This document provides information on diseases of the vagina and vulva. It begins with the anatomy of the vagina and vulva. It then discusses common vaginal infections and inflammations like bacterial vaginosis, yeast infections, and trichomoniasis. Diagnosis and treatment of vaginal infections is outlined. Cysts and benign conditions of the vulva and vagina are described including lichen sclerosis and lichen planus. Finally, neoplasms of the vulva like vulvar intraepithelial neoplasia and squamous cell carcinoma are discussed.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Endometritis is caused by an infection in the uterus. It can be due to chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal bacteria. It is more likely to occur after miscarriage or childbirth. It is also more common after a long labor or C-section.
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Endometritis is caused by an infection in the uterus. It can be due to chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal bacteria. It is more likely to occur after miscarriage or childbirth. It is also more common after a long labor or C-section.
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
this ppt is about the vaginal disorders, types of vaginal infections, etiological factors and risk factors. the pathophysiology of vaginal infections, its management, treatment and prevention.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. DISEASES OF VAGINA & VULVA
Mrs. U SREEVIDYA,
Msc. NURSING,
Associate Professor,
Apollo college of nursing,
CHITTOOR
2.
3.
4. Mucosa
• Lined by stratified squamous epithelium without secreting
glands.
• Loose connective tissue.
Submucosa
Muscular
layer
• Consists of indistinct inner circular and outer longitudinal.
• Fibrous coat derived from vascular endopelvic fascia.
5. Age pH
Birth-2weeks Acidic 4-5
2 weeks till puberty Alkaline 6-8
Reproductive period Acidic 4-5 (4.5 is normal)
Post menopausal Neutral or alkaline 6-7
•Varies during menstrual cycle and different phases of life.
•Acidity is due to lactic acid
•Oestrogen gycogen from vaginal epithelial cells
doderlein’s bacilli
lactic acid
7. CONTENTS OF NORMAL VAGINAL DISCHARGE:
Squamous cells debris
Doderlein’s bacilli
Lactic acid
Tissue fluid
8. Anatomical consideration of vulva
• Vulvar skin comprises stratified squamous epithelium as in other
parts of body.
• The mons pubis and labia majora contain fat, sebaceous, apocrine
and eccrine sweat glands and blood vessels , which can develop
varicosities.
• Labia minora are rich in sebaceous glands, contain few sweat
glands but no hair follicles.
• The epithelium of the vestibule is neither pigmented nor
keratinized, but contain eccrine glands. These glands and epithelial
appendages are source of lumps
12. Vaginitis is an inflammation of the vagina. It can result in
discharge, itching and pain, and is often associated with an irritation or
infection of the vulva. It is usually due to infection.
Symptoms
• Irritation and/or itching of the genital area
• Inflammation (irritation, redness, and swelling caused by the presence of
extra immune cells) of the labia majora, labia minora, or perineal area
• Vaginal discharge
• Foul vaginal odor
• Pain/irritation with
sexual intercourse
13. Types and Causes of Vaginitis
Various conditions can cause an infection or inflammation of
the vagina as "vaginitis." The most common kinds are:
•Bacterial vaginosis, inflammation of the vagina due to an overgrowth
of bacteria. It typically causes a strong fishy odor.
•Candida or "yeast" infection, an overgrowth of the fungus candida,
which is normally found in small amounts in the vagina.
•Chlamydia is the most common sexually transmitted infection (STI)
in women, usually in those ages 18 to 35 who have
multiple sex partners.
14. Second most common cause
of vaginal inflammation
after bacterial vaginosis.
Most commonly caused by a
type of fungus known
as Candida albicans
nucleus
Epithelial
cell
hypha
blastospores
15. •Gonorrhea is another common infection spread through sex. It
often comes along with chlamydia.
•Trichomoniasis is an infection spread by sex that’s caused by
a parasite. It raises the risk for other STIs.
•Viral vaginitis is inflammation caused by a virus, like
the herpes simplex virus (HSV) or human papillomavirus
(HPV), which spread through sex. Sores or warts on the
genitals can be painful.
17. •Vaginal atrophy: This condition commonly occurs
after menopause. It can also develop during other times in the
life when estrogen levels decline, such as while breastfeeding.
Reduced hormone levels can cause vaginal thinning
and dryness. These can lead to vaginal inflammation.
•Irritants: Soaps, body washes, perfumes, and vaginal
contraceptives can all irritate vagina. This can cause
inflammation. Tight-fitting clothes may also cause heat
rashes that irritate vagina.
19. Normal Bacterial Vaginosis Candidiasis Trichomoniasis
Symptom
presentation
Odor, discharge, itch
Itch, discomfort,
dysuria, thick
discharge
Itch, discharge,50%
asymptomatic
Vaginal discharge
Clear to
white
Homogenous,
adherent, thin, milky
white; malodorous
“foul fishy”
Thick, clumpy, white
“cottage cheese”
Frothy, gray or yellow-
green; malodorous
Clinical findings
erythema “strawberry cervix”
Vaginal pH 3.8 - 4.2 > 4.5 Usually < 4.5 > 4.5
KOH “whiff” test Negative Positive Negative Often positive
Inflammation and Cervical petechiae
NaCl wet mount Lacto-bacilli
Clue cells (> 20%),
no/few WBCs
Few WBCs
Motile flagellated
protozoa, many
WBCs
20. TREATMENT:
Treatment for vaginal infections will depend on cause of the
infection. Like:
•Metronidazole tablets, cream, or gel, or clindamycin cream or gel
may be prescribed for a bacterial infection.
•Antifungal creams or suppositories may be prescribed for a yeast
infection.
•Metronidazole or tinidazole tablets may be prescribed for
trichomoniasis.
•Estrogen creams or tablets may be prescribed for vaginal atrophy.
If infection is caused by an irritant, such as soap, doctor
will recommend a different product to reduce irritation.
21. Vaginitis Prevention
• Proper hygiene can help to prevent some vaginal infections.
• Avoid clothes that hold in heat and moisture and should
wear cotton underwear.
• Eating yogurt can reduce the chance of fewer infections.
• Condoms are the best way to prevent passing infections between
sexual partners.
• Get a complete gynecologic exam every year, including a Pap
smear if doctor recommends it.
23. Vaginal Cysts
Gartner’s cyst
Lies on anterolateral vaginal wall
Arise from remnants of mesonephric duct.
Treatment: simple excision.
Inclusion cyst
Posterior surface of lower end of vagina
Develops in episiotomy or surgical wounds.
Treatment: simple excision.
24. Bartholin’s cyst
Infection of Bartholin’s Gland
Protrudes into lower part of vagina.
Treatment:Treated surgically by marsupialization
Endometriotic cyst
Posterior vaginal wall behind cervix.
Bluish bulge or subepithelial irregular nodular
mass.
Treatment: surgical excision or danazole.
26. Vulvo-vaginal problems are among 10 leading
disorders encountered by primary care clinicians.
* Benign lesions of the vulva are mentioned in three
categories :
1. Epithelial conditions.
2. Benign neoplastic disorders.
3. Dermatologic disorders.
* VIN (Vulval intra epithelial neoplasia)
* Cancer vulva
28. 1) Lichen Simplex
“ squamous cell hyperplasia “
* it is a local thickening of the epithelium resulting
from a prolonged itching .
* symptoms :
pruritus and pain.
* signs :
white or reddish thickened ,leathery ,raised surface.
usually discrete lesion but may be multiple.
* treatment :
• moderate-strength steroid ointment.
• antipruritic agent.
30. 2) Lichen Sclerosis
* it is a chronic progressive disease which constrict
and destroy the normal genital anatomy . In the
long term ,labia minora are lost ,labia majora
flatten ,clitoris becomes inverted .
* frequently found on the vulva of postmenopausal
women & can involve all the genital area from
mons to the anal area.
31. * symptoms:
intense pruritus , dyspareunia and burning pain.
* signs:
thin inelastic atrophic skin ,white with a crinkled ,
tissue paper appearance.
32. * diagnosis:
• multiple biopsies are necessary.
• it reveals a thin atrophic epithelium with inflammatory cells
lining the basement membrane.
* treatment:
● potent topical steroids.
• 80% of lesions respond- long term therapy with low potent
steroids.
● other local treatments are: esrtogen cream and
anaesthetics.
34. 3) Lichen planus
* it is a purplish ,polygonal papules that may
appear in their erosive form.
* it involve the vulva ,the vagina and the mouth
( vulval – vaginal –gingival syndrome ).
* symptoms:
vulval burning , severe dyspareunia when
vaginal stenosis develop in advanced stages.
* treatment:
topical and systemic steroids .
36. (2) Benign Neoplastic condions
1) epidermal inclusion and sebaceous cysts.
2) vulvar varicosities.
3) fibromas and lipomas.
4) clitoromegaly.
37. 1) epidermal inclusion & sebaceous cysts
* they are nontender , mobile , spherical ,slow
growing cysts located below the epidermis.
* sebaceous cysts are firmer because they are
filled with dry caseous material.
* treatment :
most of inclusion cysts require no treatment. If
they are symptomatic - surgical excision.
38. 2) Vulval Varicosities
Can enlarge especially during pregnancy
to cause discomfort and carry a possible
risks for rupture or thrombosis.
39. 3) Fibromas and Lipomas
Fibromas:
* are the most common benign solid tumors
that arise in the deeper connective tissue
of the vulva.
* they are slow growing 1–10 cm in diameter,
but may become huge .
Lipomas:
* slow growing tumors composed of adipose
cells.
41. 4) Clitoromegaly
* may develop after birth in response to
excessive androgen exposure . It is a sign
of virilization.
* diagnosed when the clitoral length exceeds
30 mm or the width at the base exceeds
10 mm.
43. 1) Psoriasis
• appears velvety but lack the characteristics.
• scaly patches found on the knees & elbows,
vulva.
• Treatment: Topical corticosteroids
44. 2) Behcet ′s syndrome
* ulcers in the vulval , oral and ocular areas.
* genital lesions can result over time in a scarred
vulva.
* etiology : is unknown.
* diagnosis : based on the concurrence ulcers in
vulva ,mouth & ocular involvement ,
• the recurrent nature of the disease and exclusion of
syphilis and Crohn’s disease.
* treatment : no effective treatment.
46. 3) Crohn’s disease
* vulval ulcers can precede the
development of GIT ulcerations .
* vulval ulcers are slit-like or knife – cut ulcers
with prominent edema.
• Draining sinuses and fistulas to the rectum may
occur.
47. 4) Acanthosis nigricans
* most commonly found in the axilla or the
nape of the neck and then vulva.
* characterized by its darky pigmented
velvety or warty surface .
* etiology : related to insulin resistance.
48. Vulval Neoplasms
Introduction
• 5% of female genital malignancies
• Usually occurs in the 70-80 year old population
• Histology is necessary for diagnosis
• Occurs anywhere on vulva
• Most common type is squamous cell carcinoma
• Melanoma is 2nd most common – but still <5%
• Associated with HPV
49. Epidemiology
Two different etiologic types of vulval cancers :
1. A less common type:
* in younger women .
* related to HPV infection and smoking.
* commonly associated with VIN .
50. 2. The more common type:
* in old women .
* unrelated to HPV infection or smoking.
* concurrent VIN is uncommon.
* long standing lichen sclerosis is common.
• 5% of patients have +ve serologic tests for
syphilis , lymphogranuloma venereum
and granuloma inguinale.
51. Vulval Intraepithelial Neoplasia (VIN)
2 types of VIN :
1. squamous cell carcinoma in situ
VIN III or Bowen’s disease.
2. Adenocarcinoma in situ
VIN III or Paget’s disease.
52. Squamous cell carcinoma in situ:
VIN III ( Bowen′s disease )
* mean age 45 years.
* symptoms:
50% asymptomatic.
itching is the most common symptom.
* signs:
most lesions are elevated ,white ,red ,pink ,
brown or grey in color.
20% of lesions are warty in appearance.
54. * diagnosis:
1.careful inspection of the vulva in bright
light and with the aid of a magnifying glass.
2. 5% acetic acid aceto white areas.
55. * treatment :
1. local superficial excision.
with margins of 5 mm are adequate.
2. skinning vulvectomy in extensive lesions.
3. laser therapy
if lesions involves the clitoris , labia minora
or perineal area.
56. Adenocarcinoma in situ
VIN III ( Paget′ s disease )
* occurs in white postmenopausal elderly women.
also occurs in the nipple area of the breast.
* 20% is associated with adenocarcinoma.
symptoms:
itching and tenderness are common.
signs:
* well demarcated and eczematus with white
plaque like lesions.
* growth may progresses beyond the vulva to the
mons pubis ,buttocks & thighs.
57. * diagnosis
histologically:
adenocarcinoma in situ characterized by
large ,pale , pathognomonic Paget’ s cells,
typically located both in the epidermic and
in the adnexal structures.
* treatment:
1. local superficial excision.
with margins 5-10 mm.
2. laser therapy
in recurrences which are common.
59. FIGO Staging of Cancer Vulva
Tumor limited to the vulva or perineum or both ,and
2 cm or < in diameter ,and no nodal metastases.
as above + stromal invasion < 1mm.
as above + stromal invasion > 1 mm.
Tumor limited to the vulva or perineum or both ,and
> 2 cm in diameter ,and no nodal metastases.
Tumor of any size with :
• adjacent spread to the urethra &/or vagina &/or
anus with localized lymphnode involvement
Stage I
Ia
Ib
Stage II
Stage III
60. Tumor invades any of the following pelvic :
upper urethra ,bladder mucosa ,rectal
mucosa ,pelvic bone or bilateral regional
node metastasis ,or a combination.
Any distant metastasis including pelvic
lymph nodes.
Stage IV
IVa
IVb
61. Special Investigations
• A biopsy with histological confirmation
• A full blood count, Urea and electrolytes, Liver
function tests
• Colposcopy in early lesions, Chest X-ray
• FNA of the lymph nodes
• Urethrocystoscopy, Proctoscopy
• MRI, CTS
62. Management
A) Early vulval cancer
* Stage I a
( penetration depth < 1mm below the basement
membrane & no nodal metastases )
radical local excision é surgical margins
1cm, patient do not need groin dissection.
* Stage I b & Stage II
( penetration > 1mm )
radical local excision + ipsilateral inguinal
femoral lymphadenectomy
63. B) Advanced vulval cancer
* Stage III
( involves the proximal urethra ,anus or rectovaginal
septum )
radical vulvectomy which includes a bowel,
urinary stroma or rectovaginal septum.
+ bilateral groin dissection.
Preoperative radiation or chemo-radiation should
be used to shrink the tumor ,followed by more
conservative surgical excision.
64. C) Stage-IV- with Positive lymph nodes
Radiation is,
used with > one nodal metastasis (<5mm),
or evidence of extra nodal spread .
postoperative radiation to both groins
and to the pelvis.
Prognosis:
= it correlate significantly with LN status.
with –ve nodes have a 5-yrs survival rate is 90%.
with +ve nodes have a 5-yrs survival rate is 50%.
= patient with no involved node have a good
prognosis regardless of stage.
65. Malignant Melanoma
* the 2nd most common vulvar cancer.
* may arise from a preexisting uveal - commonly
involve labia minora or clitoris.
* occurs in postmenopausal white women.
* diagnosis :
*any pigmented lesion of the vulva - requires
excisional biopsy for histopathology.
* usually smaller lesions and tend to
metastasized early.
67. * prognosis and treatment:
correlates to the depth of penetration into
the dermis. The 5-yrs survival rate is seen in 30%.
* superficial lesion radical local excision alone
with margins of 1 cm, is adequate.
* deeper lesions 1 mm or > radical local
excision + ipsilateral inguinal femoral
lymphadenectomy.