Pocket Guide to Obstetrics and Gynecology
Pocket Obstetrics and Gynecology pdf is you know very well about this book .lets we discuss about some frequently encountered obgyne problems.
Paget’s disease of the vulva is thought to arise from an aberrant stem cell. Clinically, it presents with pruritis and appears as red velvety skin with white overlying plaques Histologically, the individual and clustered Paget cells are seen at the dermal-epidermal interface and percolating up the epithelium (so-called Pagetoid spread Paget’s disease is usually an in situ lesion, but invasive Paget’s can occur.
Paget’s is treated commonly by surgical excision. Vulvar Paget’s disease tends to extend beyond the grossly visible lesion, and hence positive margins may be part of why the disease is often associated with local recurrence.
Paget’s disease of the vulva is associated with an underlying carcinoma in about 25–30 % of cases, much less frequently than the breast lesion, a totally different disease, although histologically similar. Underlying cancers associated with vulvar Paget’s disease may include invasive Paget’s, skin appendage carcinomas, or even distal carcinoma of unrelated organs.
In addition, histologically, spread of urothelial or anorectal carcinoma can be by pagetoid spread (individual cells percolating up the epithe-lium). Immunohistochemistry can assist in making the distinction.
My favorite topic is Leiomyomas of the vulva are rare, and similar in appearance to the uterine counter-part. The criteria for malignancy is more stringent than the uterine lesions, with evaluation of the following criteria:: ≥5 cm in greatest dimension, infi ltrative mar-gins, ≥5 mitoses per 10 high power fi elds, and moderate to severe cytologic atypia. If three or more are present, the lesion is a leiomyosarcoma, if two, atypical, and if one or less, benign. Recommendations have been suggested for follow-up of all groups, with wider excision for the leiomyosarcomas.
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