How good are your diagnostic skills?

September 11, 2019

Dr Diana Curran, MD is associate Professor, Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.

, John O. DeLancey, MD

John O. DeLancey, MD

Norman F. Miller Professor of Gynecology, Director, Pelvic Floor Research, Group Director, Fellowship in Female Pelvic Medicine and Reconstructive Surgery

, Hope K Haefner, MD

Hope K Haefner, MD

Dr Hope K Haefner, MD, is Profesor in the Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.

These three cases illustrate common diseases that patients with vulvar conditions may present with. Can you make the correct diagnosis and identify the best treatment plan?

These three cases illustrate common diseases that patients with vulvar conditions may present with. Can you make the correct diagnosis and identify the best treatment plan?

Presentation

A 42 y.o. woman presents for her annual gynecologic exam and complains of a non-painful mass on her right vulva. On examination, there is a 6-cm right-sided, mobile, non-tender mass just lateral to her right labium majus. It is bothersome when sitting and she cannot comfortably ride her bicycle. On physical examination, the mass is not compressible.

A. Hernia	A. Nothing
B. Lipoma	B. Excision
C. Vulvar abscess	C. Wide local excision
D. Bartholin cyst	D. Biospy

Correct diagnosis: B. Lipoma

Correct treatment plan: C. Wide local excision

Presentation

A 72 year-old woman is referred to your office by her internist for vulvar lesions. She denies itching or pain and states that the lesions have been there for years. Her medical history is unremarkable.

A. Molluscum contagiosum	A. Excision of the lesions
B. Condylomata accuminata	B. Laser therapy
C. Epithelial inclusion cysts	C. Dermal curette of the lesions
D. High-grade squamous intraepithelial lesions of the vulva (HSIL)	D. No treatment required

Correct diagnosis: C. Epithelial inclusion cysts

Treatment plan: D. No treatment required

Presentation

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

Correct diagnosis: A. Contact dermatitis

Treatment: Oral agents for symptom control (tricyclic antidepressants or anticonvulsants) may be needed to help avoid overuse of topical agents.