medical notes

Apr 16th, 2015
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PREMALIGNANT AND MALIGNANT VULVAL DISORDERSAnatomy of the vulvaThe vulva develops in association with the urogenital sinus, the caudal extension of the paramesonephric ducts( mullerian ducts) and the development of the anus posteriorly.It is made up of the labia majora,labia minora, clitoris, perineum, mons pubis and the vestibule.Nerve supply:Ilio-inguinal, genital branch of the Genitofemoral Nn , posterior branches of the perineal Nn( pudendal N) and perineal branches from the Posterior Femoral Cutaeneous N, ( L1-S4)Arterial Supply; External pudendal branch of the Femoral aa, a branch from the Ilio-gastric aa, Pudendal branch of the internal iliac aa.Lymphatic drainage follows the vessels, but the initial drainage being to the superficial and deep inguinal lymph nodes.Premalignant and Malignant Vulval DisordersThese disorders are classified into three main groups:1. Non-neoplastic epithelial disorders of skin and mucosa (eg, lichen sclerosus or other dermatoses)2. Squamous (ie, vulvar intraepithelial neoplasia) and nonsquamous intraepithelial neoplasias (eg, Paget's disease, melanoma in situ)3. Invasive neoplasmsVULVAL INTRAEPITHELIAL NEOPLASIAEpidemiology and Risk Factors75% of VIN cases occur in premenopausal women, with no racial predisposition. Risk factors, which are similar to those for vulvar cancer, include human papillomavirus - most often associated with oncogenic HPV subtypes 16, 18 and 31, cigarette smoking, and immunodeficiency or immunosupp

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