Vulvar dysplasia and vulvar cancer Quiz: Ace Your Exams
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A 57-year-old woman presents to the gynecologist’s office for evaluation of vulvar itching for three months. Over the same time, she has noticed raised areas on the skin of the vulva. She has used multiple courses of topical over-the-counter antifungal medications thinking it could be a yeast infection. However, there has been no improvement in symptoms. Past medical history is significant for a colposcopy done for abnormal cervical cytology and human papillomavirus (HPV) detected on a pap smear ten years ago. The biopsy taken from colposcopy returned cervical intraepithelial neoplasia (CIN) 2 that required a loop electrosurgical excision procedure (LEEP) and more frequent pap smears. She has also been treated once for chlamydia and has a history of uterine leiomyomas. Vital signs are within normal limits. Chaperoned examination of the vulva reveals several small skin-colored raised lesions. Biopsy of the lesions shows atypical koliocytes in the upper layers of the epithelium. Which of the following is the greatest risk factor for the patient’s current condition?
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