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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, 86 Bacterial infections, 77-93 Bacterial vaginosis, 3, 84 diagnosis, 84, 92 risk factors, 84 therapy, 84, 92 Bartholin's adenocarcinomas, 160 Bartholin's duct cyst, 135-136 Bartholin's glands. See Vestibular glands Basal cell carcinoma, 166 Basal layer hyperpigmentation, 114 Basaloid lesions, 158 Behcet's syndrome, 53-54 Behcet's disease, 7 Benign nevi. See Melanocytic nevi Benign tumor-like lesions endometriosis, 139-140

[Benign tumor-like lesions]

fibroepithelial stromal polyp, 139 vestibular adenosis, 138-139 Bullous diseases, 54

Calymmatobacterium granulomatosis, 79 Candida albicans, 3, 93

vulvovaginal, 96 Candida glabrata, 3, 93 Candida krusei, 93 Candida lusitaniae, 93 Candida parapsilosis, 93 Candida tropicalis, 93 Candidiasis, 93 diagnosis, 94-95 vulvovaginal, 3, 93 Carcinoma

Bartholin's gland, 167 basal cell, 166-167 cervical, 183

lymphoepithelioma-like, 167 squamous cell, 161-164 urethral, 175 verrucous, 162-165 Caruncles hymenalis, 12 Cellulitis, 4, 86 Cervical carcinoma, 183 Cervical dysplasia, 74 Chancroid, 81-83 Chickenpox. See Varicella Chlamydia trachomatis, 80, 135 Circumcision, female genital, 6 Clitoris, 13

prepuce and frenulum of, 21 suspensory ligament of, 14 Clobetasol propionate, 51 Colle's fascia, 13 Condylomata acuminata, 4

Condylomata lata, 78 Corynebacterium minutissimum, 90 Crohn's disease, 45-46 Cystic tumors, 4 Cysts ciliated, 135

epidermal inclusion cysts, 135-137 mesonephric-like, 138 mesothelial, 138 mucinous, 135, 137-138 paraurethral (Skene's duct), 170

Darier's disease, 55, 146 Dermatofibroma, 148-149 Dermatofibrosarcoma protuberans (DFSP),

167, 169-170 Dermatophytosis, 97 Desmin, 140 Dysplasia cervical, 74 vulvar, 9

diagnosis of, 183

Eczema, 37-38

Elective lymph node dissection

(ELND), 124 Endometriosis, 139-141 Epidermophyton floccosum, 97 Epithelial lesions keratoacanthomas, 146-148 seborrheic keratosis, 144-146 warty dyskeratomas (WDs), 146-147 Epstein-Barr virus (EBV), 166 Erythema, 39, 42, 63 Erythrasma, 90, 91 Erythroplakia, 9 Escherichia coli infection, 170 Estrogen receptors (ER), 29, 140

Fasciitis, necrotizing, 89-90 Fibers elastic, 22

parasympathetic, 17 Fibroepithelial stromal polyp, 139 Fibroma, 156

Fixed drug eruption (FDE), 62 Folliculitis, 4

bacterial, 86 Fournier's gangrene, 89 Fungal infections, 93-100 Furunculosis, 87

Gardnerella vaginalis, 84 Genital anomalies imperforate hymen, 32, 33 longitudinal vaginal septum, 32 transverse vaginal septum, 32 vaginal agenesis, 31-32 vulvovaginal abnormalities, 34 Genital herpes virus infection, 3 Genital mucosa chronic ulcer of, 54 genetic, 55 Genital mutilation, 184 Genital staphylococcal infections, 85 Genital tuberculosis, 84 Genital warts, 4 therapy of, 75 Genitalia, ambiguous, 31 Granular cell tumors, 152-155 Granuloma inguinale, 79-80 Granuloma pyogenicum. See Pyogenic granulomas

Haemophilus ducreyi, 81 Hailey-Hailey disease, 54 Hemangioma, 149-150 Hemophilus ducreyi, 4 Herpes simplex virus (HSV), 4, 73 infection, 69 of anogenital skin, 72 diagnosis of, 72 of mouth, 71 neonatal, 72 recurrent, 71 treatment, 72 serotypes of, 69 Herpes zoster, 69

Hidradenitis suppurativa, 46, 48-49 Hidradenoma, papillary, 143-144 Hidradenoma papilliferum, 20 Human immunodeficiency virus (HIV), 7 Human papilloma virus (HPV), 141 infection, 183 types, 73 Hyperinsulinemia, 110 Hyperpigmentation, 110

basal layer, 114 Hyperplasia, squamous cell, 2

Keratoacanthomas, 146-148

Labia minora, 1 Leiomyoma, 154 of urethra, 174-175

Lesions, 40 diagnosis of, 8 etiology of, 1

sexually transmitted infections with, 4 See also individual lesion types Leukoplakia, 9 Lichen aureus, 45-46 Lichen planopilaris, 42 Lichen planus (LP), 40-45 hypertrophic, 42-43

immunofluorescent (IMF) studies of, 43 and lichen sclerosus (LS), 43 on tongue, 41 treatment of, 44 vulvar, 40

clinical forms of, 40 pigmented flexural, 40 Lichen sclerosus (LS), 2, 127 lesions of, 49

squamous cell carcinoma (SCC) and, 40 treatment of, 50, 182 Lichen sclerosus et atrophicus (LSA) metabolic activity in, 182 vulvar, 182 Lichen simplex, 59 histological changes of, 61 lesions of, 61 treatment of, 61 Lipoma, 156 Lipschutz's ulcer, 51

treatment, 52-53 Lupus erythematosus, 59 Lymphangiectasia, 60

treatment, 61 Lymphangioma circumscriptum, 150-153 Lymphoepithelioma-like carcinoma, 166, 168

Lymphogranuloma venereum (LGV) complications, 81 symptoms, 80 treatment, 81

Malacoplakia, 169, 173 Malignant melanoma, 5 Melanocytes, 28 Melanocytic hyperplasia, 120 Melanocytic lesions, 111 Melanocytic nevi histopathology, 115 treatment, 116 Melanoma

Breslow system, 124 clinical advantages of, 121

[Melanoma]

differential diagnosis of, 121 factors, 125 histopathology of, 122 with lichen sclerosus, 127 lymph node evaluation for, 124 malignant, 5 signs and symptoms, 121 staging system, 123 treatment of, 124 Melanoma antigen-encoding genes

(MAGE), 125 Melanoma antigen recognized by T-cells 1

(MART-1), 125 Melanoma in situ (MIS) definition of, 119 differential diagnosis of, 121 histopathology of, 119 treatment of, 120 Melanosis benign vulvar, 112 diagnosis of, 114 histopathology, 113 treatment of, 114 Melanotic macule, 112 Merkel cells, 28 Mesenchymal lesions aggressive angiomyxoma, 152, 154 angiokeratoma, 150-150 angiomyofibroblastoma, 151, 153 dermatofibroma, 148-149 fibroma, 156

granular cell tumors, 152-155 hemangioma, 149-150 leiomyoma, 154 lipoma, 156

lymphangioma circumscriptum,

150-151 neurofibroma, 157, 160 Mesonephric duct cysts, 33 Mesonephric-like cysts, 138 Mesothelial cyst, 138 Metastatic tumors, 168, 171 Micropapillomatosis labialis (MPL), 140, 143

Microphthalmia transcription factor, 125 Molluscum contagiosum, 75

treatment, 77 Monsel's solution, 51 Mucinous cysts, 135, 137, 138 Mucinous glands, 26 Mucosa-associated lymphoid tissue

(MALT), 28 Mucous membrane lesions, 67

Mycobacterium tuberculosis, 83 Mycoplasma hominis, 83 Myofibroblasts cells, 22

Necrolytic migratory erythema, 63 Necrotizing fasciitis, 88-90 diagnosis, 90 mortality rates of, 89 symptoms, 89 Neisseria gonorrhoeae, 135 Neoplasms benign, 143

of dermal appendages, 143 invasive, 157, 161 and lesions, 135 of vulva, 135, 157 Neurofibroma, 157, 160 Nipple, ectopic, 158 Nonneoplastic epithelial disorders, 2 Nymphae. See Labia minora Nymphohymeneal sulcus, 55 Nystatin vaginal tablets, 96

Ovarian follicles, 29

Pagetoid spread, 161 Paget's disease extramammary, 159 of vulva, 159 Papillary hidradenoma, 143-144 Parasitic infections, 100-104 Paraurethral (Skene's duct) cyst, 170,

173-174 Pelvic tumors, 6 Pemphigus, 58 Perineum anatomical compartment of, 11 central tendon of, 15 clinical, 11 lesions, 49 membrane, 14 superficial, 13 Peutz-Jeghers syndrome, 112 Phthirus pubis, 103 Pigmented lesions, 109, 183 Pityriasis versicolor, 98-100 diagnosis, 99 treatment, 99 Plasma cell vulvitis (PCV), 44 Primordial germ cells, 29 Progesterone receptors (PR), 20, 140

Prostate-specific antigen (PSA)-stained cells, 26 Pseudohermaphrodites, 31 Pseudosarcoma botryoides, 140 Psoriasis, 3, 39 Pubic lice, 103-104 Pudendal nerve, 1, 16 Purpura, 46

chronic, 45 Pyoderma gangrenosum, 57, 59 Pyogenic granulomas, 150, 152

Reiter's disease, treatment of, 40

Saccharomyces cerevisiae, 93 Sarcoptes scabiei, 101-102 Scabies, 101-103 diagnosis, 101 in skin folds, 102 treatment, 101 Seborrheic keratosis, 144-146 Sentinel lymph node biopsy

(SLNB), 122 Sexually transmitted infections, 4 Skene's gland adenocarcinoma, 172, 174 Skin associated lymphoid tissue

(SALT), 28 Skin lesions, keratinized, 67 Squamous cell carcinoma (SCC), 40, 161-164, 181 of vulva, 5, 183 Squamous cell hyperplasia, 2 Staphylococcal impetigo, 85 Staphylococcal infection, 88 genital, 86 group B, 91 Staphylococcus aureus genital skin infections, 85 signs of, 87 therapy of, 88 Stevens-Johnson syndrome, 56, 139

drugs for, 57 Stromal receptors, 29 Syphilis, 77 diagnosis, 77 symptoms, 77 treatment, 78 Syringoma, 144-145

Tinea cruris, 99 diagnosis of, 97

[Tinea cruris] symptoms, 97 treatment, 98 Trauma, 6

Treponema pallidum, 77 Trichoepitheliomas, 143-145 Trichomonas vaginalis, 100 Trichomonas vaginitis, 3, 100-101 Trichophyton mentagrophytes, 97 Trichophyton rubrum, 97 Trimethoprim-sulfamethoxazole, 88 Tuberculin skin test, 83 Tuberculosis (TB), genital, 83 Tumors cystic, 4 genital, 6

metastatic, 168, 171 pelvic, 6

Ulcers, 53, 58 Urethra benign lesions of, 168 carcinoma of, 175-176 caruncles, 168, 172 diverticulum, 172 leiomyoma of, 174-175 malacoplakia of, 169 malignant lesions of, 175 pelvic, 17 perineal, 17 Urogenital diaphragm, 15 Urticarial plaques, 68

Vagina diseases, 3 layers of, 17

lymphatic drainage of, 17 Vaginosis, bacterial, 3, 84 Vancomycin, 88 Varicella zoster virus (VSV), 67 diagnosis of, 68 infection, 67, 70

complications of, 68 treatment, 69 Verrucous carcinoma, 50, 162-165 Vestibular adenosis, 138-139 Vestibular glands, 4, 26-27 Vimentin, 140 Viral infections, 67-77 Vitiligo, 48

Von Recklinghausen's disease, 157

Vulva benign aphthae of, 51

treatment, 52 biopsy of, 9 blood supply of, 1 deep anatomy arteries, 15 Colle's fascia, 13 perineal body, 15 urogenital diaphragm, 15 vestibular glands, 14 dysesthesia, 6 embryology of, 29-30 histology of, 18

interlabial sulcus, 20 labium majus, 18 labium minus, 20 mons pubis, 19 mucinous glands, 26 perineum, 19 urethra, 26 vagina, 25 lymphatic drainage of, 16 superficial fascia of, 16 surface anatomy clinical perineum, 13 clitoris, 13 fossa navicularis, 13 labia majora, 11 labia minora, 12 mons pubis, 11 urethral meatus, 13 vagina vestibule, 12 surface limits of, 11 Vulvar intraepithelial neoplasia (VIN), 5 squamous, 158, 161-162 Vulvar vestibulitis syndrome (VVS), treatment of, 184 Vulvodynia, 95

Vulvovaginal candidiasis, 3, 93

treatment, 95 Vulvovaginal infections, 75, 93

Warty dyskeratomas (WDs), 146-147 Warty lesions, 158

Wolffian duct-like cysts. See Mesonephric-like cysts

Zoon's vulvitis, 44-45 treatment, 45

Labia Majora Cysts
Figure 2.18 Estrogen receptors are positive. (brown-stained nuclei) in the deeper layers of the vestibular epithelium. An identical appearance is seen in the squamous epithelium of the vagina and urethra. (See p. 29)
Vulvodynia Inner Labia

Figure 2.20 Septate vagina, inferior view. Source: Courtesy of Dr. John Cassey, Newcastle, New South Wales, Australia. (See p. 32)

Vulvar Disease
Figure 3.1 Irritant eczema. Glazed erythema of the most exposed areas in a patient with urinary incontinence. (See p. 38)
Psoriasis Labia Minora
Figure 3.3 (A) Flexural psoriasis. Well-marginated erythema of anogenital skin with some crusting. (B) Psoriasis. Characteristic elongated rete ridges and papillae, dilated vessels within papillae, and intraepithelial. (Munro's) microabscess. (See p. 39)
Hypertrophic Lichen Planus Vagina
Figure 3.6 Vulvovaginal lichen planus. Glazed erythema on the inner aspects of the labia minora bordered on the left-hand side with a white edge. (See p. 42)

Figure 3.7 Lichen planus. Glazed erythema of the gingiva with striae in the sulcus. (See P. 42)

Unequal Labia Hypertrophy

Figure 3.8 (A) Hypertrophic lichen planus. (LP) There is loss of the labia minora and the clitoris is buried. The vulval skin is white and hyperkeratotic with erythema in the inner aspect. (C) LP—saw-toothing deformity of rete ridges, uneven hypergranulosis, and orthokeratotic hyperkeratosis. (See p. 43)

Figure 3.8 (A) Hypertrophic lichen planus. (LP) There is loss of the labia minora and the clitoris is buried. The vulval skin is white and hyperkeratotic with erythema in the inner aspect. (C) LP—saw-toothing deformity of rete ridges, uneven hypergranulosis, and orthokeratotic hyperkeratosis. (See p. 43)

Uneven Labia Minora

Figure 3.11 Crohn's disease. (B) Inner aspect of vulva in Figure 9. (p. 45) showing lymphangiectasia. (See p. 47)

Hypertrophy Labia

Figure 3.13 (B) Lichen sclerosus involving the vulva and perianal skin with extension into the genitocrural folds, resulting in loss of the labia minora and sealing over of the clitoral hood. (C) Lichen sclerosus—there is thinning of the epidermis with loss of rete pegs and dermal homogeniza-tion. Dermal inflammation beneath the area of dermal homogenization is variable and is minimal here. (See p. 50)

Figure 3.13 (B) Lichen sclerosus involving the vulva and perianal skin with extension into the genitocrural folds, resulting in loss of the labia minora and sealing over of the clitoral hood. (C) Lichen sclerosus—there is thinning of the epidermis with loss of rete pegs and dermal homogeniza-tion. Dermal inflammation beneath the area of dermal homogenization is variable and is minimal here. (See p. 50)

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Thin Labia Minora

Figure 3.15 Lipschutz' ulcer. There are two large and deep ulcers apposed on either side. (See p. 52)

Figure 3.14 Benign aphthae with erythematous halo and slough-covered central ulceration. (See P. 52)

Figure 3.15 Lipschutz' ulcer. There are two large and deep ulcers apposed on either side. (See p. 52)

Lipschutz Ulcers
Figure 3.17 Hailey-Hailey disease. There is erythema with maceration in the genitocrural fold and tiny erosions. (See p. 54)
Lipschutz Ulcers
Figure 3.19 Erythema multiforme—characteristic targetoid lesions. Source: Image courtesy of W. Clark Lambert, MD, PhD., UMDNJ-New Jersey Medical School, Newark, New Jersey, U.S.A. (See p. 56)
Lipschutz Ulcers

Figure 3.22 (A) Bullous pemphigoid. Erythematous lesions with erosions and flaccid blisters. (See p. 57)

Figure 3.23 Pemphigus. (A) Erosions on right side of vulva. (See p. 58)

Figure 3.22 (A) Bullous pemphigoid. Erythematous lesions with erosions and flaccid blisters. (See p. 57)

Figure 3.25 (C) Fixed drug Figure 3.26 Postinflammatory hyperpigmenta-eruption—vacuolization of the tion—pigment incontinence is seen. (See p. 60) basal layer and pigmentary incontinence are seen. (See p. 60)

Figure 4.8 Despite the careful descriptions of differing morphologies of ulcers in the various ulcerative sexually transmitted diseases, the ulcers often appear discouragingly similar. This lesion of chancroid cannot be diagnosed on morphology alone, but rather on clinical suspicion and laboratory investigation. (See p. 82)

Jav Fetish Unwashed Pussy

Figure 4.13 Necrotizing fasciitis is characterized by hemorrhagic bullae because of ischemia from underlying infection that has destroyed the cutaneous vascular supply; resulting ulceration and hemorrhage can be seen in this patient who is in the healing phase. (See p. 89)

Figure 4.14 Erythrasma resembles tinea cruris, but the color is often more tan than red, and there is no peripheral accentuation of scale. (See p. 91)
Fissuring Vulva

Figure 4.17 Vulvovaginal candidiasis can produce redness, edema, and fissuring. (See p. 94)

Figure 4.15 In uncommon cases, bacterial vaginitis can occur, extending to infect the skin and producing red, scaling, or exudative skin. (See p. 92)

Figure 4.17 Vulvovaginal candidiasis can produce redness, edema, and fissuring. (See p. 94)

Vulvar Disease Pictures

Figure 4.19 Classic tinea cruris shows a red plaque on the proximal, medial thighs with accentuation and scale at the periphery of the plaque. (See p. 97)

Benign Vulvua Nevus
Figure 4.21 Pityriasis versicolor is characterized by hypopigmented, pink, or tan. (as seen here) well-demarcated flat papules with very subtle scale. (See p. 99)
Teardrop Pube Hair
Figure 4.24 Pubic lice are small parasites that cling to pubic hair, with nits appearing as teardrop-shaped eggs attached to hair shafts. (See p. 103)
Figure 5.6 Melanotic macule. (lentigo and melanosis) Basal layer hyperpigmentation is seen without an increase in melanocytes or melanocytic atypia. (See p. 114)
Figure 5.9 Benign nevus on right labium minus. (See p. 116)

Figure 5.16 Atypical junctional melanocy-tic hyperplasia of the vulva. Melanocytes with slight cytologic atypia are arrayed as solitary cells along the basal layer of the epidermis. (See p. 120)

Figure 5.17 Melanoma in situ of the vulva. Cytologically atypical melanocytes are present in all levels of the epidermis. (See p. 121)

Figure 5.18 Melanoma of the left labium minus characterized by an irregular dark area. Source: From Refs. 30 and 50. (See p. 122)

Figure 5.20 Melanoma in 10-year-old child on two areas of the vulva in association with lichen sclerosus. Source: From Ref. 30. (See p. 127)

Figure 6.3 (A) Mucinous cyst of the vestibule. (See p. 137)

Figure 6.7 Endometriosis. (A) Grossly endometriotic implants on the vulva often have a blue appearance. (See p. 141)

Year Old Labium

Figure 6.12 Syringoma: the characteristic comma-shaped epithelial nests in a collagen-ous background are seen. (See p. 145)

Figure 6.17 (C) Senile telangiectasiae. (See p. 149)

Figure 6.21 Angiomyofibroblastoma. (B) Bland spindle cells in a collagenous background with numerous thin-walled vessels. (See p. 153)

Figure 6.22 Aggressive angiomyxoma: the lesion tends to be more hypocellular than angiomyo-fibroblastoma, with a myxoid background. Vessels tend to be thicker walled. The lesions are poorly circumscribed. (See p. 154)
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Figure 6.23 Granular cell tumor: the name comes from the granular appearance of the eosino-philic cytoplasm. (See p. 155)
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