Professional Documents
Culture Documents
Vulva
Inflammatory dermatologic diseases that affect skin elsewhere also occur on the vulva,
such as psoriasis, eczema, and allergic dermatitis
more prone to skin infections, constantly exposed to secretions and moisture
Nonspecific vulvitis due to immunosuppression
Most skin cysts (epidermal inclusion cysts) and skin tumors also occur.
Bartholin Cyst
Infection of the Bartholin gland acute inflammation within the gland (adenitis) /+
leading to abscess require drainage.
Bartholin duct cysts relatively common result from obstruction of the duct by an
inflammation.
Cysts lined by flattened epithelium; can be large (i.e., 3 to 5 cm diameter) and painful
Lichen Sclerosus
Lesions begin as papules or macules that eventually coalesce into smooth, white
parchment-like areas.
Microscopically, there is:
epidermal thinning,
disappearance of rete pegs,
hydropic degeneration of the basal cells,
superficial hyperkeratosis, and
dermal fibrosis with a scant mononuclear perivascular infiltrate.
When entire vulva is affected, the labia can become atrophic and stiffened, with
constriction of the vaginal orifice.
occurs in all age groups but is most common in postmenopausal women.
An autoimmune response is implicated because:
presence of activated T cells in the subepithelial inflammatory infiltrate, and
the increased frequency of autoimmune disorders in these women
Condyloma Acuminatum
sexually transmitted,
benign lesions
distinct verrucous gross appearance
more frequently multifocal: they may involve vulvar, perineal, and perianal regions as well
as the vagina and, less commonly, the cervix.
The lesions are identical to those found on the penis and around the anus in males
HPV types 6 or 11.
Histologically, they consist of branching, treelike cores of stroma covered by thickened
squamous epithelium
Mature superficial cells exhibit nuclear enlargement, hyperchromasia, and a cytoplasmic
perinuclear halo (koilocytotic atypia).
Not considered pre-cancerous.
Malignant Melanoma
Melanomas of the vulva are rare
Representing less than 5% of all vulvar cancers and 2% of all melanomas in women.
they have a peak incidence between ages 60 and 80 years.
Histologic characteristics are comparable to melanomas at other sites + capable of
widespread metastatic dissemination.
5-year survival is less than 32% due to delays in detection and rapid progression to a
vertical growth phase.
It can usually be differentiated by from Paget disease:
its uniform reactivity with antibodies to S100 protein,
absence of reactivity with antibodies to cytokeratin, and
lack of mucopolysaccharides.
Cervix
Cervicitis
Inflammatory conditions of the cervix are extremely common
may be associated with a purulent vaginal discharge
Cervicitis can be subclassified as infectious or noninfectious.
differentiation is difficult owing to the presence of normal vaginal flora including
incidental vaginal aerobes and anaerobes, streptococci, staphylococci, enterococci, and
Escherichia coli and Candida spp.
Much more important are:
Chlamydia trachomatis,
Ureaplasma urealyticum,
T. vaginalis,
Neisseria gonorrhoeae,
HSV-2 (the agent of herpes genitalis), and certain types of HPV, all of which are often
sexually transmitted.
C. trachomatis; most common; 40% of cases.
Neoplasia of Cervix
Pathogenesis
Risk factors: Common risk factors of CIN and carcinoma of cervix include:
(1) human papilloma virus,
(2) environmental factors.
Uterus
Endometritis
Inflammation of the endometrium
classified as acute or chronic depending on whether a neutrophilic or a lymphoplasmacytic
infiltrate predominates
Acute endometritis:
uncommon
usually caused by bacterial infections occurring after delivery or miscarriage and is
related to retained products of conception. Curettage and antibiotics are usually
sufficient therapy.
Chronic endometritis:
diagnosis of chronic endometritis generally requires the presence of plasma cells, as
lymphocytes are present even in the normal endometrium.
occurs in patients with:
Chronic PID (Chlamydia; most common, N. gonorrhoeae)
Retained gestational tissue post-abortion or postpartum
Intrauterine contraceptive devices
Disseminated tuberculosis (rare), (granulomatous endometritis, along with
tuberculous salpingitis and peritonitis)
15% have no obvious cause
Clinical Presentation:
fever,
abdominal pain,
menstrual abnormalities
increased risk of infertility
ectopic pregnancy due to damage and scarring of the fallopian tubes.
Adenomyosis
Definition: Adenomyosis is defined as the presence of endometrial tissue within the
myometrium (uterine wall).
Nests of endometrial stroma, glands, or both are found deep in the myometrium
(interposed between the muscle bundles), and continuous with endometrial lining.
Induces reactive hypertrophy of the myometrium, resulting in an enlarged, globular uterus,
with a thickened uterine wall.
Clinically: produce menorrhagia, dysmenorrhea, and pelvic pain, particularly just prior to
menstruation, and can coexist with endometriosis
Endometriosis
Definition: Endometriosis is the presence of endometrial glands and stroma) outside of the
uterus.
Involves:
pelvic structures (ovaries, pouch of Douglas, uterine ligaments, tubes, and rectovaginal
septum).
Less frequently, distant areas of the peritoneal cavity or periumbilical tissues are
involved.
Uncommonly, distant sites such as lymph nodes, lungs, and even heart, skeletal muscle,
or bone are affected
Age: 10% of women in their reproductive years and in nearly half of women with infertility
Four hypotheses:
The regurgitation theory, which is currently favored, proposes that menstrual backflow
through the fallopian tubes leads to implantation.
The benign metastases theory holds that endometrial tissue from the uterus can
“spread” to distant sites via blood vessels and lymphatics.
The metaplastic theory, on the other hand, posits endometrial differentiation of
coelomic epithelium (mesothelium of pelvis and abdomen from which endometrium
originates) as the source.
The extrauterine stem/progenitor cell theory, proposes that circulating stem/progenitor
cells from the bone marrow differentiate into endometrial tissue
Molecular changes:
endometriotic tissue exhibits increased levels of inflammatory mediators, particularly
prostaglandin E2 recruitment and activation of macrophages by factors made by
endometrial stromal cells inflammation.
Stromal cells make aromatase local production of estrogen.
These factors enhance the survival and persistence of the endometriotic tissue within a
foreign location (a key feature in the pathogenesis of endometriosis)
help to explain the beneficial effects of COX-2 inhibitors and aromatase inhibitors in the
treatment of endometriosis
Clinical Presentation:
Severe dysmenorrhea
pelvic pain resulting from intra-pelvic bleeding and intra-abdominal adhesion
discomfort in the lower abdomen and infertility (due to extensive scarring of the
fallopian tubes and ovaries)
pain on defecation (Rectal wall involvement)
dyspareunia (painful intercourse) and dysuria (involvement of the uterine or bladder
serosa)
Disorders of Development
Milkline remnants:
These can produce hormone responsive supernumerary nipples or breast tissue from
the axilla to the perineum.
These mainly come to attention secondary to painful pre-menstrual enlargement.
Accessory axillary breast tissue:
Occasionally, normal ductal tissue extends into subcutaneous tissue of the axilla or chest
wall.
present as a lump in the setting of lactational hyperplasia, or it can give rise to
carcinoma outside the breast proper.
Congenital nipple inversion:
Common
Usually corrects during pregnancy or with traction;
acquired nipple inversion is concerning for carcinoma or inflammatory conditions
INFLAMMATORY PROCESSES
Rare
caused by infections, autoimmune disease, or foreign body–type reactions
Symptoms:
Erythema
edema,
pain
focal tenderness
possibility that the symptoms are caused by inflammatory carcinoma should always be
considered
Staphylococcus aureus: