The document discusses vulval pre-cancer and cancer. It covers the embryology, anatomy, physiology and functions of the vulva. It describes the epidemiology of vulval pre-cancer and discusses risk factors such as HPV infection and conditions like lichen sclerosus. The clinical features, investigations, grading and treatment options for vulval pre-cancer are explained. Wide local excision is described as the treatment of choice for older women with vulval intraepithelial neoplasia. Complications of treatment include altered psychosexual function and missing invasive lesions.
The document discusses cutaneous stigmata that can indicate underlying spinal dysraphism. Embryological errors between 2-6 weeks can result in open or occult spinal dysraphism. Various cutaneous findings are described, including subcutaneous masses, myelomeningoceles, hypertrichosis, dermal sinus tracts, vascular lesions, dimples, and gluteal cleft deviations. Imaging like ultrasound and MRI can help evaluate any associated spinal abnormalities. While not all skin findings carry the same risk, multiple stigmata increase the likelihood of underlying occult spinal dysraphism. Surgical intervention may be needed if neurological or urological symptoms appear.
This document discusses the anatomy, etiology, clinical presentation, diagnostic workup, staging, and prognostic factors of cervical cancer. It begins with an overview of the anatomy of the cervix and uterus, including lymphatic drainage. It then covers the main etiological factor of HPV, risk factors, pre-cancerous stages of dysplasia, and pathological classifications. The typical clinical presentation of symptoms is outlined. Details of the diagnostic workup including examinations, imaging, and FIGO staging of cervical cancer are provided. Finally, important prognostic factors such as age, medical conditions, treatment duration, and lymph node involvement are summarized.
Cervical intraepithelial neoplasia (CIN) refers to pre-cancerous changes that occur in the cells of the cervix. CIN is classified into three grades (CIN 1-3) based on how deep the abnormal cells are in the cervix. Human papillomavirus infection is the main cause of CIN. Screening through Pap tests and HPV testing can detect CIN early. Diagnosis involves colposcopy and biopsy of abnormal areas. Treatment options depend on the grade of CIN and include cryotherapy, loop electrosurgical excision, and conization. Leaving low-grade CIN untreated may allow spontaneous regression.
Tuberculosis of the spine, also known as Pott's disease, was first described in 1799. It is caused by the bacterium Mycobacterium tuberculosis which spreads hematogenously from a primary infection site to the spine. India has a high prevalence of spinal tuberculosis, accounting for around 1-3% of all TB cases. The disease most commonly affects the lower thoracic and upper lumbar spine. Clinical features include back pain, stiffness, deformity, and neurological deficits in advanced cases. Diagnosis involves imaging like X-rays and MRI to identify vertebral body destruction, as well as tests to detect M. tuberculosis from biopsy or aspirate samples. Advanced disease can compress the spinal cord, potentially causing parapleg
This case report describes a surgical technique for treating umbilical pilonidal sinus, a rare condition where hair lodges in the umbilical pit causing inflammation. The authors present their technique of excising the umbilical sinus and reconstructing the umbilicus in 52 patients. Their technique involves making an elliptical incision below the umbilicus, excising the sinus and surrounding tissue, reapproximating the umbilicus using sutures, and closing the skin. Follow up of 9-13 years found no recurrent disease and good cosmetic results. The authors conclude their simple technique is effective at eradicating the disease while preserving umbilical appearance.
This case report describes a rare case of adenoid cystic carcinoma (ACC) of the cervix in a 57-year-old African woman. ACC is an uncommon type of cervical cancer that arises from reserve cells of the endocervix. Histopathological examination of a cervical biopsy found ACC localized to the superficial endocervix. The patient underwent a hysterectomy and has since had no recurrence of cancer. ACC of the cervix is more aggressive than squamous cell carcinoma with higher recurrence rates. Standard treatment involves surgery and radiation therapy due to the rarity of cases and lack of prospective studies.
This document presents a case report of a rare occurrence of basal cell adenoma in the palate of a 25-year-old male patient. It describes the clinical findings and diagnostic workup including imaging, biopsy, histopathological examination, and immunohistochemical analysis of the excised tumor. The pathological features were consistent with basal cell adenoma. The tumor was successfully removed surgically and the patient recovered well, with the tumor representing an unusual site for this rare minor salivary gland tumor.
The document discusses cutaneous stigmata that can indicate underlying spinal dysraphism. Embryological errors between 2-6 weeks can result in open or occult spinal dysraphism. Various cutaneous findings are described, including subcutaneous masses, myelomeningoceles, hypertrichosis, dermal sinus tracts, vascular lesions, dimples, and gluteal cleft deviations. Imaging like ultrasound and MRI can help evaluate any associated spinal abnormalities. While not all skin findings carry the same risk, multiple stigmata increase the likelihood of underlying occult spinal dysraphism. Surgical intervention may be needed if neurological or urological symptoms appear.
This document discusses the anatomy, etiology, clinical presentation, diagnostic workup, staging, and prognostic factors of cervical cancer. It begins with an overview of the anatomy of the cervix and uterus, including lymphatic drainage. It then covers the main etiological factor of HPV, risk factors, pre-cancerous stages of dysplasia, and pathological classifications. The typical clinical presentation of symptoms is outlined. Details of the diagnostic workup including examinations, imaging, and FIGO staging of cervical cancer are provided. Finally, important prognostic factors such as age, medical conditions, treatment duration, and lymph node involvement are summarized.
Cervical intraepithelial neoplasia (CIN) refers to pre-cancerous changes that occur in the cells of the cervix. CIN is classified into three grades (CIN 1-3) based on how deep the abnormal cells are in the cervix. Human papillomavirus infection is the main cause of CIN. Screening through Pap tests and HPV testing can detect CIN early. Diagnosis involves colposcopy and biopsy of abnormal areas. Treatment options depend on the grade of CIN and include cryotherapy, loop electrosurgical excision, and conization. Leaving low-grade CIN untreated may allow spontaneous regression.
Tuberculosis of the spine, also known as Pott's disease, was first described in 1799. It is caused by the bacterium Mycobacterium tuberculosis which spreads hematogenously from a primary infection site to the spine. India has a high prevalence of spinal tuberculosis, accounting for around 1-3% of all TB cases. The disease most commonly affects the lower thoracic and upper lumbar spine. Clinical features include back pain, stiffness, deformity, and neurological deficits in advanced cases. Diagnosis involves imaging like X-rays and MRI to identify vertebral body destruction, as well as tests to detect M. tuberculosis from biopsy or aspirate samples. Advanced disease can compress the spinal cord, potentially causing parapleg
This case report describes a surgical technique for treating umbilical pilonidal sinus, a rare condition where hair lodges in the umbilical pit causing inflammation. The authors present their technique of excising the umbilical sinus and reconstructing the umbilicus in 52 patients. Their technique involves making an elliptical incision below the umbilicus, excising the sinus and surrounding tissue, reapproximating the umbilicus using sutures, and closing the skin. Follow up of 9-13 years found no recurrent disease and good cosmetic results. The authors conclude their simple technique is effective at eradicating the disease while preserving umbilical appearance.
This case report describes a rare case of adenoid cystic carcinoma (ACC) of the cervix in a 57-year-old African woman. ACC is an uncommon type of cervical cancer that arises from reserve cells of the endocervix. Histopathological examination of a cervical biopsy found ACC localized to the superficial endocervix. The patient underwent a hysterectomy and has since had no recurrence of cancer. ACC of the cervix is more aggressive than squamous cell carcinoma with higher recurrence rates. Standard treatment involves surgery and radiation therapy due to the rarity of cases and lack of prospective studies.
This document presents a case report of a rare occurrence of basal cell adenoma in the palate of a 25-year-old male patient. It describes the clinical findings and diagnostic workup including imaging, biopsy, histopathological examination, and immunohistochemical analysis of the excised tumor. The pathological features were consistent with basal cell adenoma. The tumor was successfully removed surgically and the patient recovered well, with the tumor representing an unusual site for this rare minor salivary gland tumor.
1 hydrocele created by Dr.Nitin AlapureNitin Alapure
This document summarizes various scrotal diseases and conditions, including their anatomy, etiology, clinical features, investigations, complications, and treatments. It discusses the layers of the scrotum and the descent of the testes from the abdomen to the scrotum during development. It provides details on hydrocele, including its classifications, types like communicating vs non-communicating, investigations like ultrasound and treatments like tapping, sclerotherapy, and Lord's plication surgery. It also summarizes varicocele and its presentation as a bag of worms, as well as testicular torsion and its medical emergency requiring urgent surgery.
Cervical cancer occurs when abnormal cells grow uncontrolled on the cervix. It is caused by human papillomavirus (HPV) infection and other risk factors like early sexual activity and smoking. Most cases occur in low- and middle-income countries. Early stages may be asymptomatic but later stages can cause abnormal bleeding, discharge and metastasis. Screening tests like Pap smears and HPV tests can find pre-cancerous lesions for treatment to prevent invasive cancer. Treatment depends on stage but may include surgery, radiation, chemotherapy or a combination. With treatment, survival rates are over 50% on average but drop with more advanced stages. Prevention focuses on HPV vaccination, screening programs, and addressing risk factors.
Hysteroscopy plays a crucial role in the management of infertility by allowing direct visualization of the uterine cavity. It can be used for both diagnostic and therapeutic purposes to assess and treat intrauterine abnormalities that may cause infertility such as submucosal fibroids, polyps, and adhesions. Hysteroscopy has advantages over other imaging modalities as it provides more accurate diagnosis and allows treatment to be performed in the same setting. Common procedures include polypectomy, myomectomy and adhesiolysis which have been shown to improve fertility outcomes.
Bored with Barretts: Diagnosing Gastric Intestinal Metaplasia, Meckels, & Pa...Patricia Raymond
We all know what to do with the border disorder that is Barretts, but what about other mucosal heterotopia: intestinal mucosa in the stomach, stomach mucosa in the intestine, pancreas mucosa in the stomach...what's going on with all this meandering mucosa? Join us for a discussion about how to diagnose and manage various misplaced gastrointestinal mucosa.
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Epidemiology and risk factors
Complete and incomplete, types I-III based on mucin expression
Risk of progression to cancer
Proper surveillance and endoscopic mapping
Management
35 min
Meckels
Describe the presumed anatomical development of Meckel's Diverticulum, summarize the 'Rule Of Twos', formulate management of a Meckel's associated cryptic bleed
Who was Meckel
Epidemiology and risk factors
Rule of twos
Risk of bleed
Management
10 min
Pancreatic Rests
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Review the endoscopic appearance of the Pancreatic Rest, discuss rare symptoms attributable to the finding and current endoscopic evaluation and management
Endoscopic appearance
Anatomic development
Risks for pancreatitis, cancer, obstruction
Endoscopic and surgical management
10 min
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.KETAN VAGHOLKAR
This document discusses gossypiboma, which is a retained surgical sponge or foreign body left inside the body after surgery. It can occur due to various risk factors like emergency surgery or unexpected changes during the procedure. Retained foreign bodies can elicit an inflammatory response and cause complications like infection, obstruction, or fistula formation. Diagnosis is usually made using imaging like x-rays, ultrasound, or CT scan. Treatment requires surgical removal of the foreign body. Prevention relies on accurate counting of sponges and instruments before, during, and after surgery. Failure to prevent gossypiboma can result in legal liability for surgeons under negligence laws.
Hints about tuberculosis , Epididymis anatomy and functions, Epididymis infection with TB, Incidence, Clinical picture and complications of it, Hints about the diagnosis and treatment
Presented in the department of Urology, Sohag school of medicine
Pelvic inflammatory disease is an infection of the female reproductive organs that often occurs when sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. There are three main classifications: endometriosis, adenomyosis, and endometrial hyperplasia. Endometriosis occurs when endometrial tissue grows outside the uterus, adenomyosis involves endometrial tissue growing into the uterine wall, and endometrial hyperplasia is an overgrowth of the endometrial lining. Symptoms vary depending on the specific condition but can include pelvic pain and menstrual irregularities. Treatment involves antibiotics, hormonal therapy, or in severe cases surgery to remove infected tissues.
CERVICAL NECROTIZING FASCIITIS BY VINCENT MUBANGA.pptxvincentmubanga
This presentation discusses cervical necrotizing fasciitis, a severe soft tissue infection that spreads rapidly along fascial planes in the neck. It has a high mortality rate and requires aggressive surgical debridement and broad-spectrum antibiotics. The presentation covers the epidemiology, risk factors, classification, pathophysiology, clinical presentation, diagnostics including use of the LRINEC score, management, complications, and prognosis of cervical necrotizing fasciitis.
This document provides tips and instructions for using a PowerPoint presentation on Hydatid disease:
1. The PPT can be freely downloaded, edited, and modified. It includes blank slides to engage students by asking questions before providing information.
2. The presentation is to be used for active learning sessions where blank slides are first shown to elicit student responses, followed by the content slides.
3. This format allows for repetition and revision of content through multiple iterations of questioning and answering.
A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina. Cervical biopsies can be done in several ways.
PROFESSOR ION CHIRICUTA, A TALENTED SURGEON, A SKILLED MANAGER AND A DEDICATE...SinzianaIonescu1
Prof. Ion Chiricuta was a talented Romanian surgeon who made many contributions in the fields of oncology and surgery in the mid-20th century. He graduated from medical school in 1942 and went on to hold several leadership roles, including heading the Oncology Institute in Cluj, Romania. Chiricuta developed over 15 new surgical procedures and published hundreds of papers. He helped modernize the Oncology Institute in Cluj and was a skilled researcher who advanced the understanding of cancer.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
This document summarizes a seminar presentation on cervical cancer screening. It discusses the history of Pap smears, guidelines for cervical cancer screening, the Bethesda system for reporting cytology results, specimen collection and preparation methods, normal cervical cytology findings, abnormalities identified in cervical cytology, and the conclusion that screening has significantly reduced cervical cancer mortality when implemented widely.
Ulcerative colitis is a type of inflammatory bowel disease that causes long-lasting inflammation and ulcers in the lining of the large intestine. It commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon. Diagnosis involves colonoscopy, biopsy, and lab tests. Treatment depends on severity and may include medications to reduce inflammation, immunosuppressants, corticosteroids, or surgery to remove all or part of the colon. Complications can include toxic megacolon, colonic perforation, hemorrhage, strictures, and colon cancer with long-standing disease. Prognosis is generally good with treatment, though some patients may eventually require surgery.
Colposcopy is a technique used to examine the cervix that was developed in 1925. It allows physicians to better define and delineate abnormalities found during cervical screening. Technological advances like computer imaging and telecolposcopy have improved colposcopy. The document outlines the history, current uses, and future of colposcopy. It discusses indications, diagnostic criteria, management recommendations, and challenges in colposcopy practice. The future of colposcopy is focused on greater use of digital imaging and telemedicine to improve patient care and quality control in a more cost-effective manner.
1) Urethral stricture is an abnormal narrowing of the urethra caused by progressive scarring that can result from trauma, infections, medical procedures or other causes.
2) The document discusses the definition, anatomy, epidemiology, etiology, pathophysiology, classification and clinical manifestations of urethral stricture.
3) The most common causes of stricture vary between developed and developing countries, with iatrogenic factors, external trauma, and infections being the primary causes discussed in the document.
This document discusses emerging technologies in wound care, focusing on hyperbaric oxygen therapy, advanced cell-based therapies using mesenchymal stem cells and bioengineered skin substitutes, and intermittent pneumatic compression devices. It reviews evidence that hyperbaric oxygen therapy significantly increases wound healing rates compared to placebo treatment. New cell-based therapies utilize fibroblasts, keratinocytes, and mesenchymal stem cells from sources like bone marrow and amniotic membrane to reduce inflammation and promote proliferation, angiogenesis, and collagen deposition. Intermittent pneumatic compression enhances lymphatic return, arterial perfusion, and oxygen delivery to wounds.
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
1 hydrocele created by Dr.Nitin AlapureNitin Alapure
This document summarizes various scrotal diseases and conditions, including their anatomy, etiology, clinical features, investigations, complications, and treatments. It discusses the layers of the scrotum and the descent of the testes from the abdomen to the scrotum during development. It provides details on hydrocele, including its classifications, types like communicating vs non-communicating, investigations like ultrasound and treatments like tapping, sclerotherapy, and Lord's plication surgery. It also summarizes varicocele and its presentation as a bag of worms, as well as testicular torsion and its medical emergency requiring urgent surgery.
Cervical cancer occurs when abnormal cells grow uncontrolled on the cervix. It is caused by human papillomavirus (HPV) infection and other risk factors like early sexual activity and smoking. Most cases occur in low- and middle-income countries. Early stages may be asymptomatic but later stages can cause abnormal bleeding, discharge and metastasis. Screening tests like Pap smears and HPV tests can find pre-cancerous lesions for treatment to prevent invasive cancer. Treatment depends on stage but may include surgery, radiation, chemotherapy or a combination. With treatment, survival rates are over 50% on average but drop with more advanced stages. Prevention focuses on HPV vaccination, screening programs, and addressing risk factors.
Hysteroscopy plays a crucial role in the management of infertility by allowing direct visualization of the uterine cavity. It can be used for both diagnostic and therapeutic purposes to assess and treat intrauterine abnormalities that may cause infertility such as submucosal fibroids, polyps, and adhesions. Hysteroscopy has advantages over other imaging modalities as it provides more accurate diagnosis and allows treatment to be performed in the same setting. Common procedures include polypectomy, myomectomy and adhesiolysis which have been shown to improve fertility outcomes.
Bored with Barretts: Diagnosing Gastric Intestinal Metaplasia, Meckels, & Pa...Patricia Raymond
We all know what to do with the border disorder that is Barretts, but what about other mucosal heterotopia: intestinal mucosa in the stomach, stomach mucosa in the intestine, pancreas mucosa in the stomach...what's going on with all this meandering mucosa? Join us for a discussion about how to diagnose and manage various misplaced gastrointestinal mucosa.
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Epidemiology and risk factors
Complete and incomplete, types I-III based on mucin expression
Risk of progression to cancer
Proper surveillance and endoscopic mapping
Management
35 min
Meckels
Describe the presumed anatomical development of Meckel's Diverticulum, summarize the 'Rule Of Twos', formulate management of a Meckel's associated cryptic bleed
Who was Meckel
Epidemiology and risk factors
Rule of twos
Risk of bleed
Management
10 min
Pancreatic Rests
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Review the endoscopic appearance of the Pancreatic Rest, discuss rare symptoms attributable to the finding and current endoscopic evaluation and management
Endoscopic appearance
Anatomic development
Risks for pancreatitis, cancer, obstruction
Endoscopic and surgical management
10 min
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.KETAN VAGHOLKAR
This document discusses gossypiboma, which is a retained surgical sponge or foreign body left inside the body after surgery. It can occur due to various risk factors like emergency surgery or unexpected changes during the procedure. Retained foreign bodies can elicit an inflammatory response and cause complications like infection, obstruction, or fistula formation. Diagnosis is usually made using imaging like x-rays, ultrasound, or CT scan. Treatment requires surgical removal of the foreign body. Prevention relies on accurate counting of sponges and instruments before, during, and after surgery. Failure to prevent gossypiboma can result in legal liability for surgeons under negligence laws.
Hints about tuberculosis , Epididymis anatomy and functions, Epididymis infection with TB, Incidence, Clinical picture and complications of it, Hints about the diagnosis and treatment
Presented in the department of Urology, Sohag school of medicine
Pelvic inflammatory disease is an infection of the female reproductive organs that often occurs when sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. There are three main classifications: endometriosis, adenomyosis, and endometrial hyperplasia. Endometriosis occurs when endometrial tissue grows outside the uterus, adenomyosis involves endometrial tissue growing into the uterine wall, and endometrial hyperplasia is an overgrowth of the endometrial lining. Symptoms vary depending on the specific condition but can include pelvic pain and menstrual irregularities. Treatment involves antibiotics, hormonal therapy, or in severe cases surgery to remove infected tissues.
CERVICAL NECROTIZING FASCIITIS BY VINCENT MUBANGA.pptxvincentmubanga
This presentation discusses cervical necrotizing fasciitis, a severe soft tissue infection that spreads rapidly along fascial planes in the neck. It has a high mortality rate and requires aggressive surgical debridement and broad-spectrum antibiotics. The presentation covers the epidemiology, risk factors, classification, pathophysiology, clinical presentation, diagnostics including use of the LRINEC score, management, complications, and prognosis of cervical necrotizing fasciitis.
This document provides tips and instructions for using a PowerPoint presentation on Hydatid disease:
1. The PPT can be freely downloaded, edited, and modified. It includes blank slides to engage students by asking questions before providing information.
2. The presentation is to be used for active learning sessions where blank slides are first shown to elicit student responses, followed by the content slides.
3. This format allows for repetition and revision of content through multiple iterations of questioning and answering.
A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina. Cervical biopsies can be done in several ways.
PROFESSOR ION CHIRICUTA, A TALENTED SURGEON, A SKILLED MANAGER AND A DEDICATE...SinzianaIonescu1
Prof. Ion Chiricuta was a talented Romanian surgeon who made many contributions in the fields of oncology and surgery in the mid-20th century. He graduated from medical school in 1942 and went on to hold several leadership roles, including heading the Oncology Institute in Cluj, Romania. Chiricuta developed over 15 new surgical procedures and published hundreds of papers. He helped modernize the Oncology Institute in Cluj and was a skilled researcher who advanced the understanding of cancer.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
This document summarizes a seminar presentation on cervical cancer screening. It discusses the history of Pap smears, guidelines for cervical cancer screening, the Bethesda system for reporting cytology results, specimen collection and preparation methods, normal cervical cytology findings, abnormalities identified in cervical cytology, and the conclusion that screening has significantly reduced cervical cancer mortality when implemented widely.
Ulcerative colitis is a type of inflammatory bowel disease that causes long-lasting inflammation and ulcers in the lining of the large intestine. It commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon. Diagnosis involves colonoscopy, biopsy, and lab tests. Treatment depends on severity and may include medications to reduce inflammation, immunosuppressants, corticosteroids, or surgery to remove all or part of the colon. Complications can include toxic megacolon, colonic perforation, hemorrhage, strictures, and colon cancer with long-standing disease. Prognosis is generally good with treatment, though some patients may eventually require surgery.
Colposcopy is a technique used to examine the cervix that was developed in 1925. It allows physicians to better define and delineate abnormalities found during cervical screening. Technological advances like computer imaging and telecolposcopy have improved colposcopy. The document outlines the history, current uses, and future of colposcopy. It discusses indications, diagnostic criteria, management recommendations, and challenges in colposcopy practice. The future of colposcopy is focused on greater use of digital imaging and telemedicine to improve patient care and quality control in a more cost-effective manner.
1) Urethral stricture is an abnormal narrowing of the urethra caused by progressive scarring that can result from trauma, infections, medical procedures or other causes.
2) The document discusses the definition, anatomy, epidemiology, etiology, pathophysiology, classification and clinical manifestations of urethral stricture.
3) The most common causes of stricture vary between developed and developing countries, with iatrogenic factors, external trauma, and infections being the primary causes discussed in the document.
This document discusses emerging technologies in wound care, focusing on hyperbaric oxygen therapy, advanced cell-based therapies using mesenchymal stem cells and bioengineered skin substitutes, and intermittent pneumatic compression devices. It reviews evidence that hyperbaric oxygen therapy significantly increases wound healing rates compared to placebo treatment. New cell-based therapies utilize fibroblasts, keratinocytes, and mesenchymal stem cells from sources like bone marrow and amniotic membrane to reduce inflammation and promote proliferation, angiogenesis, and collagen deposition. Intermittent pneumatic compression enhances lymphatic return, arterial perfusion, and oxygen delivery to wounds.
Similar to Vulval pre-cancer and Cancer-Diagnosis & Management.pptx (18)
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
India Home Healthcare Market: Driving Forces and Disruptive Trends [2029]Kumar Satyam
According to the TechSci Research report titled "India Home Healthcare Market - By Region, Competition, Forecast and Opportunities, 2029," the India home healthcare market is anticipated to grow at an impressive rate during the forecast period. This growth can be attributed to several factors, including the rising demand for managing health issues such as chronic diseases, post-operative care, elderly care, palliative care, and mental health. The growing preference for personalized healthcare among people is also a significant driver. Additionally, rapid advancements in science and technology, increasing healthcare costs, changes in food laws affecting label and product claims, a burgeoning aging population, and a rising interest in attaining wellness through diet are expected to escalate the growth of the India home healthcare market in the coming years.
Browse over XX market data Figures spread through 70 Pages and an in-depth TOC on "India Home Healthcare Market”
https://www.techsciresearch.com/report/india-home-healthcare-market/15508.html
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Vulval pre-cancer and Cancer-Diagnosis & Management.pptx
1. Vulval Pre-cancer and Cancer: Diagnosis and Management
Akin-Tunde Ademola ODUKOGBE
Professor / Honorary Consultant
Gynaecologic Oncology Unit
Department of Obstetrics and Gynaecology
College of Medicine, University of Ibadan / University College Hospital, Ibadan, Nigeria
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 1
2. Vulval Pre-cancer: Diagnosis & Management
•Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 2
3. Introduction
• The vulva is the external female genitalia
• Its size belies its importance in the function of the female, spanning urination,
sexual intercourse in its varied forms and female reproduction
• It is affected by numerous diseases, most of which originate from other systems,
while its diseases also affect many systems
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 3
4. Introduction
• Definitions
- VIN consists of varied neoplastic changes from mild cellular atypia to almost
invasive carcinoma
• Abbreviations
(1). VSCC – vulval squamous cell cancer. (2). VC – vulval cancer.
(3). HPV – human papilloma virus. (4). ISSVD – International Society for the Study
of Vulvovaginal Disease. (5). HPV-d – HPV-dependent vulval cancer, HPV-i – HPV-
independent. (6). VIN – vulval intraepithelial neoplasia. (7). uVIN – usual VIN. (8).
dVIN – differentiated VIN.
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 4
6. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
•Embryology, Anatomy and
Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 6
7. Embryology, Anatomy and Physiology
Early Development
• 3rd WOL. Mesenchymal cells from primitive streak form pair of cloacal folds
• Cranially unite to form genital tubercle, caudally split into urethral, anal folds
• Genital swellings form on each side of urethral folds. Later form labia majora
• Genital tubercle forms the clitoris, and urethral folds, the labia minora
• Urogenital groove forms the vestibule
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 7
8. EMBRYOLOGY OF THE VULVA
• A and B: Indifferent stages of the
external genitalia (A is
approximately 4 weeks, B is
approximately 6 weeks)
• C: Scanning electron micrograph
of the external genitalia of a human
embryo at approximately the
seventh week – AF = anal fold,
arrowhead = anal opening; GS =
genital swelling; GT = genital
tubercle; T = tail; UF = urethral fold
9.
10. Embryology, Anatomy and Physiology
Phenotype, blood supply, lymphatic drainage, nerve supply
• Mons pubis (mons veneris): pad of fat, hair bearing, alters in course of life
• Labia majora: lateral boundaries of vulva. External-dark, hairy. Pink inner has SGs.
Subcutaneous layer has Camper’s and Colles’ fascia similar to abdominal wall.
Forms anterior commissure and posterior commissure (posterior limit of vulva)
• Labia minora: cutaneous folds, flank vaginal orifice, splitting anteriorly to form
the hood (prepuce) and frenulum of clitoris. Numerous SGs on medial surface.
• Vestibule: has six openings [a. urethral meatus, b. Skene’s ducts (lesser vestibular
glands, like prostate glands) – 2, c. vaginal orifice, d. Bartholin’s ducts (greater
vestibular glands) – 2]. Shallow vestibular fossa
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 10
11. Embryology, Anatomy and Physiology
Phenotype, blood supply, lymphatic drainage, nerve supply
• Clitoris: erectile structure; has root, body (two corpora cavernosa with dense
fibrous tissue) and glans. Attached to pubic symphysis, ischiopubic rami.
• Bulbs of vestibule: one each side of the vestibule
• Abundant arterial supply: Femoral – superficial external pudendal (labia minora).
Internal pudendal – (most of skin, external genitalia, perineal muscles), labial
artery
• Venous drainage of vulval skin is through external pudendal to long saphenous.
Drainage of clitoris is through deep dorsal to internal pudendal, superficial dorsal
to external pudendal and both to long saphenous
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 11
12. Embryology, Anatomy and Physiology
Phenotype, blood supply, lymphatic drainage, nerve supply
• Connecting lymph vessels from labial skin, clitoris and perineum form 3 – 4
collecting trunks to drain into superficial inguinal nodes on the cribriform fascia
onwards to deep inguinal nodes medial to femoral vein. The deep inguinal nodes
drain through femoral canal to pelvic nodes. Cloquet’s node is the last deep
inguinal node. From the clitoris, drainage is to deep inguinal nodes or directly to
internal iliac nodes. Rectal plexus drain lower part of labia majora and perineum
• Nerve supply: inferior rectal and perineal nerves (vulva) and dorsal nerve (clitoris)
– from pudendal nerve (S2,3,4). Ilioinguinal [L1, anterior third of labium majus],
posterior labial branches of perineal [S3, posterior two-thirds], perineal branch of
posterior cutaneous nerve of thigh [S2, lateral aspect of labium majus.
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 12
15. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
•Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 15
16. Epidemiology
• Disease of the elderly (seventh decade)
• Younger women (third to fourth decades) increasingly affected due to HIV / AIDS
Form over 90% of cases
• Compared with CIN (6% of those screened – population based), VIN has a low
incidence
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 16
17. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
•Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 17
18. Aetiopathogenesis
• Two pathways
1. HPV related: 16, 18. Multifocal, in younger women,
2. Prior vulval lesions or non-HPV related: older women
• Part of ‘Field Carcinogenesis Phenomenon’ or ‘Field Effect’. Concomitant lesions
in up to 44%
• Predisposing lesions
Lichen sclerosus – chronic inflammation from vulval irritation / itching / scratching
• Autoimmune diseases
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 18
19. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
•Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 19
20. Clinical Features
SYMPTOMS
• May be asymptomatic
• Vulval itching
• Irritation
• Burning
• Dyspareunia
SIGNS
• General examination – physical and mental state examination
• Markers of ill – health (systematic systemic examination)
• Lesions may be white, red, leukoplakic, velvety, erythematous, ulcerated,
hyperpigmented indistinct macular, well-defined raised plaque (single or
multiple). Most on labia minora, and may involve perianal region in 40%
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 20
22. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
•Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 22
23. Investigations
General
FBC, HIV I & II, OGTT, HPV test, E & U, Cr & UA, CXR, Lipid profile, TFT
Specific
• Simple inspection using white light
• Acetic acid painting (3-5% acetic acid), with magnifying glass
• Pap smear
• Colposcopy
• Biopsy – colposcopically directed, using Keyes dermal punch
Histology
• Loss of polarity
• Features of neoplasia
• Exclusion of invasion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 23
24. Investigations
GRADING
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 24
Type Extent Remarks / Progression ISSVD (2015)
VIN 1 Mild. Dysplastic cells in lower
third
VIN 2 Moderate. Lower two – thirds
VIN 3 Severe. Carcinoma – in – situ.
Whole layer
• Warty or condylomatous.
HPV+
Undulating or spiked surface. Koilocytes
seen. Surface keratinocytes
Vulval LSIL, flat condyloma, HPV
effect
• Basaloid or undifferentiated.
HPV+
Flat surface, with immature parabasal cells. Vulval HSIL, VIN usual type
• Differentiated or simplex.
Older women
Basal or parabasal cells, normal
maturationkeratin pearls
Differentiated type VIN
25. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
•Treatment
• Ablative
• Medical
• Surgery
• Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 25
26. Treatment
• VIN II and VIN III should be treated, and all women with HSIL, uVIN
• Options
- Topical agents (Interferon gel, retinyl acetate gel, 5-fluoro-uracil, imiquimod). No
specimen for histology
- CO2 laser. Ideal for women less than 40 years, with no invasive lesions. Depth 3 –
4mm. Little scarring. No specimen for histology
- Wide local excision. Curative in 75% of cases if only VIN. Treatment of choice in
older women
- Simple vulvectomy (complete or partial)
- Skinning vulvectomy with split-thickness skin graft. Less distortion of anatomy
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 26
27. Treatment
• Rules when excising
- Gross margins to be 0.5 – 1.0cm
- Avoid injury to clitoris, urethra, anus
COMPLICATIONS
• Altered psychosexual function from defects, scarring, injury to clitoris and glands
• Missing invasive lesions (18.8% - Chua et al 1996)
• Hair bearing areas have deeper involvement which can be easily missed
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 27
28. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
•Prognosis
• Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 28
Treatment
29. Prognosis
• Lesion may regress spontaneously, recur after local excision (significant, 10% if
edges are free or 50% if involved) or progress to VSCC (10%)
• Markers of progression – increasing age, immunosuppression, smoking, raised
lesions with irregular surface
• Long term follow-up is crucial
- yearly, using VIA (3 – 5% acetic acid) and magnifying glass / colposcope
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 29
30. Vulval Pre-cancer: Diagnosis & Management
• Introduction
• Definitions
• Abbreviations
• Embryology, Anatomy and Physiology
• Early Development
• Phenotype, blood supply, lymphatic drainage, nerve supply
• Functions
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Treatment
• Ablative
• Medical
• Surgery
• Prognosis
•Prevention
• Life style changes, including use of condom
• Vaccination
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 30
Treatment
31. Prevention
• Vulval self examination
• Education
• Lifestyle adjustment. Smoking cessation
• Protected sex – especially female condom which covers the vulva
• Vaccination. 2 types (16, 18), 4 types (6, 11, 16, 18), 9 types (6, 11, 16, 18, 31, 33,
45, 52, 58)
• Screening of high risk groups – hrHPV, smokers, immunocompromised, previous
VIN, CIN, VAIN or perianal IN
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 31
32. Vulval Cancer: Diagnosis & Management
•Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 32
33. Epidemiology
• GLOBOCAN 2018 worldwide estimates – 44,235 new cases, 15,222 deaths. Age
adjusted incidence 0-4.6/100,000. Less than 5% of female genital tract cancers
(Forman D et al 2014, De Martel C 2012, Odukogbe et al 2004).
• 20th most common cancer among women in the UK, 3.7/100,000
• Incidence of VIN is increasing worldwide.
• Age distribution:
• Geographical distribution:
HICs have higher rates (65%) than Africa and Asia (35%)
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 33
35. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
•Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 35
36. Aetiopathogenesis
• Risk Factors
-Young women: smoking, high number of sexual partners, and compromised
immune status (Del Pino M – 2013, Van der Avoort IA – 2006, McCluggage WG – 2013).
Associated with HPV-d.
-Older women, p53 mutation, history of lichen sclerosus or chronic dermatosis
with autoimmune diseases (Del Pino M – 2013, Van der Avoort IA – 2006, McCluggage WG – 2013).
-HIV infection increases women’s risk for genital warts and VIN. High CD4 can lead
to spontaneous regression or enhances response to treatment of warts.
-Low CD4 (<500/mm3) increases incidence of VIN 2 and 3 (Massad LS – 2011).
-The burden of hr-HPV infection is high among heterosexual men in sub-Saharan
Africa and most pronounced among the HIV-infected individuals (Tobian et al 2013).
-Vulval carcinoma can arise from normal skin.
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 36
37. Aetiopathogenesis
• Aetiological Factors
-HPV DNA prevalence in vulval cancer is 20 – 40% (Bruni L et al – 2014, De Sanjosé S – 2013): HPV –
dependant and HPV – independent (HPV 16 forms 75% of HPV-D)
-DNA damage from pelvic irradiation
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 37
38. Aetiopathogenesis
HPV – dependent HPV - independent
HPV 16 75% of the cases
Precursor uVIN dVIN
Risk to VSCC 10% of uVIN, and 3% if uVIN treated Higher
Social status
Age
Smoking
Number of sexual partners
Immune status
p53
Younger
+
High
Compromised
-
Older women
Nil
Autoimmune diseases
+
Benign lesions - More
Prognosis Fair Worse
Comorbidity
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 38
39. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
•Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 39
40. Clinical Features
There may be no specific symptoms, leading to delay in treatment!
Itching
Dyspareunia
Soreness
Burning sensations
Bleeding
Lump
Ulcer
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 40
41. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
•Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 41
42. Investigations
• General
FBC, Clotting profile, Grouping and crossmatching blood
HIV I & II
OGTT
E & U, Cr & UA
Liver function tests
Lipid profile
Urinalysis, Urine MCS
ECG / Echocardiography
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 42
43. Investigations
• Specifics
1. Visual inspection after staining
2. Vulvoscopy
3. Colposcopy: Preceded by Pap smear because of ‘Field Effect’
4. Anoscopy
5. Cystoscopy
6. Rectoscopy
7. Radiology – Chest and bone Xray, IVU, CT Scan, MRI, PETScan
8. Lymphography Blue dye and radioactive colloids injected peri-lesionally
9. Lymphscintigraphy
10. Near-infrared fluorescence optimal imaging
• Histological distribution
VSCC - >90%. Keratinizing, basaloid, warty, and verrucous
• Distribution of sites – labia (80%), clitoris (10%), lower commissure (10%)
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 43
44. Investigations
• Staging
Vulval cancer can spread from the original site through
- Local invasion of adjacent tissues
- Embolization to regional lymph nodes (superficial, deep inguinal to pelvic nodes)
- Haematological to lungs, liver and bones
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 44
46. Simpler Version For The Patient
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 46
47. Investigations
TNM [Union for International Cancer Control, UICC (Sobin et al 2009)]
Comparison of both staging methods
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 47
T NM FIGO TNM
T1 Tumour confined to vulva and/or perineum N1a One or two nodules < 5mm 1A T1 N0 M0
T1a < 2cm with stromal invasion < 1.0mm N1b One nodule > 5mm 1B T1b N0 M0
T1b > 2cm with stromal invasion > 1.0mm N2b Two or more nodules > 5mm II T2 N0 M0
T2 Tumour with invasion of the lower part of
urethra/vagina/anus
N2c Extracapsular invasion IIIA T1, T2 N1a, N1b M0
T3 Invasion of the upper part of urethra/vagina,
bladder, rectal mucosa, bone, fixation in
pelvis
N3 Fixed, ulcerated IIIB T1, T2 N2a, N2b, M0
M0 Absence of distant
metastases
IIIC T1, T2 N3, M0
M1 Distant metastases IVA T1, T2 N3 M0, T3 any N M0
48. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
•Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 48
49. Treatment
• Surgery
Major form of therapy
Principles:
o Work up to reduce post operative infection (cleansing, enema, antibiotics)
o Aim is 1-2cm macroscopic margin, or less than 0.8cm histologic tumour-free
margin (Chan JK 2007). 50% recurrence rate if margins are less than 1cm
o Stage, size, site of tumour, previous excision, cell type (local recurrence, depth of
invasion)
o Distal 1/3 of urethra can be excised without loss of continence
o Lymph node dissection crucial. Sentinel node in early disease (mapping and
biopsy first described by Cabanas in 1976)
o Evolution – radical vulvectomy with en bloc bilateral inguinofemoral
lymphadenectomy (to triple incision technic: advanced cases) and radical local
excision + inguinofemoral lymphadenectomy: early disease
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 49
53. The GROINSS-V (Groningen International Study on Sentinel nodes
in Vulvar cancer)
I – Sentinel nodes in vulvar cancer. Long term follow up (Te Grootenhuis NC et al 2016)
II – Radiotherapy vs Inguinofemoral Lymphadenectomy (Oonk MHM et al 2021)
III – A Prospective Phase II Treatment Trial (Chemoradiation) (Slomovitz B. from 2021)
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 53
54. Treatment
• Radiation
- Adjuvant, after surgery
• Complications
- Radiation dermatitis, fibrosis and ulceration
- Vaginal stenosis
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 54
55. Treatment
• Neoadjuvant therapy
Usually chemoradiation:
- To shrink tumour
- To avoid injury to urethra, anus
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 55
56. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
•Prognosis
• Prevention
• Life style changes
• Vaccination
• Conclusion
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57. Prognosis
• Risk of transformation from VIN to VSCC is 10%, or 3% if VIN is treated.
• dVIN is a precursor and has a higher progression towards VSCC. Prognosis worse
in HPV-d compared to HPV-i (Del Pino M – 2013, Van der Avoort IA – 2006, McCluggage WG – 2013).
• Lymph node involvement is the most important prognostic factor
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FIGO Stage 5 year survival (%) Remarks
I 79 Stages of presentation of
most cases in HICs
II 59
III 43 Stages of presentation of
most cases in LMICs
IV 13
58. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
•Prevention
• Life style changes
• Vaccination
• Conclusion
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59. Prevention
• Incidence of vulval cancer can be reduced by half using HPV vaccines 16 and 18
(Hampl M et al 2006), and others
• Early biopsy of vulval lesions
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60. Vulval Cancer: Diagnosis & Management
• Epidemiology
• Age distribution
• Geographical spread
• Aetiopathogenesis
• Risk factors
• Aetiological factors
• Clinical Features
• History
• Examination
• Investigations
• General
• Specifics
• Staging
• Treatment
• Surgery
• Adjuvant therapy
• Neoadjuvant
• Prognosis
• Prevention
• Life style changes
• Vaccination
•Conclusion
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61. Conclusion
• Increasing incidence of VIN / VC
- Increasing life expectancy
- Increasing HPV, HIV diseases
• Better and still evolving diagnostic tools
• Better and still evolving treatment options
• Increasing preventive options – HPV vaccinations
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62. References
• Odukogbe AA, Adebamowo CA, Ola B, Olayemi O, Oladokun A, Adewole IF, Omigbodun OA, Aimakhu, Okunlola MA, Fakulujo O and Oluyemi FA
(2004). Ovarian cancer in Ibadan: characteristics and management. Journal of Obstetrics and Gynaecology, 24:3,294-297.
• Jean-Philippe Spano, Laurence Moureau-Zabotto, Mathieu Minsat and Quéro (2015). Cancer of the penis, anus, and vulva. In: Eds. Jean-Pierre
Droz, Bernard Carme, Pierre Couppié, Mathieu Nacher and Catherine Thiéblemont. Tropical Hemato-Oncology. Springer International
Publishing, Switzerland. ISBN 978-3-319-18256-8. Part IV, Chapter 45, 443-448.
• Forman D, Bray F, Brewster DH et al (2014). Cancer incidence in five continents, vol. X (electronic version). IARC, Lyon. http://ci5.iarc.fr.
• de Martel C, Ferlay J, Franceschi S et al (2012). Global burden of cancers attributable to infections in 2008: a review and synthetic analysis.
Lancet Oncol 13:607-615.
• Bruni L, Barrionuevo-Rosas L, Serrano B et al (2014). ICO Information Centre on HPV and Cancer (HPV Information Centre).
HumanLaurentPapillomavirus and Related Diseases in World. Barcelona, Spain. Summary Report 2014-08-22.
• De Sanjosé S, Alemany L, Ordi J et al (2013). Worldwide human papilloma genotype attribution in over 2000 cases of intraepithelial and
invasive lesions of the vulva. Eur J Cancer 49:3450-3461.
• Del Pino M, Rodriguez-Carunchio L, Ordi J (2013). Pathways of vulvar intraepithelial neoplasia and squamous cell cancer. Histopathology 62
(1):161-175.
• Van der Avoort IA, Shirango H, Hoevenaars BM, Grefte JM, de Hullu JA, de Wilde PC, Bulten J, Melchers WJ, Massuger LF (2006). Vulvar
squamous cell cancer is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol 25 (1):22-29.
• McCluggage WG (2013). Premalignant lesions of the lower female genital tract: cervix, vagina and vulva. Pathology 45(3):214-228.
• Massad LS, Xie X, Darragh T, Minkoff H, Levine AM, Watts DH, Wright RL, D’Souza G, Colie C, Strickler HD, Women’s Interagency HIV Study
Collaborative Study Group (2011). Genital warts and vulvar intraepithelial neoplasia: natural history and effects of treatment and human
immunodeficiency virus infection. Obstet Gynecol 118(4):831-839.
• Sobin LH, Gospodarowicz MK, Wittekind C (2019) UICC: TNM classification of malignant tumours, 7th edn. Wiley – Blackwell, Oxford. ISBN 978-
1-4443-3241-4.
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 62
63. References
• Pecorelli S (2009). Revised FIGO staging for cancer of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105(2):103-104.
• Tobian AA, Grabowski MK, Kigozi G, Gravitt PE, Eaton KP, Serwadda D, Nalugoda F, Wawer MJ, Quinn TC, Gray RH (2013). High-risk human
papillomavirus prevalence is associated with HIV Infection among heterosexual men in Rakai, Uganda. Sex Transm Infect. 2013
Mar;89(2):122-7. doi: 10.1136/sextrans-2012-050524. Epub 2012 May 24.
• Hampl M, Sarajuuri H, Wentzensen N, Bender HG, Kueppers V (2006). Effect of human papillomavirus vaccines on vulvar, vaginal, and anal
intraepithelial lesions and vulvar cancer. Obstet Gynecol 108(6):1361-1368.
• Chan JK, Sugiyama V, Pham H, Gu M, Rutgers J, Osann K, Cheung MK, Berman ML, Disaia PJ (2007). Margin distance and other clinic-pathologic
prognostic factors in vulvar cancer: a multivariate analysis. Gynecol Oncol 104(3):636-641.
• Oonk MHM et al (2021). Radiotherapy versus inguinofemoral lymphadenectomy as treatment for vulval cancer patients with micrometastases
in the sentinel node: Results of GROINSS-V II. J Clin Oncol.39(32):3623-3632.
• Te Grootenhuis NC et al (2016). Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes
in Vulvar cancer (GROINSS-V) I. Gynecol Oncol. 140(1):8-14.
• Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for
36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394- 424.
• Olawaiye AB et al (2021). FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynecol Obstet. 155:43-47. https://doi.org/10.1002/ijgo.13880
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64. Thank You!
Best of luck
22/09/2023 Akin-Tunde Ademola ODUKOGBE. 2022. 64