Paraurethral Skenes Duct Cyst

Skene's duct cysts are uncommon benign cysts that occasionally occur in the para-urethral region in infants as well as adults (Fig. 43). Cysts may arise from Skene's ducts or some of the smaller periurethral glands. Skene's glands are analogous to the male prostate, and the glands may contribute to lubrication during sexual arousal. Skene's duct cysts are lined by transitional epithelium (80). A variety of cysts in this region may be lined by squamous, transitional, or a mixture of epithelia...

Labium Minus

Cancer Labium Majus

The labium minus is always keratinized, that is, shows a stratum corneum, indicating skin rather than mucosa, on the lateral side (Fig. 8) (11). In our experience, the medial side is also always keratinized, although Jones found that keratinization was absent in 62 (11). Perhaps because the transition to vestibule may be vague, the allegedly mucosal part may be, in fact, vestibule. Any parakeratosis is abnormal (11). The basal layer of keratinized labium minus may be pigmented and small rete...

Anatomy

Many women are uncertain about their genital anatomy and may present complaining of vaginal itching or simply itching down there.'' The vulva comprises the entire external genitalia from the mons pubis anteriorly to the anus posteriorly and laterally to the genito-crural folds. Included in this area are the labia majora, labia minora, clitoris, urethral meatus, vestibule, posterior fourchette, hymen, and the Bartholin's, Skene's, and minor vestibular glands and the vestibular bulbs. The labia...

Pagets Disease of the Vulva Extramammary Pagets Disease

Paget Disease The Vulva

Paget's disease of the vulva presents as a velvety red lesion with overlying white plaques and may present with severe pruritis, burning, or bleeding (Fig. 31A and B). Figure 28 (A) Neurofibromatosis numerous lesions are seen on the mons pubis. (B) Neurofibroma typical ''shredded carrot'' bundles of collagen in a myxoid background containing cells of neural origin. Figure 28 (A) Neurofibromatosis numerous lesions are seen on the mons pubis. (B) Neurofibroma typical ''shredded carrot'' bundles...

Urethral Caruncle

Urethral caruncles are not uncommon in postmenopausal women, but their bright red fleshy appearance may occasionally raise the concern for a carcinoma (Fig. 41). Figure 37 Bartholin's carcinoma. (A) Note swelling in the region of the left Bartholin's gland. (B) These lesions may be squamous, transitional, or adenocarcinoma as shown here. Figure 37 Bartholin's carcinoma. (A) Note swelling in the region of the left Bartholin's gland. (B) These lesions may be squamous, transitional, or...

Necrolytic Migratory Erythema

This rare dermatosis occurs most frequently on the genital skin and lower abdomen. The distinctive eruption consists of an erythema with erosions, vesiculation, and bulla formation. The rash extends outward with healing and crusting at the outer edge. Postinflammatory pigmentation is common. There is also an associated weight loss, glossitis, and angular cheilitis. The patient may also have diabetes. Histologi-cally, there is marked epidermal necrolysis and a mild dermal lymphocytic infiltrate....

Human Papillomavirus

Hyperpigmented Labia

Human papillomavirus (HPV) belongs to the Papovaviridae family of double-stranded DNA viruses. Transmission of genital HPV occurs through skin-to-skin contact. There are more than 200 HPV types identified by PCR techniques. Different HPV types have preferences for different body tissues, with some types preferentially affecting the mucosa, others affecting thinner keratinized skin such as lower legs or dorsal hands, and still others found primarily on palms and soles. Common, plantar, and flat...

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Psoriasis Labia Minora

Acanthosis nigricans (AN), 63 diagnosis, 110 histopathology, 110 pathophysiology, 110 treatment, 111 Acrochordons. See Fibroepithelial stromal polyp Adenocarcinoma Bartholin's, 160 Skene's gland, 172, 174 Adenosis, vestibular, 138-139 Angiokeratoma, 150-151 Angiomyofibroblastoma, 151, 153 Angiomyxoma, aggressive, 152, 154 Anogenital disease, 48 Apocrine glands, 46 Atypical junctional melanocytic hyperplasia (AJMH) biologic behavior, 116 histopathology, 117 treatment, 117 Bacterial folliculitis,...

Genital Anomalies Without Intersex

Remains The Hymen

Vaginal agenesis is a rare abnormality (1 per 4000-1 per 10,000 females) due to failure of development of the Mullerian duct system (21). This is usually associated with absent corpus and cervix (Mayer-Rokitansky-Kuster-Hauser syndrome), but 7 to 10 will have a normal or rudimentary obstructed uterus. Extragenital, mainly uro-logical, and skeletal abnormalities are seen in 25 to 50 . The ovaries are normal (22). Transverse vaginal septa are very rare, with an incidence of 1 in 30,000 to 1 in...

Melanoma

Growth Labia Minora

Although not commonly encountered in routine practice, melanoma is the second most common vulvar invasive malignancy after squamous cell carcinoma (Fig. 34A and B) (See chapter on pigmented lesions of the vulva) (59). Pigmented lesions of the vulva must be viewed with this in mind, as prognosis for melanoma relates to depth of invasion (thickness), and hence early diagnosis is critical. The cells of melanoma may percolate up through the epithelium in a manner similar to Paget's cells, but can...

Suburethral Diverticulum

Urinary Meatus Irritation

The etiology of urethral diverticulum is unknown (Fig. 44). Although postulated to occur as a result of childbirth trauma, they occur in nulliparous women as well. One theory is that they result from infection of Skene's glands, and frequent catheterizations have also been proposed as an etiology (84). Urethral diverticuli are most common in the third to fifth decade (84). They may be difficult to diagnose (84), but may cause significant symptomatology. Occasionally calculi may form because of...

Mucinous Glands

Paraurethral Ducts Photos

There are vulvar and urethral, but normally no vaginal mucinous glands. The mucin-ous glands are exocrine and consist of mucinous acini that drain into a duct system lined by pseudostratified columnar epithelium. The largest are the major vestibular (Bartholin's) glands (Fig. 15). These have well-developed lobules and ducts that normally open at the posterolateral five and seven o'clock positions of the introitus, just external to the hymenal ring. The minor vestibular glands are a variable...

Lsa And

Vulvar LSA has been incriminated as a precursor to some vulvar SCC, but the progression is suggested to occur in only 3 to 4 of patients with LSA (10-12). There are no studies to show LSA attack rates in the normal vulva with subsequent progression to SCC. The finding of LSA in patients with SCC does not necessarily confirm a causal relation as this may be pure coincidence, but a somewhat higher risk for SCC probably exists for vulvar dysplasia hyperplasia (13). Because vulvar LSA is a...

Mesenchymal Lesions

Caucasian Vulva

Dermatofibromas are rare on the vulva (Fig. 16). They are usually slow-growing solitary reddish brown lesions that are flat or slightly raised, typically less than 1 cm in diameter. Characteristically, a dimple sign may be seen, a central umbilication upon squeezing the lesion. Histologically, the lesion is well circumscribed, with histiocytes and spindle cells interspersed with collagen bundles. Xanthoma cells and multinucleated giant cells may also be present. Overlying epithelium may show...

Vulvovaginal Infections

Medical Vulva Development

Southeast Vulvar Clinic, Charlotte, North Carolina, U.S.A. VIRAL INFECTIONS Varicella Zoster Virus Varicella zoster virus (VZV) is a member of the herpes virus group. It persists in the body as a latent infection after the primary infection. Primary infection with VZV results in chicken pox (varicella). Herpes zoster (shingles) represents a one-time reactivation. VZV enters through the respiratory tract and conjunctiva. The initial infection results from transmission through the respiratory...

Lipoma On Vulva

Photo Labial Tissue

Figure 21 Angiomyofibroblastoma. (A) The lesion is well circumscribed. (B) (See color insert) Bland spindle cells in a collagenous background with numerous thin-walled vessels. (C) Mixed hypocellular and more hypercellular areas, with cells tending to cluster around vessels. Source Courtesy of James Scurry, MD, Nextpath, Newcastle, Australia. Figure 21 Angiomyofibroblastoma. (A) The lesion is well circumscribed. (B) (See color insert) Bland spindle cells in a collagenous background with...

Introduction

Numerous pigmented conditions affect the vulva. These include common benign vulvar conditions with a variety of terminology, such as nevus, seborrheic keratosis, acanthosis nigricans (AN), lentigo simplex (lentigines), melanosis, condylomata, pigmented apocrine hamartoma, postinflammatory hyperpigmentation in association with lichen simplex chronicus, vulvar intraepithelial neoplasia (VIN), and angiokeratoma to name a few. Various medical conditions have hyperpigmentation as a sign, such as...

Crohns Disease

Crohn And Labia Fissures

Anogenital lesions occur in about 30 of patients with intestinal Crohn's, either as a direct extension of active intestinal disease or as a secondary disease. Vulvar disease Zoon's Asymptomatic, itch, Glassy red VIN, lichen or burning erythema planus Rx underlying condition topical lidocaine and barrier ointments Figure 10 (A) Lichen aureus lichen aureus is in the differential diagnosis of a band-like dermal infiltrate of chronic inflammatory cells. (B) Lichen aureus increased numbers of dermal...

Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignancy normally seen in subcutaneous tissues (Fig. 38A and B). It rarely involves the vulva. It tends to recur after excision but rarely metastasizes (70), although the rare development of fibrosarcoma has been described (71). Histologically, DFSP is composed of bland spindle cells that stain for CD34. It often extends beyond the obvious gross borders in small projections, which is probably contributory to the recurrences (Table 38)....

Invasive Neoplasms Of The Vulva Squamous Cell Carcinoma

Squamous Cell Carcinoma Vulva

It is now recognized that there are two types of squamous cell carcinoma (SCC) of the vulva the human papilloma virus (HPV)-related lesions seen in younger women and those unrelated to HPV seen in older women (Fig. 32A-D). The HPV-related lesions Figure 30 Differentiated vulvar intraepithelial neoplasia (VIN). (A) The atypia of differentiated VIN is often subtle, with a few basal atypical cells, and dyskeratosis. (B) (See color insert) The cells show glassy eosinophilic cytoplasm, pronounced...

Necrotizing Fasciitis Deep Tissue Necrotizing Infection

Necrotizing Fasciitis Disease Process

The term necrotizing fasciitis'' was first used by Wilson in 1952 to describe bacterial infection producing necrosis of the fascia and subcutaneous tissue with sparing of the underlying muscle. Over half of these infections occur on the perineum, where they are called Fournier's gangrene (35). Common recent terminology that is less specific but includes serious destructive necrotizing infection is that of deep tissue necrotizing infection. These infections share common causes and treatment. The...

Leiomyoma of the Urethra

Urethral leiomyomas are rare (Fig. 45). They present as masses in the vaginal wall, or protruding through the urethral meatus (86). Pathogenesis is uncertain however they are felt to be ER dependent (87,88). Malignant transformation has not been reported. Histologically, they are composed of interlacing bundles of benign smooth muscle cells (Table 45). Skene's Mass, dysuria, duct urinary Cystic mass Urethral diverticulum, prolapsed Excision, ectopic ureterocele, cystocele, marsupia-urethrocele,...

Histology Labium Majus

The skin of the labium majus is keratinized on both the lateral and the medial surfaces. The epidermis shows the usual four layers of stratum corneum with basket-weave orthokeratosis (keratin), granular cell, prickle cell, and basal layers. Any parakeratosis is abnormal (11). The basal layer may show pigmentation. Rete ridges are present. The dermis is divided into the papillary and reticular dermis. The papillary dermis is superficial, thin, and composed of fine collagen. The reticular dermis...

Pubic Lice

Tear Drop Shape Mites Skin

Pubic lice, Phthirus pubis, are small, macroscopic parasites that are generally sexually transmitted, annoying, and medically trivial. Fomites also are known to transmit lice. Also called ''crabs,'' these organisms localize to the pubic hair and eyelashes, and these are distinct from head lice. The primary symptom of lice is itching. Physical findings are often very, very subtle. The 1 to 2 mm mites are nearly skin colored and attached to hair. Very close examination with magnification...

Tuberculosis

Tuberculosis (TB) is a leading cause of death among adults worldwide. Initially, pulmonary infection is the most common site of primary disease. Extrapulmonary TB may spread by hematogenous, lymphatic, or local routes. Genital TB arises primarily from hematogenous spread after primary infection. Genital TB is nearly always pelvic disease rather than vulvar or vaginal. Primary TB is transmitted by infected airborne particles and usually results in mild pneumonic illness that frequently is...

Lichen Simplex

Protruding Mons Pubis Pictures

Lichen simplex is used to describe the skin changes seen secondary to scratching or rubbing in response to the symptom of itch. The itch may be because of a low-grade dermatitis such as psoriasis or seborrheic eczema but often is a sensory abnormality alone. The lesions of lichen simplex tend to be in one isolated area, usually on the labia majora or mons pubis. The change is characterized by a well-defined pale gray or white surface with an accentuation of the normal rhomboidal markings. The...

References

Lichen sclerosus of the vulva in children. Obstet Gynecol 1966 27 637-642. 2. Clark JA, Muller SA. Lichen sclerosus in children. Arch Dermatol 1967 95 476-482. 3. Steigleder GK, Schluter M. Lichen sclerosus et atrophicus. In Andrade R, Gumport SL, Popkin GL, Rees TO, eds. Cancer of the Skin. Philadelphia W.B.Saunders Company, 1976 635-645. 4. Grimmer H. Lichen sclerosus (Kraurosis) vulvae (mit besonderer Berucksichtigung der subfocalen Corticoidtherapie). Z Haut...

Behets Syndrome

Pyoderma Gangrenosum Female Genitals

This is a syndrome of recurrent oral ulceration accompanied by two of the following genital ulceration, eye lesions including anterior uveitis and retinitis, other cutaneous lesions, i.e., erythema nodosum, sterile pustules, erythema multiforme, and pustu-lation at sites of trauma (pathergy). It is a multisystem disorder (37) and there may be gastrointestinal, neurological, psychiatric, rheumatological, cardiological, and pulmonary involvement. Vascular complications include superficial and...

Etiology

The evaluation of vulvar lesions can be challenging because there are a variety of potential causes including infectious diseases, nonneoplastic epithelial disorders, and benign and malignant neoplasms. In addition, these conditions will frequently coexist for example, the patient with recurrent vulvovaginal candidiasis may develop contact dermatitis from frequent application of irritating topical products to the affected skin. In addition, some women present with chronic vulvar itching and...

Inflammatory Dermatoses Eczema

Desquamative Inflammatory Vaginitis

Vulvar eczema is characterized by erythema and scaling on the outer labia majora and erythema and fissures and erosions on the inner aspects. Vulvar eczema is pruritic, often out of proportion to the clinical findings. The skin may become ede-matous, excoriated, and lichenified because of scratching. This is the commonest form of vulvar eczema in clinical practice. This is usually seen in the elderly and is often because of urinary incontinence. It is also more likely to occur in fair-skinned...

Hidradenitis Suppurativa

Hidradenitis Suppurativa

This is a chronic inflammatory disease occurring on skin containing apocrine glands. It is commoner in women and occurs in the anogenital area as well as the axillae, breasts, thighs, and buttocks. It is a problem of follicular occlusion with the consequent complications of obstruction to the outflow of other apocrine and sometimes sebaceous glands (18). It can be associated with similar conditions such as conglobate acne and pilonidal sinus. Bacteria play a secondary but important role, in the...

Melanoma In Situ

Frenulum Clitoris

MIS is defined as Stage 0, confined to the epidermis and adnexal epithelium. It was classified as a subset of the International Society for the Study of Vulvovaginal Disease classification of'VIN (31) but has subsequently been discarded in the newer classification (31a). The concept of MIS was first described in 1949. In 1992, a panel at the Consensus Development Conference sponsored by the National Institutes of Health officially acknowledged this diagnostic category (32). The terminology was...

Benign Nevi

Labiumminus

Melanocytic nevi (moles) on the vulva are relatively common. They present clinically as macules or papules of different shades of brown, sometimes pink or dark blue, occasionally black, generally with a smooth surface. Melanocytes are found in the basal layer of the epidermis, every 4th to 10th cell, as well as in hair follicles throughout the entire skin surface. Melanocytic nevi are benign neoplasms composed of nests of modified melanocytes (nevus cells) located in the epidermis, dermis, or...

Bacterial Vaginosis

Bacterial vaginosis is polymicrobial in origin and caused by changes in the normal vaginal flora. It primarily affects reproductive-age women and is associated with sexual activity, although transmission is not fully understood. Risk factors include multiple sexual partners, a new sexual partner, non-white race, previous pregnancy, intrauterine device, and use of douches. There is a reduction of hydrogen peroxide-producing lactobacilli and an increased growth of Gardnerella vaginalis and...

Bacterial Vaginitis

Vaginal Discharge Strep

Bacterial vaginitis is an uncommon, but by no means rare, cause of vaginitis. Distinct from bacterial vaginosis, bacterial vaginitis can occur with group B Streptococcus with no apparent risk factors, and as a result of secondary infection with any of several bacteria, most often in a setting of a foreign body, atrophic vaginitis, or an erosive disease such as lichen planus (41-43). Diagnosis Symptoms appearance Differential diagnosis Therapy Erythrasma None Pink-tan, lightly Tinea cruris,...

Molluscum Contagiosum

Moist Labia

Molluscum contagiosum is a benign lesion produced by a virus that is a member of the Poxviridae family. Transmission occurs by direct skin contact with an infected individual, and when occurring on anogenital skin, it is generally sexually transmitted. However, genital mollusca in a child do not suggest sexual contact. Most often, molluscum contagiosum is an asymptomatic infection, although when the immune system mounts an inflammatory reaction itching can occur. Mol-luscum contagiosum in...

Lymphogranuloma Venereum

LGV is primarily an infection of the lymphatics and lymph nodes caused by Chlamydia trachomatis serotypes L1, L2, and L3. LGV is a rare disease that is more frequently seen in men than in women. Transmission is by sexual contact, primarily with asymptomatic female carriers. The incubation period is 3 to 30 days after inoculation. Constitutional symptoms may be present, and the anorectal syndrome is more common in females and homosexual males, consisting of pruritus, pain, and tenesmus. LGV...

Lichen Sclerosus

Lichen Sclerosus Vulva

LS is a lymphocyte-mediated inflammatory disease characterized by pallor and scarring. It is commoner in females and can affect any age but the majority of patients are either prepubertal or menopausal (21-26). The etiology is unknown, but there is evidence to support that LS is an autoimmune disorder, and in females it may be Pain and, less often, itch. Wetness if lymphatics are leaking lymph Edema, erythema, Hidradenitis and ulceration. suppurativa Deep, wide fissures. Edematous perianal skin...

Staphylococcus aureus

Staphlococus Disease The Vaginal

Staphylococcus aureus genital skin infections vary in appearance and severity. The staphylococcal bacterium is characterized by gram-positive cocci in clusters under the microscope. Bacteria often gain access to underlying tissue through abrasions, burns, bites, cuts, fissures, or surgical incisions. Both community-acquired and hospital-acquired staphylococcal infections have continued to rise. Genital staphylococcal infections are most often manifested as impetigo (superficial epidermal...

Herpes Simplex Virus

Mucous Membrane With Herpes

HSV infection is a member of the herpesviridae family. Two serotypes of HSV have been identified HSV-1 and HSV-2. HSV-1 most often affects the mouth and is usually transmitted in childhood by contact with infected saliva. HSV-2 is generally Table 1 Varicella Zoster Virus Infections Table 1 Varicella Zoster Virus Infections herpes simplex hand, foot, and mouth disease rickettsialpox impetigo zoster immuno-globulin within 96 hr of exposure for naive patient otherwise, acyclovir, valacyclovir,...

Tinea Cruris

Tinea Cruris Treatment For Labia Majora

Tinea cruris, a dermatophytosis infection of the anogenital skin, represents ringworm. Also called jock itch, this is a disease much more common in men than in women. Primarily caused by Epidermophyton floccosum, Trichophyton rubrum, and Trichophyton mentagrophytes, tinea cruris often represents infection that has spread from the great toe nails onychomycosis or the feet tinea pedis , also infections that are much more common in men. Obesity also predisposes to tinea cruris 52 . The predominant...

Fixed Drug Eruption

FDE appears to be an extremely rare occurrence on the anogenital skin in females, whereas it is reasonably well documented in males. The author has only seen one case, which involved the mons pubis, buttocks, and nongenital sites because of fluconazole Fig. 25A and B . The patient was treated for recurrent thrush'' with oral fluconazole and developed urticated erythematous plaques on the trunk and anogenital skin. There were no further problems on discontinuation of the repeated doses of...

Trauma

In the emergency care setting, traumatic injuries to the vulva may be seen. Accidental injuries may occur in the setting of athletic activities such as bicycling or from a fall, and may cause lacerations or hematomas. Sexual assault and accidental injuries associated with sexual activity are the most common cause of vulvar trauma 7 . Obstetrical lacerations and episiotomies may be associated with chronic peri-neal pain as well as the formation of neuromas or scar tissue. Genital piercing is...

Ambiguous Genitalia Intersex

True hermaphrodites are rare individuals who have both testicular and ovarian tissues. The cause appears to be mosaicism, with one cell line containing Y chromosome genes. The gonads may be separate or combined as an ovotestis that may be found above or below the inguinal ring. Pseudohermaphrodites are individuals with a normal genetic sex, but an intersex phenotype for hormonal reasons. The development of the male genitalia is under the influence of testosterone produced by the fetal testis....

Chancroid

Chancroid is a sexually transmitted disease caused by inoculation of Haemophilus ducreyi through genital breaks in the skin. Chancroid is rare in the United States but common in Africa and some parts of Asia. It is more common in men than in women and associated with lower socioeconomic groups. Chancroid is commonly associated with coexisting syphilis or HIV. Within four to seven days after exposure, a tender papule arises. Within another one to two days, the lesion becomes pustular or...

Parasitic Infections Trichomonas

Trichomonas vaginitis is a sexually transmitted infection produced by the protozoan Trichomonas vaginalis. The organism is found not only in the vagina but also in the urethra and in Skene's glands and paraurethral ducts. The primary symptom of Trichomonas vaginitis is severe pruritus, irritation, and, often, vulvar dysuria, accompanied by a grossly and microscopically purulent vaginal discharge. Sometimes, pelvic pain is present. The severity of disease varies widely, with some patients...

Anatomy Vulva

The vulva represents the external female genitalia, whose functions include sexual arousal, entrance for coitus, exit for the newborn, and outlet for the urinary tract. It lies within the anatomical compartment of the perineum, defined superiorly by the pelvic diaphragm, inferiorly by the skin between the buttocks and the thighs, and transversely by a diamond-shaped osteoligamentous frame, whose points are the pubis, ischial tuberosities, and coccyx. The perineum is divided by a transverse line...

Pityriasis Versicolor

Tinea Versicolor Labia

Pityriasis versicolor is a fungal infection of keratinized skin produced by several different kinds of Malassezia species 55 . Also known by the misnomer, tinea Diagnosis Symptoms Clinical appearance Differential diagnosis Red, well-demarcated scaling plaques with accentuation of peripheral scale on proximal, medial thighs Psoriasis, lichen simplex chronicus eczema, candidiasis, erythrasma Any topical azole cream or terbinafine. If fungal folli-culitis is present, oral griseofulvin,...

Aphthae

Genital Ulcers Vulva

Benign aphthae of the vulva may or may not occur with concomitant oral lesions. The age of onset is in childhood, by about the age of six, and there may be a family history. The lesions are usually multiple and small. Less commonly, the lesions are solitary or few but larger, referred to as giant aphthae. Herpetic infection has to be excluded and there is often a premenstrual exacerbation once the menarche is reached. The etiology remains unknown. The lesions are superficial and painful with a...

Epidermal Inclusion Cyst Vulva

Bartholins Cyst

A A large swelling is noted on the left. B The cyst wall is lined by transitional epithelium, consistent with Bartholin's duct. Figure 1 Bartholin's cyst. A A large swelling is noted on the left. B The cyst wall is lined by transitional epithelium, consistent with Bartholin's duct. Figure 2 Epidermal inclusion cysts. A Multiple firm tan nodules are seen. B The cyst is lined by stratified squamous epithelium. The cyst contents are composed of keratinaceous debris....

Interlabial Sulcus

The interlabial sulcus is the main site of mammary-like glands 12 . Mammary-like glands are a newly described type of skin appendage confined to the anogenital region. They open by ducts into the interlabial sulcus, and to a lesser extent, perineal and perianal skin. Vulvar mammary-like glands resemble eutopic mammary lactiferous ducts and glands with diverticula, branches, lobules, and the expression of estrogen and progesterone receptors Figs. 6 and 7 . They may also show apocrine metaplasia...

Mesonephric Like Cyst Wolffian Duct Like Cyst

While cysts of the vulva are more likely to be mucinous than nonmucinous, the nonmucinous ones have been postulated to arise from Wolffian duct remnants Fig. 4 8 . These are much less common than cysts of Mullerian origin. Grossly, they are usually thin-walled cysts. They can occur along the tract of the Wolffian duct, and, so while more often occurring in the lateral vaginal wall, may be seen in the upper vulva near the hymen 9 . They are lined by a cuboidal to columnar epithelium Table 4 .

Benign Neoplasms Neoplasms of Dermal Appendages

Papillary Hidradenoma Hidradenoma Papilliferum Hidradenomas are benign sweat gland tumors that may raise the issue of malignancy with both clinicians and pathologists Fig. 10A and B . The clinician may observe a flesh-colored or blue nodular lesion, frequently with central umbilication, usually less than 1 cm. Hidradenomas may become ulcerated, exposing bright red papillary tissue 22 , hence raising the concern for malignancy. Histologically, the lesion is composed of tightly packed cystic and...

Atypical Junctional Melanocytic Hyperplasia

Black Vulva

Atypical junctional melanocytic hyperplasia AJMH is a superficial process localized to the junctional region. This condition is distinctive from common acquired nevi. These changes are macular, often clinically ill-defined, may be large and uniformly darkly pigmented, with an asymmetric outline and irregular borders 29 Table 4 . The biologic behavior of AJMH is uncertain and unpredictable. However, AJMH may progress to melanoma and is associated with frequent local recurrence after incomplete...

Epithelial Lesions

Vulvar Lesion

Seborrheic keratoses can occur anywhere on the body, but are occasionally seen on the vulva, usually in middle-aged to older women Fig. 13A and B . The lesion Figure 11 Trichoepithelioma. A Epithelial subunits surrounded by a dense fibroconnective tissue stroma. B Detail of basaloid cells of an epithelial subunit. Figure 11 Trichoepithelioma. A Epithelial subunits surrounded by a dense fibroconnective tissue stroma. B Detail of basaloid cells of an epithelial subunit. Figure 12 See color insert...

Benign Tumorlike Lesions Vestibular Adenosis

Adenosis, the presence of cervical, tubal, or endometrial type glands within the wall of the vagina, has been extensively described as resulting from in utero exposure to Figure 4 Mesonephric cyst mesonephric cysts are lined by a cuboidal nonciliated epithelium as shown in this mesonephric remnant. Often abundant eosinophilic material is seen in the lumen. Figure 4 Mesonephric cyst mesonephric cysts are lined by a cuboidal nonciliated epithelium as shown in this mesonephric remnant. Often...

Scabies

Scabies The Vulva

Scabies is an excruciatingly pruritic skin infection produced by the mite, Sarcoptes scabiei. The mite is transmitted by close contact with an infected person, and infects the stratum corneum of the skin. The itching occurs after a week or two, as a result of the host immune response to the presence of the mite. Therefore, not all infected people may be symptomatic initially. In addition to the intense itching, which is often the worst at night, patients present primarily with signs consistent...

Erythrasma

Vulva Disease

Erythrasma is a superficial bacterial infection of skin folds that mimics tinea cruris. Caused by Corynebacterium minutissimum, this medically insignificant disease occurs primarily in men. Usually, erythrasma is asymptomatic. Morphologically, it is characterized by well-demarcated, pink tan, lightly scaling, or slightly crinkled plaques that, in the antibiotics, with or without hyperbaric oxygen to affected tissues genital area, occur on the proximal, medial thighs with sparing of the vulva...

Fungal Infections Candidiasis

Vulva Insert

Vulvovaginal yeast infections are very common, medically trivial but sometimes symp-tomatically miserable infections. Most women and many physicians rightly or wrongly attribute nearly all vulvovaginal symptoms to vulvovaginal candidiasis. The majority of vulvovaginal yeast is produced by Candida albicans, but an increasingly large proportion of yeast infections involve Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Candida lusitaniae, Saccharomyces cerevisiae, or...

Zoons Vulvitis Plasma Cell Vulvitis

Severe Vulvar Lichen Sclerosus

There is some doubt whether plasma cell vulvitis PCV is a distinct clinicopatholo-gical entity as many of the reports in females of Zoon's are probably LP 14 . A plasma-cell-rich infiltrate in a vestibular biopsy may be a misleading finding because plasma cells are commonly found in inflammatory conditions of the vestibule because it is a mucosal epithelium, so PCV is probably not a single disease entity but represents a reaction pattern to other inflammatory conditions such as LP Fig. 9A and B...

Squamous Intraepithelial Neoplasia Vulvar Intraepithelial Neoplasia

There are two distinct types of vulvar intraepithelial neoplasia VIN . One is related to HPV, the usual type of VIN, and is discussed here Fig. 29A-D . VIN Lipoma Usually Soft mass Bartholin's duct None, excision, none lesion cyst, fibrolipoma, liposuction Figure 27 Ectopic nipple this example of ectopic mammary tissue is seen on the thigh. unrelated to HPV, differentiated VIN, is discussed below. Usual VIN has a wide variety of clinical appearances and may appear as red, white, dark, flat,...

Melanosis

Vulva Inspection

Benign vulvar melanosis melanotic macule or genital lentigo consists of a brown discoloration and is generally asymptomatic Fig. 2 . Table 2 outlines the symptoms, clinical appearance, differential diagnosis, and therapy of melanosis. It can be found in a variety of vulvar locations including the periurethral area 22 . Often, there will be more than one lesion present. Melanosis may be found incidentally during a pelvic examination. Melanosis of the vulva may mimic melanoma on visual appearance...

Fibroepithelial Stromal Polyp Acrochordon Skin

Cyst The Canal Nuck

Fibroepithelial polyps acrochordons are more common in the vagina, but are seen in the vulva. They may be single, or multiple, particularly during pregnancy Figure 5 Cyst of the canal of Nuck cysts of the canal of Nuck are lined by a flattened mesothelial lining. Figure 5 Cyst of the canal of Nuck cysts of the canal of Nuck are lined by a flattened mesothelial lining. Inguinal or labial mass. Hernia may become incarcerated Lipoma, leiomyoma, Sarcoma 11 , indirect hernia, Bartholin's cyst, or...

Micropapillomatosis Labialis

Micropapillomatosis The Vulva

Micropapillomatosis labialis MPL is characterized by multiple, small uniform finger-like projections, usually on the inner labia minora and within the vestibule Fig. 9 . The projections are composed of a stromal core covered by unremarkable Figure 7 Endometriosis. A See color insert Grossly endometriotic implants on the vulva often have a blue appearance. B,C The criterion for definitive diagnosis of endometriosis histologically is the presence of endometrial glandular epithelium and stroma. In...