2007. Langenbecks Arch Surg. 17(1):20-7. [53] It sometimes represents a paraneoplastic syndrome, revealing associated malignant epithelial tumors or lymphoproliferative disorders. 1995 Apr. [Medline]. J Am Acad Dermatol. Bashir R, Munro CS, Mason S, et al. Ann Diagn Pathol. [26]. [59, 60, 61, 62] They may become large in size. Oskay T, Sezer HK, Genç C, Kutluay L. Pimecrolimus 1% cream in the treatment of vulvar lichen sclerosus in postmenopausal women. Common Benign Growths Online Medical Reference - from diagnosis through treatment options. Improvement is observed at menopause, with pregnancy, or following oral contraceptive intake. [105], Treatment options include excision, cryotherapy, electrosurgery, and carbon dioxide laser. 1998 Sep. 43(9):790-4. Hemostasis is usually satisfactorily achieved with pressure, chemicals such as silver nitrate or Monsel solution, or electrocautery. Pyoderma gangrenosum often appears as a deep, painful nodule or pustule that breaks down, draining a purulent discharge and forming an irregular ulcer with distinct undermined and purplish edges. Accessibility Babula O, Bongiovanni AM, Ledger WJ. 1992 Sep. 79(9):863-6. Acquired benign keratinocytic tumours to be discussed in this section include seborrhoeic keratoses, corns and calluses. Marren P, Wojnarowska F, Powell S. Allergic contact dermatitis and vulvar dermatoses. Benign keratinocytic and adnexal lesions CME, Minimal Excision Technique for Epidermoid (Sebaceous) Cysts, Dermatitis papulosa nigra (black papules on face and neck of dark skinned individuals). The differential diagnosis includes cyclic monilial vulvovaginitis and dysesthetic vulvodynia. [9] If the pruritus is unresponsive to therapy, an invasive or preinvasive squamous cell carcinoma should be considered. A report of four cases. [97]. For lichen sclerosus, the treatment of choice is a potent corticosteroid cream. Mucous cysts are dysontogenetic cysts arising from the minor vestibular glands or from mesonephric duct remnants. … 128(6):811-4. [Medline]. 2019 Jan. 98 (2):e13860. [37], Sexual activity, nulligravidity, bacterial infection, or candidal infections seem to be unlikely factors. 1987 Feb. 26(2):240-5. Arch Dermatol. 2020 Feb 21. Biopsy shows benign colonic mucosa with preserved crypt architecture, however mild focal crept regenerative changes noted. 72(1):74-6. Rarely, the earliest recognized change may be eosinophilic spongiosis; more commonly, the earliest noted change is spongiosis in the lower epidermis. Hyperplasia means that there are more cells than usual and they are no longer lined up in just the 2 layers. Infants with female pseudohermaphroditism usually present with an enlarged phallus, alone or associated with some degree of labioscrotal fusion. Darier disease is a heritable disorder of keratinization transmitted as an autosomal dominant trait. Treatment with topical steroids may be helpful in symptomatic patients. Vulvar involvement in Crohn disease is uncommon. It is a common condition in children and adolescents. 2008 Jul. Eur J Obstet Gynecol Reprod Biol. Familial and clinical histories are useful to suggest the diagnosis. These lesions are benign and do not require specific treatment; however, some patients request removal for cosmetic reasons. 1 This is a very timely paper. The term epidermolysis bullosa indicates a group of congenital disorders characterized by skin fragility due to an inherited defect in the epidermal, junctional, or dermal components underlying the physiologic mechanical properties of the skin. [87]. The likelihood that a superimposed carcinoma will develop from nonneoplastic epithelial lesions has been estimated to be 1-5% and is considered to be greater with lichen sclerosus or a lesion with atypia on initial biopsy. Abnormalities of the external genitalia occur in 1 in 4500 births. right thyroid, right hemithyroidectomy: - benign nodule with microfollicles in a background of nodular hyperplasia. [Medline]. Methotrexate is the treatment of choice. 135(1):89-91. The squamous mucosa shows reactive features including basal layer hyperplasia and elongation of the submucosa papillae. The diagnosis of papillomatosis is made based on clinical findings showing monomorphous papules with a symmetric distribution. [Medline]. Jang N, Fischer G. Treatment of erosive vulvovaginal lichen planus with methotrexate. Ortiz-Rey JA, Martin-Jimenez A, Alvarez C, De La Fuente A. Sebaceous gland hyperplasia of the vulva. Dermatology. Pulmonary nodular lymphoid hyperplasia is an uncommon reactive lymphoproliferative disorder that presents as an asymptomatic lung mass. [Medline]. Reiter disease is unusual in women; therefore, vulvar lesions are poorly described. Squamous cell carcinoma (SCC) is a common and important primary cutaneous malignancy. Spiradenoma is the name given to an undifferentiated or poorly differentiated benign adnexal neoplasm that has some tubular features. Instruct patients to avoid tight, hot, synthetic clothing and to keep the area cool and dry in order to stop friction and prevent relapses. 174(6):1701-5; discussion 1705-7. Many women find relief through progestin hormone treatments. The vulva has a unique environment characterized by the presence of warm temperatures, occlusion, friction, moisture (from sweat, vaginal effluent, blood, semen, urine, or feces), and various microbic flora. Hum Pathol. 48(5):735-9. An Bras Dermatol. The differential diagnosis includes recurrent herpes simplex virus (HSV) infection, lichen planus, intertrigo, The initial clinical impression was that of a salivary gland tumour. 3, Hagerstown, MD 21742; phone 800-638-3030; fax 301-223-2400. J Invest Dermatol. The term "benign follicular nodule" is applied to the most common benign pattern; where an adequate specimen is composed of varying proportion of colloid and benign follicular cells arranged as macro follicles and micro follicle fragments. If malignancy is suggested, a thorough investigation is indicated. Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa. 2004. 2005 Jan. 30(1):17-9. Bacterial and mycologic investigations may be useful to detect secondary infections. Lymphoid thymic hyperplasia, also referred to as lymphoid follicular thymic hyperplasia or autoimmune thymitis, is a form of thymic hyperplasia. Found insideThis book also emphasizes on various genetic and nongenetic alopecia types, differential diagnosis, and the measurement of hair loss. One chapter of the book is devoted to natural products for hair care and treatment. Br J Surg. A case of endometriosis infiltrating the Bartholin gland has been observed. Contributing factors include local irritation, poor hygiene, and lack of estrogen, resulting in a mild inflammatory reaction. Corticosteroid ointments may also be used for short-term treatment. Lichen simplex chronicus (localized neurodermatitis), Lichen simplex chronicus of the vulva is the end stage of the itch-scratch-itch cycle. [28] Its etiology is unknown but probably involves altered immunity in genetically predisposed subjects because an association with the expression of some HLAs (B51, DR5, and DQw3) and a racial predilection for individuals of Asian or Middle Eastern descent have been shown. [Medline]. Unusual presentation of Bartholin's gland duct cysts: anterior expansions. Hard corns are firm papules with translucent central cores, found on the dorsolateral fifth toes and dorsal aspects of other toes. The term inverted follicular keratosis is a misnomer, as it was thought that these lesions arose from hair follicles. They may also develop on genital skin (apocrine). Acantholysis first leads to the formation of clefts and then to blisters in a predominantly suprabasal location. [12, 119, 120] Clobetasol propionate 0.05% ointment, applied twice daily for 1-3 months (with the dose gradually tapered) provides short-term relief and long-term control in most patients. Fibromas, fibromyomas, and dermatofibromas usually appear as solitary, slightly raised, gray-brown, mobile indurated lesions (3-8 mm in diameter) developing along the insertion of the round ligament into the labia majora. By definition, the principal component of lipomas is mature adipocytes. Some general anatomic, embryologic, and histologic findings of the vulva merit review. 2008 Apr. Seborrheic keratoses appear as single or multiple verrucous, roundish, yellowish-brown, sharply circumscribed papules ranging in diameter from 2-10 mm and covered with a greasy friable scale. Arch Dermatol. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. [21], Atopic dermatitis usually occurs in patients with a personal or family history of asthma, hay fever, childhood eczema, or dry skin and is related to a cutaneous hypersensitivity associated with defective cell-mediated immunity and immunoglobulin E overproduction. Syringomata are sweat duct tumours most often presenting as multiple skin-coloured papules on the eyelids. Lymphofollicular hyperplasia is an increase in the number of cells found in lymph node. This is a comprehensive textbook of Hodgkin's and non-Hodgkin's lymphomas written by leaders in the field of childhood lymphomas. It includes clinical, pathologic and molecular biology of each subtype of lymphoma. 27 (1):[Medline]. The use of antiseptic solutions (eg, triclosan, chlorhexidine) and/or absorbent powders may also be helpful. Recommend gentle cleansing, sitz baths, and avoidance of irritants. The pathogenesis of vulvar vestibulitis is obscure. Gunthert AR, Hinney B, Nesselhut K. Vulvitis granulomatosa and unilateral hypertrophy of the vulva related to Crohn's disease: a case report. Obstet Gynecol. Treatment Options. The etiologies of other benign connective tumors in this area are unknown. Trichilemmal or pilar cysts (scalp), vellus hair cysts (eruptive papules) and steatocystoma (oily lesions on chest) have characteristic histological features. 169(1):107-12. The etiology of this condition is unknown. Benign vulvar lesions. Plasma cell vulvitis appears as an erythematous, well-demarcated, smooth, and shiny plaque that may be either asymptomatic or cause mild itching, burning, or soreness. Uses a new "road map" at the beginning of each chapter, as well as a new, more clinical focus to help you navigate through the book more quickly. The lesion may heal spontaneously, remain quiescent for months (even years), or worsen again after minimal trauma, surgery, or an inapparent triggering cause. Vulvar pruritus is an important symptom. No effective treatment is currently available. General attention to proper hygiene is suggested. Early vulvar lichen sclerosus: a histopathological challenge. [108], Although demonstration of typical oral changes carries more diagnostic weight than biopsy, histopathology is often necessary to confirm the diagnosis. [Medline]. The diagnosis of angiokeratoma is based on clinical and histopathologic features. In general, therapies currently used in the management of extensive vitiligo are not indicated for lesions limited to the vulva. Follicular and hurthle cells are normal cells found in the thyroid. Typically painless, rarely bothersome, and most often found on fair-skinned people, it is thought to be a hereditary affliction. Scurry J, van der Putte SC, Pyman J, Chetty N, Szabo R. Mammary-like gland adenoma of the vulva: review of 46 cases. Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes.The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts.These cells normally occupy the follicles (nodular swirls of various types of lymphocytes) in the germinal centers of lymphoid tissues such as lymph nodes. [164, 165] It should not be used to treat a gland abscess. [Medline]. 2010 Feb. 12 (1):51-2. Articles report on outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. [Medline]. 54(7):1565-71. Horowitz BJ. Because of its acute nature, an orthokeratotic stratum corneum is formed. Furthermore, all patients with a nonneoplastic vulvar epithelial disorder should be checked at regular intervals. [Medline]. 2009 Aug. 114(2 Pt 2):487-9. BJS Open. Because most of these conditions frequently occur in the anogenital area, vulvar problems may be common. Delicate and whitish reticulated papules may be present on the mucosa, but no atrophy or scarring is observed. Features of patients with vulvar dermatoses in dermatologic and gynecologic practice in Turkey: is there a need for an interdisciplinary approach?. Tazarotene gel is a new-generation topical retinoid that provides a useful and safe alternative for patients with mild disease in whom the use of systemic retinoids or other drugs is contraindicated. [Medline]. Treatment options for CLH are summarized in the Table 1. [7] ) Itching is rare, but pain, burning, and irritation occur and may be responsible for dyspareunia and dysuria. Found inside – Page 332In Graves' disease (or toxic diffuse hyperplasia), an autoimmune stimulus causes increased benign proliferation of follicular cells (hyperplasia), ... Results. [Full Text]. 2005 Oct. 31(5):427-31. Open study of topical 0.025% tretinoin in the treatment of vulvar lichen sclerosus. benign follicular adenoma. A prospective study of treatments for adult-onset divergence insufficiency–type esotropia. The color can range from brown to black, although it is usually irregular and can also show scattered patches of hypopigmentation. [Medline]. These lesions usually cause no symptoms until they reach a larger size and/or are located near the introitus or urethra. Found insideWritten and edited by leading international experts in the field, this is an essential resource for trainee pediatric pathologists, as well as general pathologists who may encounter pediatric cases. It appears to be related to conditions that approximate vulvar intraepithelial neoplasms (VINs) and has been found to progress to invasive carcinoma in 10% of cases. Int J STD AIDS. Prevention and treatment information (HHS). Patients with congenital labial hypertrophy are asymptomatic except for nuisances regarding hygiene, physical activity, or sexual intercourse. Histology shows chronic dermal inflammation with fibrosis and foreign body giant cells and the presence of neutrophils and bacteria in apocrine gland ducts. Because their onset and aggravation may be related with puberty, menstruation, or pregnancy, a hormonal influence has been suggested, but results of immunostaining for estrogen and progesterone receptors are controversial. erbium:yttrium-aluminum-garnet (Er:YAG) laser, Sigma Xi, The Scientific Research Honor Society, European Society for Pediatric Dermatology, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, American Institute of Ultrasound in Medicine, International Society for Clinical Densitometry, Association of Reproductive Health Professionals. An overview of therapeutic approaches. Some patients have responded to intralesional interferon alfa. 149(1):181-4. Most skin growths are benign and harmless, but differentiation from malignancy is essential. [92, 94] and the lack of another satisfactory etiology. [Medline]. Lipomas, or fatty tumors, are the second most common solid tumors found in the vulvar area. Photodermatol Photoimmunol Photomed. Encouraging results have been obtained with tretinoin cream 0.025% and systemic acitretin. Differentiation disorders arise from an abnormality of the number or structure of the X and Y chromosomes or of a male-specific transplant antigen that interacts with the Y chromosome to induce testicular differentiation. [Medline]. The lesion may sometimes be clinically misdiagnosed as anogenital warts, molluscum contagiosum, or other noninfectious conditions, and in such cases diagnosis is made by biopsy. If the skin is moist or macerated, aluminum acetate 5% (Burow) solution applied 3 … Int J STD AIDS. [Medline]. Patients should avoid excessive drying of this skin after bathing. Benign follicular hyperplasia . The abnormal growth can affect one-half of the gland (one lobe) or the entire gland (both lobes and the isthmus). However, the exact role of this major histocompatibility class I antigen in the development of Reiter disease remains unclear. Excoriation secondary to repeated scratching may cause bacterial superinfection with honey-colored crusting and, in chronic forms, lichenification. Summers PR, Hunn J. Lymphocytoma cutis is a rare pseudolymphoma that has also been known as ‘ cutaneous lymphoid hyperplasia ’ or ‘lymphadenosis benigna cutis’. Thomas R, Barnhill D, Bibro M, Hoskins W. Hidradenitis suppurativa: a case presentation and review of the literature. There are often prominent blood vessels, best seen using dermoscopy. 2007 Apr. Their contents can be expressed and have an unpleasant, cheesy odour. Behçet disease is a rare multisystem disorder characterized by the triad of oral ulcers, genital ulcers, and posterior uveitis; however, almost any organ system may be involved. Erythema multiforme major, vulvar involvement. 1995 Jun;75(3):395-403. doi: 10.1016/s0039-6109(16)46629-6. Dermoscopic and clinical features of pigmented skin lesions of the genital area. Women who have atypical endometrial hyperplasia have a higher risk of developing uterine cancer. Common symptoms include vulvar itching, soreness, and pain, along with the presence of mucosal erosions and vaginal discharge. Sexual ambiguity is a term used to describe situations in which the external genital organs are not clearly female or male at birth. Immunoglobulin E antibodies to seminal fluid in women with vulvar vestibulitis syndrome: relation to onset and timing of symptoms. Early lesions are very cellular with few vascular channels; mitotic figures and mast cells may be prominent. Cystic Degeneration of Follicular Nodules. [64] : Dilatations of preexisting vessels (31, 36%), Tumors with significant vascular component (11, 13%). A multidisciplinary approach that includes gynecologists, dermatologists, and gastroenterologists is needed to successfully manage the condition. Lupus erythematosus is an idiopathic autoimmune disorder that can affect many organ systems. Gynecol Oncol. Wain EM, Neill S. Fixed drug eruption of the vulva secondary to fluconazole. Treatment is the same as that for bullous pemphigoid. Eruptive syringomata sometimes affect hands and feet (eccrine). Physical examination often reveals dryness, scaling, excoriations, and, at times, ulceration. [12, 13, 14, 15, 16]. J Reprod Med. On skin biopsies, SCC is characterized by significant squamous cell atypia, abnormal keratinization, and invasive features. J Am Acad Dermatol. The diagnosis is made based on personal and family history and on clinical detection of typical lesions elsewhere in the body. Mizushima Y. Behcet's disease. One year of therapy. [30]. To further evaluate vulvar pathology (and to avoid a trial-and-error treatment method), order biopsies and histologic evaluations of any chronic dermatoses that do not respond to medical therapy in order to exclude extramammary Paget disease, VIN, and frank carcinoma. Goldstein AT, Thaçi D, Luger T. Topical calcineurin inhibitors for the treatment of vulvar dermatoses. Obstet Gynecol. 2002 May. Presse Med. Bohm-Starke N, Johannesson U, Hilliges M. Decreased mechanical pain threshold in the vestibular mucosa of women using oral contraceptives: a contributing factor in vulvar vestibulitis?. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. 81(1):81-7. The topics covered in this book should mainly be considered as adjuncts to common textbooks on thyroid pathology. The contributions should help pathologists in their routine diagnosis and should stimulate further thyroid research. Corns and calluses. Found inside – Page ivThis superbly illustrated book is the most comprehensive available guide to adnexal neoplasms of the skin. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1992 Jun. J Reprod Med. Allergic vulvitis. When seborrheic dermatitis involves the vulva, the labia majora and mons pubis are primarily affected. [Medline]. 1991 Feb. 4(1):17-35. 2003 May. Noted at puberty, hypertrophy of the labia minora is not an uncommon developmental anomaly. Cysts of the canal of Nuck can give rise to a hydrocele located high in the labia majora and are associated with a concurrent inguinal hernia in 30% of cases. 1995 Aug. 17(4):410-3. Yorganci A, Kale A, Dunder I, Ensari A, Sertcelik A. Vulvar syringoma showing progesterone receptor positivity. The differential diagnosis includes benign vulvar melanosis and vulvar intraepithelial neoplasia. [Medline]. 2006 May;34(5):330-4. doi: 10.1002/dc.20440. [11, 12]. Acta Derm Venereol. Kennedy CM, Peterson LB, Galask RP. Lichen planus of the vulva. Nevus cells deriving from the neural crest migrate into the skin during embryogenesis and collect in the basal cell layer of the epidermis, where they proliferate in small nests. Endometriosis is an uncommon benign neoplasm in the vulva produced by implantation of endometrial fragments, often following trauma or surgical procedures (eg, endometrial curettage, cesarean delivery). [104], Histopathologic features may be confusing; for example, a complex papillary-adenomatous pattern arranged in an aggressive fashion with absent mitoses may be observed. Long-term application of a bland ointment after a daily warm water soak and gentle traction is recommended to reduce the risk of recurrence. It is sometimes associated with underlying adenocarcinoma arising in adjacent but not necessarily contiguous tissue. Some patients may improve with weight loss and a subsequent change in hormonal status. [Medline]. [1] As the condition becomes more pronounced, hygiene becomes progressively difficult to maintain, and the buildup of keratotic debris causes secondary infection and a foul smell. Follicular hyperplasia (FH) is a type of lymphoid hyperplasia and is classified as a lymphadenopathy, which means a disease of the lymph nodes.It is caused by a stimulation of the B cell compartment and by abnormal cell growth of secondary follicles.This typically occurs in the cortex without disrupting the lymph node capsule. Submucosal resection may be necessary if the mass is extremely large or if mucosal damage is extensive. [Medline]. Ulcers may be solitary, deep, and necrotic, possibly leading to formation of fistulae. Tanaka K, Mikamo H, Ninomiya M, Tamaya T, Izumi K, Ito K. Microbiology of Bartholin's gland abscess in Japan. Excision and laser destruction are the most effective ablative procedures. The differential diagnosis of lentigo and vulvar melanosis includes postinflammatory hyperpigmentation, melanocytic nevi, malignant melanoma, and pigmented basal cell carcinoma. Postinflammatory hypopigmentation is due to temporary or permanent melanocyte damage of different causes, including skin injury with scar formation and chronic inflammatory skin diseases (eg, lichen sclerosus, discoid lupus erythematosus).
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