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1. Labia majora and outside: Skin + glands
2. Labia minora: Mucocutaneous
Vaginal wall: Squamous mucosa until the ectocervix.
Endocervix, uterus: Glandular epithelium.
Squamous hyperplasia: Chronic rubbing due to itching. Known as lichen simplex chronic. Tree Bark appearance due to hyperkeratosis associated with skin thickening. Thicker stratum corner. Reddish color due to itching.
Endogenous causes= eczema
Exogenous causes: Allergic contact dermatitis.
Lichen sclerosis: Chronic, inflammatory at the Introitous. It is mucocutaneous( squamous mucosa, until labia major.) Age group: Bimodal= post menopausal and pre puberty. Looks like parchment( white wrinkle look, looks like cigarette paper) Symptoms: Itching, fibrosis--> dyspareunia. Biopsy: Band like inflammation underneath the epithelium.
Vulvar intraepithelial neoplasia:
1. Vulval Low grade intraepithelial lesion: Flat condyloma, HPV effect changes in epidermis
2. Vulvar high grade intraepithelial lesion: VIN of usual type( old name)
3. VIN differentiated type: Not HPV related changes seen in post menopausal women. Related to dysplasia arisen to lichen sclerosis.
Condyloma accumminata: Exophytic. HPV warts; Not considered pre-malignant. No neoplasia. 10% associated with HPV 16,18. Majority are done by HPV 6, HPV 11.
VIN treatment: Symptoms--> itchy in absence of clinical findings due biopsy; visible lesions can be either red or white( if wet)
On examination we will see multiple papule that when fused form plaques( nodules). Pre-malignant lesions are ablated.
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