Adolescent and Pediatric Vaginal Clear Cell Carcinoma
Introduction
Introduction to vaginal clear cell carcinoma in adolescents and children Adolescent and pediatric vaginal clear cell carcinoma is a malignant tumor that occurs in adolescents and children with vaginal or cervix. It is related to the mother's treatment of estrogen during pregnancy, especially in patients treated with diethylstilbestrol before 18 weeks of gestation. The risk of cell cancer increases. basic knowledge The proportion of the disease: the disease is rare, the incidence rate is about 0.001% -0.002% Susceptible people: women Mode of infection: non-infectious Complications: urinary tract infection edema
Cause
Adolescents and children with vaginal clear cell carcinoma
(1) Causes of the disease
Vaginal or cervical clear cell carcinoma of adolescents and children is greatly affected by mothers. In the 1940s, diethylstilbestrol was widely used to prevent adverse reactions during pregnancy. In 1971, the US FDA reported that it had side effects of vaginal clear cell carcinoma in female offspring. After 50 years, its side effects still attract widespread attention. Robboy believes that the mother of the patient receives estrogen treatment within the first 3 months of pregnancy. Although it lasts only 1 to 2 months, the offspring may have cancer. Because the incubation period of carcinogenic factors can be as long as 10 to 20 years, and induced by endogenous hormones secreted by the ovaries during puberty, Poskanzer performed vaginal biopsy on 110 adolescents who used estrogen, confirming that 35% of vaginal glands occur. The disease was only 1% in the untreated estrogen group.
(two) pathogenesis
The tumor is cystic or tubular, and some are solid or papillary. The needle-like cells are often seen under the microscope. It is a typical middle renal tubular epithelial cell. The globular nucleus is in the sac or lumen. The cytoplasm is rich in glycogen (Fig. 1, 2). Clear cell type adenocarcinoma is different from secretory adenocarcinoma. In cells of clear cell carcinoma under electron microscope, mitochondria do not increase, no nucleoli, and glycogen synthesis is increased. Performance.
Clear cell carcinoma often spreads locally to the surrounding lymph nodes. Anderson et al believe that patients with vaginal clear cell carcinoma who are exposed to estrogen in the uterus have more lymphatic metastases than those who have not been exposed to estrogen in the vaginal squamous cell carcinoma. Herbst Lymph node metastasis was reported to be related to tumor size and depth of invasion. Lymph node metastasis occurred when the smallest lesion was 2.0 cm × 1.5 cm, or the lesion depth and tissue depth were <3 mm. The pelvic lymph node biopsy was positive, indicating that the early patients were There is a possibility of lymphatic metastasis.
Prevention
Prevention of vaginal clear cell cancer in adolescents and children
1. Regular physical examination of high-risk personnel, early detection, thorough treatment of early disease, such as only partial resection of the local lesions, the recurrence rate is still high, therefore, no matter whether the disease is early or late, radical surgery is required.
2. After the mother has used estrogen during the embryonic period, the adolescents born with high risk of vaginal or cervical clear cell carcinoma, whether or not they have symptoms, should undergo vaginal cytology smear examination and gynecological examination every 6 months.
Complication
Adolescent and pediatric vaginal clear cell carcinoma complications Complications urinary tract infection edema
Concurrent infections, mainly vulva, vaginal itching, increased vaginal secretions. Vulva, clitoris urethra, vaginal mucosa congestion, edema. Increased secretions, and even purulent secretions, a large number of secretions stimulate the vulva itching, irritability, and even scratched by hand. The infection spreads further through the fingers and scratches. Some may be accompanied by urinary urgency, frequent urination and other symptoms of urinary tract infections. And systemic infections, lung infections, and more.
Symptom
Adolescents and children with vaginal clear cell cancer symptoms Common symptoms Vaginal bleeding Vaginal irregular bleeding abnormal Uterine bleeding Enuresis polyps Acute abdomen nodules Pus vaginal vaginal vaginal appearance...
More common in the upper part of the vagina, followed by the cervix, according to (International Obstetrics and Gynecology Alliance) FIGO classification, the ratio of vagina to cervix is 10:7, the tumor is usually limited to 1/3 of the vagina, the front wall is more common than the posterior wall, occasionally Also appears on the side wall or the lower third of the vagina.
Vaginal drainage, bloody vaginal discharge, irregular vaginal bleeding is the main symptom, some patients have no obvious symptoms, only found in gynecological examination, adolescent vaginal abnormal bleeding is easily misdiagnosed as menstrual disorders, therefore, if there is abnormality in the high-risk age of clear cell carcinoma Drainage or bleeding, should be vigilant, when the diameter of the lesion is as small as 3mm, it is not clinically detectable. Some lesions can be as large as 10cm in diameter, showing nodular or polypoid, touching the grainy, hard and protruding. Some tumors are flat, slightly protruding from the vaginal wall, and some penetrate deeper.
Examine
Examination of vaginal clear cell carcinoma in adolescents and children
Vaginal smear or cervical smear: Anderson et al believe that Papanicolaou vaginal smears have a 73% accuracy in the diagnosis of clear cell carcinoma. False negatives may be due to improper collection of specimens or smears, staining and other technical problems; tumors are located in the lower layers of the epithelium; Cell interference and polymorphic leukocyte coverage; infiltrating lesions are small, there are few exfoliated cells, cancer cells are usually clustered or piled up, and there are also single cells. Although tumor cells vary in size, they are larger than normal endocervical cells and have many cytoplasms. Occasionally Small cell nucleus, small cytoplasm, crowded or piles of cell clusters, rounded nucleus, oval or irregular, different in shape and size, sometimes thick at the edges, sometimes naked or multinucleated in the smear, rare in the nucleus Vaginal smear not only has certain value in screening diagnosis, but also contributes to monitoring treatment and follow-up review. If the smear continues to be positive after treatment, it means that the tumor has not subsided; if the cell has been degenerative, but multiple smears It was also found that typical tumor cells indicate tumor recurrence and require further treatment.
If necessary, perform a multi-point biopsy under the iodine test, or take a living tissue examination at the suspicious place under direct vision of the vaginal speculum.
Diagnosis
Diagnosis and differential diagnosis of vaginal clear cell carcinoma in adolescents and children
diagnosis
According to clinical manifestations, physical signs and gynecological examinations, laboratory tests, diagnosis can be made, and pathological examination can be used to determine the diagnosis. The genitals of adolescents and children are not yet mature. Especially the genitalia of children is located in the deep pelvic cavity. Gynecological examination is difficult. Abdominal and anal examination, when the child is anal examination, it is best to use the little finger to reach the rectum, if the condition requires, still should be vaginal examination.
1. Indications for vaginal examination
Genital bleeding, infection, suspected genital foreign body, tumor, trauma, etc. are the absolute indications for vaginal examination, and must be checked immediately to avoid delay in diagnosis, congenital malformation, developmental disorders, acute abdomen, anorectal disease, enuresis, etc. The certificate needs to be checked in conjunction with other specialists.
2. Vaginal examination equipment
Check the vaginal and cervix of children generally use vaginoscope (vaginoscope), you can also use otolaryngoscope, etc., according to the size of the hymen hole, choose the corresponding diameter of the vaginal speculum, the general baby with a small vaginal speculum, smaller For children, the medium size is larger for children. In addition, it is not advisable to use a cotton swab when taking the upper part of the vagina, so that the cotton may fall off and fall into the vagina when it is taken out. It is best to use a sterile glass pipette or a plastic tube instead.
3. Vaginal examination method
Before performing vaginal speculum examination, first of all, you need to get the consent of your family and get cooperation. Generally, you don't need anesthesia. However, if the sick child can't cooperate well and the hymen hole is too small, you can do it under general anesthesia, take the supine position, assistant. Fix the sick child's hip joint and knee joint, make the two legs flex, the abdominal wall is slack, slowly put into the vaginal speculum, the operation must be gentle, so as not to cause damage and bleeding, it must be noted that the child's vagina is immature, limited capacity, relative Short and narrow, the Qianlong has not yet formed. In the early childhood, the vaginal length is only 4.5-5.5cm on average. The vaginal wall is thin and easy to be damaged. In the late childhood, the vaginal length is 7.5cm on average. The cervix is flat and resembles a button-like protrusion. At the menarche, the shape of the cervix is like the shape of an adult.
4. When adolescents have abnormal vaginal bleeding, if they have not been diagnosed by gynecology, they cannot be easily diagnosed as functional diseases. The medical history and the history of medication in the embryonic period must be inquired. Be alert to the possibility of vaginal organic lesions. When vaginal examination, pay attention to the vagina. The upper part and the cervix have no nodularity, cystic or solid protrusion, and if necessary, a multi-point biopsy is performed in the suspicious eyes or under the colposcopy to increase the positive rate.
Differential diagnosis
Adolescents and children with vaginal clear cell carcinoma must be differentiated from vaginal adenosis, endometrioid adenocarcinoma and vaginal adenocarcinoma.
