaneous candidiasis
  • Lichen planus
  • Folliculitis
  • Furunculitis
  • Impetigo
  • Hidradenitis suppurativa
• Pruritus


  Symptom of intense itching with an associated desire to scratch and rub the affected area ("itch-scratch" cycles)
• Vulvodynia


  Chronic vulvar discomfort, including burning, stinging, and "rawness"
• Vulvar vestibulitis


  Vestibular edenitis, etiology: unknown, symptoms: severe introital dyspareunia, vulvar burning, pain at the introitus, signs: focal ulceration and inflammation of the mucosa of the vestibule, spontaneous remission in 30%
• Contact dermatitis


  Site: intertriginous area, pathophysiology: primary irritant, definite allergic, acute: red, edematous, inflamed skin, weeping, eczematous, vesicles, and may be secondarily infected, common symptoms: superficial vulvar tenderness, burning, and pruritus
• Lichen planus


  Unique, chronic eruption of shiny, violaceous papules on flexor surfaces, mucous membranes, vulvar skin, sites: labia minora and vestibule, symptoms: pruritus and pain, etiology: autoimmune cell mediated response
• Hydradenitis suppurativa


  Chronic unrelenting refractory infection of the skin and subcutaneous tissue, initially subcutaneous nodules, deep scars and pits with foul discharge, sites: mons pubis, genitocrural fold, and buttocks
• Urethral diverticulum


  Permanent, epithelialized, saclike projection that arises from the posterior urethra, present as a mass of the anterior vaginal wall, peak incidence: 4th decade of life, chronic or recurrent UTI, 3mm to 3 cm in diameter, symptoms: urinary urgency, frequency and dysuria, hematuria (15%), 3D's: dysuria, dyspareunia, dribbling
• Suburethral diverticulum


  Expression of purulent material after compressing the suburethral area
• Urethral diverticulum is diagnosed by voiding cystourethrography and cystourethroscopy
• Differential diagnosis of urethral diverticulum includes gartners duct cyst and ectopic ureter
• Punch biopsy


  Diagnostic procedure to obtain a small sample of tissue for examination
• Treatment


  • Topical steroid cream (clobetasone)
  • Dapsone
• Hidradenitis suppurativa


  Chronic unrelenting refractory infection of the skin and subcutaneous tissue
• Hidradenitis suppurativa


  • Initially subcutaneous nodules, deep scars and pits with foul discharge
  • Sites: mons pubis, genitocrural fold, and buttocks
• Treatment


  • Antibiotic and steroids
  • Cyclosporine
• Differential diagnosis


  • Crohn's disease
  • Granulomatous STD
• Urethral diverticulum


  Permanent, epithelialized, saclike projection that arises from the posterior urethra
• Urethral diverticulum


  • Present as a mass of the anterior vaginal wall
  • Peak incidence: 4th decade of life
  • Chronic or recurrent UTI
  • 3mm to 3 cm in diameter
  • Symptoms: urinary urgency, frequency and dysuria
  • Hematuria (15%)
  • 3D's: dysuria, dyspareunia, dribbling
  • Suburethral diverticulum: expression of purulent material after compressing the suburethral area
• Diagnosis


  • Voiding cystourethrography
  • Cystourethroscopy