7 Vulvar Leukoplakia Causes of vulvar leukoplakia: 1-Vitiligo (loss of pigment)2-Inflammatory dermatosis: e.g. psoriasis3-Squamous intraepithelial neoplasms of the vulva (VIN) and invasive carcinoma4-Paget’s disease
9 Vulvar Intraepithelial Neoplasia (VIN) VIN I: mild dysplasia, lower third.VIN II: moderate dysplasia, lower two thirds.VIN III (CIS): Severe dysplasia, full thickness.
10 Vulvar Carcinoma Stromal invasion. 1-3% of all female genital cancers, > 60 years of age.2-Increasing Incidence of VIN (40-60 y).3-90% of malignancies are squamous cell carcinomas, 10%: adenocarcinomas, basal cell carcinomas, and melanomas.
11 Vulvar CarcinomaInitially a leukoplakia-type lesion, progresses to overt exophytic (elevated) or endophytic (ulcerated) lesion.Management and prognosis depend on size of tumor, depth of invasion, lymphatic involvement , and presence of metastasis.STAGE5 year survival:Stage I (tumor < 2 cm): 60-80%Larger tumor with metastasis: 10%
12 Local excision, radical vulvectomy, groin/pelvic LN dissection Vulvar CarcinomaSurgery: treatment of choice for early stage lesionsLocal excision, radical vulvectomy, groin/pelvic LN dissectionRadiotherapy: stage III and IV tumorsChemotherapy: Metastatic disease (low response rate)
13 Vaginal Intraepithelial Neoplasia (VAIN) and Carcinoma Uncommon, VAIN are graded I, II, and III (~VIN)Elderly females (>60 y)Preexisting or concurrent cervical or vulvar Neoplasia or carcinoma is sometimes present.
15 Endocervical polyp Inflammatory polypoid masses. Smooth surface composed of columnar mucus-secreting cells (endocervical epithelium) with underlying cystically dilated glands filled with mucus. Stromal edema inflammatory mononuclear cells.Squamous metaplasia and ulceration.
16 Cervical Intraepithelial Neoplasia (CIN) and Carcinoma Importance of early detection, adequate follow up and management.Histologic grading of precursor lesions:CIN I: Mild dysplasiaCIN II: Moderate dysplasiaCIN III : Severe dysplasia/carcinoma in situ
19 Cervical Intraepithelial Neoplasia (CIN) and Carcinoma Cytologic grading of precursor lesions1) LOW GRADE SQUAMOUS INTRAEPITHELIAL LESIONS[CIN I and Condylomas (koilocytosis)]2) HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS[CIN II, CIN III/CIS]
20 Cervical Intraepithelial Neoplasia (CIN) and Carcinoma Peak incidenceCIN : 30 YInvasive carcinoma: 45 yRisk factors1-Early age at first intercourse2-Multiple sexual partners3-A male partner with multiple previous sexual partners