- Non-neoplastic Epithelial Disorders
After completing this tutorial the student
will be able to:
- list common non-neoplastic epithelial disorders
of the vulva
- describe their clinical features
- describe/recognize histologic features
- state clinical behavior
- state treatment
The vulva epithelium is subject to all the dermatoses that affect
the body skin generally. These include psoriasis, lichen planus,
contact dermatitis, lichen simplex chronicus.
- Vulvar Dystrophy
This refers to a clinically related group of disorders of epithelial
growth that usually present as white lesions (hence the old term
leukoplakia) of the vulva.
Question: What other vulvar conditions can present as
There are two basic clinicopathologic types:
1. Lichen sclerosis (lichen sclerosis et atrophicus)
This condition affects mainly women above 50 years but can
affect any age group including children. The lesion appears
as white, atrophic, "parchment paper-like" or crinkled
paper patches of the vulvar skin, occasionally accompanied by
marked contracture with narrowing of the introitus (hence the
old term kraurosis vulvae).
Note the white epithelium with atrophic labia majora and narrowing
of the vestibule.
Question: What symptoms may this patient complain of?
There is both epidermal and dermal atrophy (atrophic vulvitis).
The epithelium is thinned with blunting or loss of rete pegs
and a band of homogeneous, acellular subepithelial zone due
to edema and hyalinization of dermal collagen. A band of chronic
inflammatory cell lies beneath this zone.
There is mild hyperkeratosis, loss of rete pegs and homogenization
of the dermis.
The disease is insidious, slow in developing and progressive.
Most lesions have no premalignant potential, but if dysplasia
is present, can be associated with a low risk for development
of squamous cell carcinoma.
2. Squamous cell hyperplasia (hyperplastic dystrophy)
This presents as thick gray white plaques of the vulva and
occurs in women between 30 and 60 years old. Areas lacking keratin
layer appear red. The patches may be circumscribed or diffuse.
Any part of the vulva, adjacent thighs, perineum or perianal
skin may be involved. The lesions are pruritic and scratching
adds trauma and chronic inflammation.
There is epithelial thickening with acanthosis and hyperkeratosis.
Parakeratosis may occur on the surface.
Mild hyperkeratosis is present along with epithelial thickening.
No nuclear atypia is present.
The lesion is not premalignant, but if dysplasia is present,
can be associated with a low risk for development of squamous
Many conditions involving the vulva, benign, premalignant and
malignant, present as white patches. It is very crucial for
patient management to distinguish between these lesions. Biopsy
is therefore very important and indicated for the diagnosis
of all white lesions of the vulva.
Hidradenitis suppurativa is a chronic, unrelenting skin condition
that results from blockage and subsequent infection of the apocrine
glands. The hair-bearing areas of the vulva are involved.
Question: Name other areas of the body that may be affected.
Patients present with deep-seated, extremely painful and tender
nodules in the vulva. The lesions progress and coalesce to form
confluent abscesses, which rupture giving rise to multiple, chronically
draining sinus tracts.
In the early stages there is a perifolliculitis with a dermal
acute and chronic inflammatory cell infiltrate. In the late stage
there is destruction of skin appendages with sinus tract formation.
- Bartholins cyst
This is due to obstruction of the duct draining the Bartholin
gland leading to retention of secretion and resultant cystic dilatation
of the duct.
The condition presents as a palpable mass in the lower third
of the vestibule, posterolateral to the introitus. It occurs at
all ages and may cause local discomfort and dyspareunia.
Bartholins cyst. The lesion is located on the right lower
third, posterolateral to the introitus.
The cyst is lined by transitional, low cuboidal or flattened
epithelium (due to increased intracystic pressure).
Marsupialization of the duct.
Question: What complication may involve the cyst?