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Polyps, cysts, and other benign changes in the cervix, vagina, and vulva

This section describes polyps recognized by colposcopic examination, polypous changes, various cysts on the cervix, in the vagina and vulva.

On the cervix, retention mucous cysts are most often formed. The mechanism of their formation is described in section 4.1.3. When the ectopia overlaps the squamous epithelium, mucus retention occurs and retention cysts form. Fibromas and fibroids are very rare, then colposcopic examination is not possible. Endometriosis is observed in the form of small, blood-filled cysts. This is also a rare occurrence. As a rule, it is impossible to prove them histologically.

Polyps. The most common polyps are in the cervix, less commonly in the uterus. During colposcopic examination, it is not possible to distinguish between a polyp of the cervix and uterine body, this is only possible with histological examination. Decidual polyps are observed during pregnancy (see Figs. 47 and 48). After operations in the vaginal area and laparotomy, slightly bleeding granulation polyps are often formed. They can lead an inexperienced doctor to the wrong diagnosis, as they have an inflamed surface. Histological examination is indicated if the granulation polyp does not disappear or even increase after several cauterization by lapis. Polyposis in the vaginal stump after surgery for a precancerous or cancerous process requires special attention. In the vaginal area, cysts are often formed. Limburg estimates that two-thirds of all woman’s vaginal cysts do not

notice. The origin of such cysts often cannot be determined histologically. Congenital cysts come from the epithelium of the Mullerian ducts or the Wolf passages (Gartner's moves). Such cysts are extremely rare. They are localized most often on the side of the vagina.

Traumatic cysts of the vagina are located on the back wall or in the front third of the vagina and appear after ruptures or incisions of the perineum or plastic surgery on the vagina. Here it is necessary to mention vaginal adenosis, often described recently in the periodical. I have also repeatedly observed this phenomenon in recent years (see Fig. 53). Opinions about the origin of the cylindrical epithelium in the vagina are different. Most often, his appearance is explained by the moves of Muller. Some authors suggest implantation after birth injury. I observed this phenomenon in nulliparous women. In addition to ectopia, transient formations are often observed in a colposcopic image. These changes are absolutely benign. Here I do not want to touch on the use of contraceptives and the occurrence of vaginal cancer, which is often observed in the United States.

Colposcopic examination of the vulva is called vulvoscopy. She gives the doctor a good overview. In this section, I describe the most important conditions that are often encountered in practice. Usually, vulvoscopy uses the 7.5x magnification found in all colposcopes. Obvious pathological changes should be considered at a larger magnification and be sure to fix on the pictures.

On the vulva, you can find small cysts that appear as a result of inflammation or trauma. Bartholin gland cysts can be recognized macroscopically.

Small sebaceous retention cysts are observed frequently. A thorough colposcopic examination of the vulva with complaints of itching is very important. Often, small erosive changes are found in this, which can only be seen in the colposcope. According to the new nomenclature, with changes in the vulva, dystrophy and dysplasia are distinguished. This division seems unsuccessful to me, because at the same time the clinical concept of “dystrophy” and the histological term “dysplasia” are used. It is believed that with dystrophy, atrophic genesis does not play any role. I can not agree with this opinion. In postmenopausal elderly women, strong atrophic changes are often found in both the vaginal part of the cervix and vagina and the vulva. In these cases, there is a lack of estrogen, which can be eliminated by therapeutic measures. Recent studies have shown that I am right. Dystrophy has a mixed genesis, i.e. You can detect both atrophy and hyperplasia. Vulvar changes, formerly called vulvar kraurosis (kraurosis vulvae), are now called sclerosing and atrophic lichen (lichen sclerosus et atrophicus). It represents severe skin atrophy. Grimmer believes that leukoplakia is secondary hyperplasia of the epithelium based on kraurosis. Of these changes, precancerous and cancerous processes may arise. Similar gross forms of leukoplakia can be observed in young patients during puberty. This is a developing cancerous tumor according to histological examination (see Fig. 146). The modern concept of "dysplasia", a histological term, corresponds to histological changes or mild - moderate - severe dysplasia - cancer in development. My long-term observations suggest that it is impossible to clearly distinguish between a benign condition (dystrophy) and a precancerous process (dysplasia), since the transition is quite vague. With the appearance of bluish nodes in the vulva, melanoma should be assumed. This especially malignant form of skin cancer rarely occurs on the vulva (see Figs. 187 and 188).

To better understand the classification of atypical changes in the epithelium in the vulva, you can use the following scheme:

- VIN - intraepithelial neoplasia of the vulva;

- I degree - mild dysplasia;

- II degree - moderate dysplasia;

- III degree - severe dysplasia - developing cancer.

In recent years, genital herpes has spread very much. Condylomas can often be seen on the vulva. In addition, various forms of inflammation are possible (I do not stop at a detailed discussion of these phenomena).

Vulvar cancer accounts for 3-5% of cases of genital cancer, mainly in postmenopausal women. Its diagnosis is primarily colposcopy. A cytological examination does not have such significance here as in the cancer process of the cervix.

At each colposcopic examination, it is necessary to examine the vulva!

Large retention mucosa

Fig. 39.

The patient is 53 years old. In the area of ​​the anterior lip of the uterine pharynx, a large retention mucous cyst overlapping the cervical canal is visible. Such large cysts are rarely detected, they contain yellowish mucus and often consist of several cavities. Branched vessels look, as usual, and do not have pathological changes.

Retention mucous cyst

Fig. 40.

The patient is 68 years old. Has one child. No complaints. Postmenopausal period. It has been monitored for several years. The state is unchanged. In the cervical canal, a retention mucous cyst is visible, which completely closes the canal. Vessels have a typical branching (see Fig. 39).

Large polyp of the cervix

Fig. 41.

Nulliparous woman 49 years old. A polyp covered on most of the surface with metaplastic inflamed squamous epithelium with the remains of a cylindrical epithelium. A light mosaic is visible on the anterior lip of the uterine pharynx, and a delicate vinegar-white epithelium is visible on the posterior lip. In this patient, histologically benign polyps of the cervix were twice removed in the past.

Large cystic polyp covering the entire surface of the cervix

Fig. 42.

The patient is 81 years old. Has 3 children, the birth went well. A large cystic polyp has dense branched vessels on the surface without pathological changes. Large size requires removal of the polyp. The patient refused the operation.

Large polyp of the cervical canal

Fig. 43.

The patient is 45 years old. A history of multiple births. A tumor-like polyp is inflamed and bleeds. Such large polyps usually come from the body and cervix. Only histological examination will give an unambiguous definition of the polyp. In this case, it turned out to be a polyp of the body and cervix.

Large polyp of the uterus

Fig. 44.

The patient is 45 years old. A large polyp that filled the external uterine pharynx led to the expansion of the cervical canal. According to a colposcopic image, one cannot say where the polyp comes from - from the cervix or from the uterus. The surface of the polyp is partially covered with metastasis squamous epithelium, partially cylindrical epithelium. Histologically determined polyp of the uterus. The patient was disturbed by severe bleeding; polyps of the uterus were twice removed. The uterus has now been removed.

Granulation polyp

Fig. 45.

On the vaginal stump after removal of the uterus, bleeding granulation tissue is visible, similar to a polyp during colposcopic examination. On the right of the image, squamous epithelium is visible, starting to grow above the inflamed granulation tissue. A similar picture for an inexperienced doctor presents difficulties in diagnosis. Typically, such inflamed granulation polyps are quickly removed by cauterization with lapis.

Granulation polyp


Nulliparous woman 44 years old. On the cult of the vagina is a large multilayer granulation polyp pierced by numerous vessels. The picture was taken 1 year after the operation (hysterectomy with removal of both ovaries due to the myomatous uterus and bilateral cystic ovarian tumor). Due to severe hormonal imbalance, the patient received estrogen-progestogen drugs. No complaints. After cauterization by lapis, the polyposis formation quickly disappeared.

Decidual polyp

Fig. 47.

The patient is 33 years old. A history of two pregnancies. A large, slightly bleeding, polyp-like formation protrudes from the cervical canal; strong secretion of mucus and blood. Inspection is difficult. It is difficult to establish an accurate diagnosis (for some explanations, see fig. 48).

Decidual polyp

Fig. 48.

The patient is 23 years old. A history of two pregnancies. The cervical canal is filled with a polypous formation, partially vinegar-white, with atypia of blood vessels. The remains of a cylindrical epithelium are visible. Diagnosis is difficult. In such cases, even with a negative Pap test, a tumor biopsy is mandatory. The result of the biopsy study: a heterotopic decidual formation with severe inflammatory changes in the area of ​​cervical ectopy.

Vaginal endometriosis

Fig. 49.

The patient is 29 years old. He has two children. In the area of ​​the posterior wall of the vagina, at the tip of the clinically palpable node in the form of a “fastener”, a bluish node and a bluish surface of the vagina are visible underneath. The patient complains of off-cycle bleeding and pulling pains. Histological conclusion: vaginal endometriosis.

Cysts in the vagina

Fig. fifty.

The patient is 54 years old. Has 3 children. A large cyst in the anterior third of the vagina does not cause complaints, arose, apparently, after childbirth and has not changed for 20 years. When it was opened, besides the mucus, the old condensed blood would be there.

Congenital vaginal cysts on the side wall at the border with the cervix

Fig. 51.

The patient is 25 years old. No complaints. A cyst was discovered by chance. Histological examination often does not reveal the causes of the appearance of a cyst. In this case, the cyst of the Gartner's passage (Wolf) is determined.

Vaginal cyst

Fig. 52.

The patient complains of extremely unpleasant sensations in the vaginal area. A cyst the size of a cherry formed in the region of the posterior commissure. On examination, yellowish mucus is visible. The wall of the cyst is thin, the vessels have a branched structure without pathological changes. The cyst appeared to be due to trauma during an episiotomy. The result of histological examination: the cyst is lined with partially flat epithelium, partially interspersed with a cylindrical epithelium.

Vaginal adenosis

Fig. 53.

Nulliparous woman of 40 years. In the area of ​​the posterior wall of the vagina immediately after the vaginal area of ​​the cervix, a cylindrical epithelium, a degenerating squamous epithelium and strong vascularization are visible. Histological examination: ectopy with the phenomena of metaplasia of squamous epithelium (see section 4.1.2).

8 year old girl's intact hymen

Fig. 54.

Damage to the hymen ring is easier to establish with a colposcopic examination than with the naked eye. In this case, it was necessary to find out whether the rape occurred. With the help of colphotograms, the integrity of the hymen was irrefutably proven. Due to hormonal function not yet involved,

atrophy and not yet formed lips. A similar picture can be noted in postmenopausal women (see also Fig. 60).

Large urethra polyp

Fig. 55.

The patient is 68 years old. A relatively small lobule is visible proximally relative to the polyp. The polyp is partially covered by metaplastic squamous epithelium. In addition, small, delicate mosaic patches are visible indicating inflammation. The polyp caused a feeling of loss and pain during urination, so it was removed.

Condition after marsupialization of the Bartholin gland cyst on the left

Fig. 56.

The patient is 33 years old. In the lower third of the left small lip, a small opening of the gland is noticeable.

Around it, the epithelium is covered with red spots.

Vulvar erosion

Fig. 57.

The patient is 24 years old. In the area of ​​the posterior commissure, an epithelial defect after childbirth, complaints of severe pain. After topical treatment, the condition quickly improved.

Prurit vulva (Reason: Pediculi pubs)

Fig. 58.

The patient is 19 years old. Severe itching in the vulva is caused by pediculosis of the pubic hairline. Dirty blue-gray spots are clearly visible on the skin. Sticky nits are visible on the hair. Creeping insects can be seen in the colposcope.

Varicose vulva

Fig. 59.

The patient is 62 years old. The condition of postmenopause, no complaints.

Vulvar dystrophy

Fig. 60.

The patient is 60 years old. He has two children. The term “vulvar dystrophy” used to mean vulvar crowus. Today we use the term "sclerosing and atrophic lichen". In this case, the lips are completely wrinkled. The patient has been taking an estrogen preparation for many years due to severe hormonal deficiency.

Vulvar dystrophy with leukoplakia (formerly called vulvar kraurosis)

Fig. 61.

The patient is 67 years old. No complaints. Secondary strong compaction, keratinization of the whitish squamous epithelium has a clear boundary with the atrophic brownish-pinkish squamous epithelium of the vulva. A follow-up inspection is required every 6 months. due to leukoplakia. Compare with precancerous changes, coarse-grained leukoplakia: rice. 146, section 6.3.

Vulvar dystrophy - sclerosing and trophic lichen

Fig. 62.

The patient is 22 years old. She suffered from recurrent inflammation in the vulva. The picture shows the condition 9 years after the start of observation. The labia is very wrinkled, traces of the former inflammation are noticeable. The patient underwent a course of laser treatment. The condition gradually returned to normal.

Severe vulvar dystrophy - Lichen sclerosus et atrophicus

Fig. 63.

The patient is 52 years old. He has two children. Atrophic changes. The observed condition arose many years ago. The diagnosis of dystrophy with secondary leukoplakia was histologically confirmed.

Angiokeratoma (benign telangiectasia)

Fig. 64.

The patient is 37 years old. Has 3 children. No complaints. On the right on the vulva is a knot the size of a cherry with an ulcerated surface. In order to avoid the development of melanoma, it is necessary to excise this node with a significant uptake of healthy tissue.

Small keratoma on the vulva

Fig. 65.

The patient is 37 years old. No complaints. On the right on the vulva is a bluish cystic cystic node the size of a cherry.

Senile hemangioma on the vulva

Fig. 66.

The patient is 74 years old. No complaints. On the vulva are visible 3 small reddish-bluish nodules that are unlikely to be detected with the naked eye. No treatment required.
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Polyps, cysts, and other benign changes in the cervix, vagina, and vulva

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    Colposcopic diagnosis of benign changes in various functional conditions of the cervix, vagina and
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