Leukoplakia
Introduction
Introduction to vulvar mucosa Vulvar leukoplakia refers to keratinized white patches or plates on the vulvar mucosa that are not easily rubbed off. At present, it tends to be considered as a benign keratotic lesion of the vulva, called leukokeratosis or simple leukoplakia, and the anaplastic lesion of the vulva is called vulvar leukoplakia or pre-cancerous leukoplakia. The cancer rate of this disease is not high, 4% to 6% may be cancerous, and most of them are benign non-cancerous lesions. basic knowledge Sickness ratio: 0.1% Susceptible people: women Mode of infection: non-infectious Complications: vulvar leukoplakia vulvar invasive squamous cell carcinoma
Cause
Vulvar leukoplakia
(1) Causes of the disease
The etiology of this disease is still unclear. It is related to certain systemic factors such as diabetes, endocrine disorders, malnutrition, vitamin deficiency, etc. Vorobe et al. found that patients with leukoplakia and sclerosing atrophic moss have obvious pituitary-ovarian system function. Disorders, mucosal leukoplakia may also be associated with Epstein-Barr virus infection, Candida albicans infection, etc. It has been reported in the literature that 22.2% of patients with oral leukoplakia can detect human papillomavirus, and p53 gene mutation is one of the causes of abnormal cell proliferation. Local factors play an important role in the occurrence of female leukoplakia. The local vulva, heat stimulation, friction, senile atrophy can lead to vulvar leukoplakia. Some people will remove the leukoplakia and transplant other parts of the skin after the vulva. The transplanted skin can develop similar lesions. If the skin of the thigh skin and the genital lesions are simultaneously removed and the skin graft is exchanged, the skin lesions of the normal thigh skin transplanted to the vulva are confirmed, thereby confirming the local environment. Disease effect.
(two) pathogenesis
The vulvar leukoplakia is mainly a proliferative lesion of the mucosal epithelium or epidermis. The normal mucosal epithelium has no stratum corneum and granular layer. In the mucosal leukoplakia, the mucosal epithelium is obviously keratinized, and there are granule layers of varying thickness, which occur in large The labial mucosa of the labia has obvious hyperkeratosis, thickened granular layer, obvious hyperplasia of mucosa or skin epithelium, thickened acanthosis, and downward extension of epithelial ridge. There are different degrees of lymphocytes and a small amount of plasma cell infiltration in the superficial dermis. The spine cell layer of the female leukoplakia has early metamorphosis: that is, some of the spine cells are heteromorphic, the nuclear size is inconsistent, the nucleus is large, the stain is deep, the cells are arranged disorderly, and the shape is irregular, and the mitotic image is visible.
Prevention
Vulvar leukoplakia prevention
Actively prevent and treat diabetes, endocrine disorders and other diseases; improve malnutrition, vitamin deficiency and other conditions, prevention and treatment of EB virus, Candida albicans infection and other related diseases; pay attention to local hygiene of the vulva, reduce moisture, friction, heat stimulation and so on.
Complication
Vulvar leukoplakia complications Complications vulvar leukoplakia vulvar invasive squamous cell carcinoma
About 20% of the long-term unhealed vulvar leukoplakia develops into invasive phosphorus cancer.
Symptom
Vulvar leukoplakia symptoms Common symptoms Mucosa slightly pale itching vulvar leukoplakia edema
The female leukoplakia appears as a white thickened infiltrating plaque with clear borders, some may have cleft palate, small pieces of erosion, ulcers, skin lesions occur in the vaginal mucosa, urethral mucosa, clitoris, the inner and outer sides of the labia minora and the inside of the labia majora. It is a single piece or a few pieces of irregular white and milky white patches or plaques, slightly bulging the mucosal surface, the boundary is clear, a few can not rise, the boundary is unclear, the surface is keratinized, rough, and the touch is hard and tough. Such as scraping off the surface white keratinized mucosa, the base is easy to bleed, usually itching, sometimes itching is severe, because rubbing rubbing can be flushed, edematous, erosive or mossy.
Examine
Examination of vulvar leukoplakia
Vaginal secretion examinations and microbiological examinations exclude infectious diseases.
Do histopathological examination to facilitate diagnosis and differential diagnosis.
Diagnosis
Diagnosis and diagnosis of leukoplakia leukoplakia
diagnosis
The diagnosis is mainly based on histopathological examination and clinical manifestations, mainly proliferative changes of mucosal epithelium or epidermis, which are easier to diagnose, but mucosal leukoplakia often has a tendency to diagnose and expand, and attention should be paid to disease identification.
Differential diagnosis
White keratosis
Histopathological examination showed that the epidermal cells had no abnormality. White keratosis often showed hypopigmentation, no infiltration or mild infiltration, unclear borders, and itching, and long-term unhealed white keratosis could further develop into vulvar leukoplakia.
2. Lichen planus
Polygonal flat purple or dark red papules appear at the junction of vulvar skin and mucosal skin, surface gloss, histopathologically prolonged epidermal process is chicken claw-like, gelatinous body, basal layer liquefaction degeneration, dermal superficial lymphoid Cell infiltration can be identified.
3. Hardening atrophic moss
Often occurs in the labia, locally visible papules consistent with the hair follicles, mucosal leukoplakia is hypertrophic vulvar dystrophy, generally without atrophy of the vulva, histopathologically thickened layers of the epidermis, axonal heteromorphism, and hardening atrophy Moss is atrophic vulvar dystrophy, skin lesions are atrophic blue-white flat papules to fuse into pale-white pigmentation, often form a "dumbbell" in the vaginal opening and perianal, itching is light, most accompanied by labia minora adhesion, atrophy Until it disappears, the clitoris shrinks, itching is light, histopathologically atrophy of the epidermis, the dermal superficial collagen fibers are purely denatured, and there is inflammatory cell infiltration underneath, which can be identified.
4. Vulvar vitiligo
Depigmentation of pigment, clear boundaries, no keratosis and infiltration, no itching, the same skin lesions often in other parts of the body, histopathology showed that the basal layer of the epidermis completely lacked melanocytes positive for dopa staining, easy to identify with leukoplakia.
5. Vulvar neurodermatitis
Distributed on the outside of the labia majora on both sides, consciously itching, white spots are not obvious, often accompanied by other parts of the skin lesions, skin pigmentation, mossy skin lesions, histopathology showed chronic dermatitis changes, thickening of the epidermis, but no spines Cells are heteromorphic and can be identified.
