Paraurethral adenocarcinoma
Introduction
Introduction to paraurethral adenocarcinoma Paraurethral adenocarcinoma occurs around the urethral opening of the vulvar vestibule, which is a rare malignant tumor. Paraurethral adenocarcinoma is very rare. The proportion of adenocarcinoma in domestic female urethral cancer is significantly higher than in other countries. Tumors can occur in any age group, minimum 4 years old, maximum 80 years old, but more common in postmenopausal and older women more common in 50 to 70 years old 75% of patients older than 50 years, mean 60 years old. Whites are more susceptible to this disease than blacks. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Etiology of paraurethral adenocarcinoma
(1) Causes of the disease
The etiology of paraurethral adenocarcinoma is not very clear. Some scholars believe that urination, sexual intercourse, pregnancy or repeated urinary tract infection may be the cause of some urinary tract cancer. Proliferative diseases such as meat mites, papilloma, adenoma, Polyps will be followed by malignant transformation, and urethral mucosal leukoplakia is considered a precancerous lesion.
(two) pathogenesis
Paraurethral adenocarcinoma is mainly adenocarcinoma structure, with translucent cell type and papillary type, urethral opening may have squamous cell carcinoma, urethra may have transitional cell carcinoma, female urethra is 3 ~ 4cm long, diameter 8 ~ 10mm, from bladder neck To the external urethra, the urethra can be divided into 3 segments, namely nearly 1/3, middle 1/3 and far 1/3 segment. The proximal 1/3 urethra is covered with the transitional epithelium, and the distal segment is 2/3 urethral stratified. Squamous epithelium, the distal 1/3 lymph fluid drained to the superficial and deep inguinal lymph nodes, and the proximal 2/3 lymph fluid drained to the pelvic lymph nodes. About 52% of the primary lesions occurred in the distal urethra, and 39% occurred in the distal urethra. Middle urethra, 9% starting in the proximal urethra.
Female urethral malignancies are the most common epidermoid carcinomas originating from squamous epithelial cells and transitional epithelial cells. Adenocarcinomas originating from glands surrounding the urethra are rare, and other types of urinary tract cancer are rare. It is reported that squamous cell carcinoma accounts for 41% to 70%. Transitional epithelial cancer accounts for 8% to 30%, malignant melanoma accounts for 2% to 4%, and other types account for 2% to 4%. Urinary tract cancer is divided into a scorpion-shaped, ring-shaped, constricted and ulcerated type.
Urinary tract cancer is mostly localized. Delcos reports that about 50% of women with urinary tract cancer are localized lesions. When the disease progresses, the lesion may affect the whole urethra and invade the bladder upwards, involving the vulva downwards, and invading the vagina backwards. The main metastatic route of female urethral cancer is lymphatic metastasis. The lymphatic drainage pathway has proximal urethral drainage to closed-cell lymph nodes, extra-orbital lymph nodes, and intra-orbital lymph nodes. The distal urethra is drained to the inguinal superficial lymph nodes and deep inguinal lymph nodes. It is difficult to confirm the clinical routine examination. There is no metastasis of regional lymph nodes. Grabstald reported that 22.8% of patients had lymph node metastasis during the course of the disease. Delclos reported that the clinical diagnosis of inguinal lymph node metastasis in female urethral cancer is generally less than 15%. The pelvic lymph node metastasis is difficult to diagnose because of its difficult diagnosis. Ray and Guinan suggested that the size of the primary tumor is not closely related to lymph node metastasis. The distant metastasis of female urethral cancer is rare. The patient died of distant metastasis accounting for 14%. The main sites of distant metastasis are lung, liver and bone. And the brain.
Currently commonly used is the Grabstald staging:
Stage 1.0 carcinoma in situ (cancer is confined to the mucosa).
2. Stage A cancer infiltration is limited to the submucosa.
3. Stage B cancer infiltrates the urethral muscle layer.
4. Stage C cancer invades the surrounding organs of the urethra.
C1: Invade the muscular layer of the vaginal wall.
C2: Invade the muscular layer of the vaginal wall and its mucosa.
C3: Invade adjacent organs (such as the labia, clitoris, bladder).
5.D distant transfer.
D1: Inguinal lymph node metastasis.
D2: pelvic lymph node metastasis.
D3: Abdominal aortic lymph node metastasis.
D4: Transfer of organs such as lung, liver and kidney.
Prevention
Paraurethral adenocarcinoma prevention
Active prevention and treatment of urinary tract infections, regular physical examination, early detection, early treatment.
Complication
Paraurethral adenocarcinoma complications Complication
Late lesions can spread to the perineal skin or vulva.
Symptom
Paraurethral gland cancer symptoms Common symptoms The urethra diffuse infiltration of the urethra of the cord-like masses Nodules urethra local swelling red papillary sputum... Bladder vaginal fistula urinary frequency urethra bleeding urethra thickening hard dysuria
Early symptoms of paraurethral adenocarcinoma are dysuria, urethral hemorrhage, frequent urination, dysuria, nodular or red hemorrhagic mass in the distal urethra or urethra, local swelling of the urethra can touch the mass, when the tumor is enlarged Can block the urethra or the external vestibule, the vaginal opening expands, there are obvious ulcers, hemorrhagic mass, accompanied by pain and possible groin, pelvic lymph node metastasis, early urethral cancer lymph node metastasis is rare, 20% to 50% at diagnosis Lymph node metastasis, about half of the late or proximal urethral cancer lymph node metastasis, it is generally believed that the lymph nodes that are swollen are mostly metastasis, not infection, adenocarcinoma often has distant metastasis, distant metastasis is the most common lung, liver, Bone and brain, proximal urethral cancer infiltrates the bladder, and the vagina is involved later. Clinically, urethral fistula or vaginal fistula may occur. Lymph node metastasis is not associated with hematogenous metastasis.
Examine
Examination of paraurethral adenocarcinoma
Urine routine examination, secretion examination, tumor marker examination, polymerase chain reaction detection.
Histopathological examination.
Diagnosis
Diagnosis and differentiation of paraurethral adenocarcinoma
diagnosis
Paraurethral adenocarcinoma can be diagnosed according to the symptoms and signs of clinical manifestations; it can be diagnosed when the urethral mass biopsy is adenocarcinoma. The time from symptom onset to diagnosis may be several days, or may be several years. Usually 3 to 12 months, in a few cases, patients can have no symptoms, they often find urinary tract cancer by accident to check other diseases.
Middle and lower urethral cancer may be discovered by visual inspection or palpation examination. The lesion may be bright red papillary sputum biosynaptic to the urethral cavity and urethral orifice. At this time, it is easy to be misdiagnosed as urethral meat emulsion, and the misdiagnosis rate is about 8%. New organisms should also be differentiated from urethral mucosal prolapse caused by acute and chronic inflammation, diverticulum and other diseases. Urethral cancer can be found through vaginal palpation. Vaginal examination can touch the urethra thickening, hardening and cord-like mass, vaginal examination Can understand the size of the lesion, texture, activity, etc., vaginal double examination can understand whether there is bladder and pelvic metastasis, when the lesion invades the vaginal wall, it is difficult to determine whether the primary lesion comes from the urethra, or from the vagina itself.
Bladder urethroscopic examination and biopsy are the main methods for diagnosing urethral cancer. Some lesions rarely grow into the urethra. Bladder urethroscopic examination may miss the diagnosis. At this time, it is better to use the fingers of the vagina to move the lesion toward the urethra. Local exposure and observation of lesions, diagnosis of urethral cancer requires biopsy pathological diagnosis, biopsy is best taken through the urethra, in a few cases can be taken through the vaginal needle, can take morning urine or use a urethral swab or curette into the urethra to take off The cells were subjected to cytological examination.
After the diagnosis, further comprehensive examination is needed to understand the extent of the lesion, to exclude cancer metastasis, and to define the clinical stage.
Differential diagnosis
1. Early paraurethral adenocarcinoma should be distinguished from urethral meat emulsion. For urethral meat fistula with suspected malignant transformation, biopsy should be performed to confirm the diagnosis.
2. Middle and advanced paraurethral adenocarcinoma should exclude whether the primary lesion is from the vestibule, but the former is adenocarcinoma and the latter is squamous cell carcinoma.
