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Chapter 20. Diseases of breast genitals

Vulvar diseases

The vulva includes the mons pubis, labia majora and labia minora, clitoris and vestibule, as well as the hymen. The vulva is covered by keratinized stratified squamous epithelium, with the exception of the vestibule and labia minora, covered by nonkeratinized epithelium.

Vulvitis is inflammation of the vulva, its most common disease. Exogenous irritants are the most common cause of vulvar inflammation. Vulvitis can also be caused by sexually transmitted infections such as human papillomavirus (HPV), herpes simplex virus types 1 and 2, and N. gonorrhoeae, Treponema, and Candida.

Vulvar tumors

Papillary hydradenoma is the most common benign tumor of the vulva from the epithelium of the apocrine glands. It looks like a clearly demarcated subcutaneous nodule with a diameter of 0,5-1 cm. Microscopically, the tumor consists of papillae, tubules and acini, lined with columnar epithelium and containing myoepithelial cells.

Vestibular papilloma develops in the area of the vulvar vestibule. It is a papillary outgrowth of loose connective tissue covered by nonkeratinized stratified squamous epithelium. It may be multiple.

Condylomata acuminata are caused by human papillomavirus (HPV) 6, 11, less commonly by other types. These tumors are often multiple and affect in addition to the vulva, the skin of the perineum and the perianal zone. The masses are represented by papillary growths of fibrous stroma with numerous vessels, covered by stratified squamous epithelium with acanthosis, hyperplasia of the parabasal layer, koilocytosis, para- and hyperkeratosis. Chronic inflammatory infiltration is determined in the stroma.

Malignant tumors of vulva

Squamous cell carcinoma is the most common malignant tumor of the vulva. Usually, cancer is accompanied by ulceration in the labia or clitoris. Microscopically, nonkeratinizing cancer is more common; the degree of differentiation varies. Basal cell carcinoma is less common; it may have a variety of growth patterns. Bartholin gland cancer usually develops in women over 50. The tumor has a pronounced infiltrative growth. Microscopically, it may have the structure of adenocarcinoma, squamous carcinoma, adenoid cystic carcinoma and other histological variants of cancer.

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