Disease of vulva
1) Non-infective inflammatory skin disorder
- acute contact dermatitis
- lichen planus - erosive and cause superficial ulceration in vulva
- lichen sclerosus - epidermal atrophy and densely collageneous upper dermal fibrosis; compact hyalinization of dermis with lymphocytic infiltrate below hyalinization
- lichen simplex chronicus - chronic dermatitis caused by repeated scratching, common cause of vulval thinking
2) Infectious
- Herpes vulvitis - painless blisters to form a painful erosion
- HPV - flat condyloma(koilocytes - vacuolated keratinocytes, typical of most viral warts), condylomata acuminata(acanthosis - abnormal epidermal thickening; hyperkeratosis and parakeratosis), strong link with intraepithelial neoplastic change
* hyperkeratosis - inappropriate thickening of keratin layer, can be orthokeratotic (devoid of nuclear remnants) or parakeratotic (keratin layer contains remnants of nuclei)
- Fungal infections (e.g. Candida albicans, dermatophytes)
3) Sexually transmitted organisms
- HPV, HSV
- Calymmatobacterium granulomatis – Granuloma Inguinale
- Chlamydia trachomatis – lymphogranuloma venereum -> inguinal lymphadenopathy, suppurating granulomas
- Haemophilus ducreyi – chancroid -> inguinal lymphadenopathy
- Treponema pallidum – syphilis
4) Benign cysts
- Benign keratin-filled epidermal cyst from skin
- Cystic dilatation of Bartholin’s gland duct(due to duct obstruction)
5) Neoplasm
- Squamous carcinoma(e.g. verrucuous carcinoma) - exophytic mass
- Vulval intraepithelial neoplasia (VIN), may be coexistent with HPV, rarely becomes invasive, more often in younger patients; VIN I(dysplastic keratinocytes confined to lower one third of epithelium), II(lower two-third), III(entire epithelium dysplastic)
- intradermal and compound nevi (from melanocytes) - nevi originate at dermal-epidermal junction, relative proportion of dermal cells increase
- malignant melanoma (from melanocytes)
- Papillary hidradenoma (from skin appendage) - the only adnexal neoplasm
- extramammary Paget’s disease (rare) - epidermis contains large pale-staining epithelioid cells that are larger than keratinocytes and arranged singly or in clumps
Disease of Vagina
1) Infections
a. Trichomonas vaginalis
b. Gardnerella vaginalis
c. Herpes simplex
d. Candida albicans
e. Gonococcus
f. Mycoplasma
g. HPV
h. Staphylococci
2) Primary Tumors (Very Rare)
a. Squamous cell carcionma
b. Adenocarcinoma – more rare, clear-cell carcinoma of the vagina -> vaginal adenosis
c. Rhabdomyosarcoma (for children)
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