Metastatic carcinoma of the vulva
Introduction
Introduction to vulvar metastatic cancer Vulvar metastatic carcinoma is rare, and it has been reported in recent years. Most of the vulvar metastatic cancers come from cervical cancer, endometrial cancer, vaginal cancer and choriocarcinoma, which are caused by vagina involving the vulva, or lymphatic and blood. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: women Mode of infection: non-infectious Complications: Cervical cancer Ovarian cancer Reproductive tract infection
Cause
Causes of vulvar metastatic cancer
(1) Causes of the disease
The metastatic carcinoma of the vulva is the same as the source and cause of the primary cancer. The spread of the primary tumor is mainly retrogradely transferred to the vulva through the venous tumor thrombus, and can also be transmitted by lymphatic metastasis or direct spread.
Cervical cancer can be transferred from the blood circulation and lymph to the vulva, or directly through the vagina involving the vulva, endometrial cancer, ovarian cancer, choriocarcinoma can be retrogradely transferred to the vulva through the bloodstream, and often transferred to the inguinal lymph nodes through the lymphatic approach of the round ligament, rectum The cancer can be directly infiltrated into the surrounding tissue or transferred to the vagina and perineum via the lymph nodes. The left ovarian vein is directly drained to the left renal vein. Therefore, the metastasis of the primary renal cancer is mostly from the left side.
(two) pathogenesis
Most of the tumors are located in the dermis or subcutaneous tissue. The images are expansively grown under light microscope, multiple lesions, no intraepithelial neoplasia, and extensive vascular invasion. The pathological morphology and differentiation of metastatic tumors and primary tumors are basically Consistently, metastatic squamous cell carcinoma is a clear epithelial cell nest in the dermis, which does not invade the epidermis, while metastatic adenocarcinoma has a tendency to invade the squamous epithelium of the vulva. The metastatic lymphoma metastasis is located in the dermis, generally not infringing. Epithelium.
Prevention
Vulvar metastatic cancer prevention
Active treatment of primary lesions has a certain effect on the prevention of vulvar cancer.
Complication
Vulvar metastatic cancer complications Complications Cervical cancer ovarian cancer reproductive tract infection
It is often accompanied by infections and other symptoms of the primary site.
Symptom
Vulvar metastatic cancer symptoms Common symptoms Urinary pain, urination, poor nodules, vulva pain, frequent urination
The first symptom of vulvar metastatic cancer is that the patient or the physical examination has accidentally found vulvar nodules, which are single or multiple, the tumor grows fast, followed by vulvar pain, and a few can manifest as urinary frequency, dysuria, poor urination and other urinary symptoms. Most of the vulvar lesions are located under the skin. As the disease progresses, the epidermis is broken and it is easy to form ulcers. A small number of patients begin to show erosion and cauliflower-like changes.
Examine
Examination of vulvar metastatic cancer
1. Blood tumor marker detection
Tumor markers refer to chemical substances produced by tumor tissues that can reflect the existence of tumors. Generally, tumor tissues are particularly obvious and significant chemical components compared with corresponding normal tissues. Tumor markers include enzymes, hormones and non- Enzyme non-hormone proteins, tumor-associated antigens, cytokines, gene markers, etc., can be used to determine the source of tumors based on markers secreted by the tumor. More literature reports suggest that combined detection of tumor markers can detect tumors early and can be used as The means of monitoring tumor therapy, but the specificity of the tissue source for determining tumors is poor.
2. Pathology
The histological examination is first to determine the benign and malignant nature of the tumor, and secondly to determine the primary or secondary tumor. According to the pathological features of the metastatic tumor, in the presence of the existing primary tumor, it is generally easy to obtain a diagnosis. Clinical diagnosis can also be obtained in the clinical features, course of disease and treatment response, and lack of pathological diagnosis.
3. Immunohistochemical examination
Immunohistochemistry is to identify the specific components contained in cells by the specific binding principle of antigen-antibodies, to identify the tissue source and type of tumors. With the promotion and application of immunohistochemistry in clinical practice, the histological method is used to judge the transfer. The role of sex cancer tissue plays a decisive role. Cupta et al applied fine needle aspiration cytology (FNAC) to skin and subcutaneous metastasis from malignant epithelial tumors including 146 cases of vulvar metastasis. The nodules were studied and found to be free of false negatives and false positives without secondary tumors. The authors believe that FNAC can rapidly, safely and accurately diagnose metastatic nodules from known tumors, and FNAC combined with immunostaining. Can effectively determine the location of unknown primary tumors.
4. Electron microscopy
In the case of inconsistencies in the usual light microscopy of tumor sources, electron microscopy can help determine the tissue source of the tumor.
The purpose of imaging and audio-visual examination is to first understand the size of the lesion in the vulva, the depth of the tumor invading the pelvis and periosteum, whether the inguinal lymph nodes and pelvic lymph nodes are involved, and then according to the characteristics of the common common site of the vulvar metastatic cancer, according to the patient's condition. And the economic situation, using imaging and audio-visual examination methods to find the primary site of the tumor.
Diagnosis
Diagnosis and differentiation of vulvar metastatic carcinoma
diagnosis
1. Diagnostic criteria for vulvar metastatic cancer
There is a primary tumor originating from the vulva; the pathological morphology or cell morphology of the vulvar tumor conforms to the morphology of the source tissue tumor; there is no basis for suspecting the tumor originating in the vulva.
2. Medical history inquiry
In the diagnosis of vulvar metastatic tumors, the medical history should be carefully asked, especially the history of diagnosis and treatment of gynecological benign or malignant tumors or organs in other parts of the body.
3. Clinical manifestations
Patients with previous or positive malignant tumors, in addition to the symptoms of the primary tumor, the vulva appears painful or asymptomatic swelling, the diagnosis of metastatic cancer is easy to consider, if the metastatic metastatic cancer site precedes the primary tumor However, it is easy to mix vulvar metastatic cancer into primary cancer. Therefore, it is necessary to distinguish from various primary vulvar cancers, and also to find the site of primary cancer.
Differential diagnosis
In addition to differentiation from various primary vulvar cancers, metastatic vulvar cancer should be differentiated from vulvar inflammatory mass, primary benign and malignant tumors, non-neoplastic cysts, hernias, etc., and confirmed by pathological examination.
Metastatic Crohn's disease
The cause of Crohn's disease is unknown, and there is often an abnormal systemic immune response. The incidence of Crohn's disease is gradually increasing in China. Metastatic Crohn's disease is a rare complication of Crohn's disease. The symptoms are complex and variable, often accompanied by active Gastrointestinal manifestations, but there are no other systemic symptoms only skin lesions, Crohn's disease skin lesions have very different macroscopic view, skin lesions are nodular erythema and ulcerative changes, skin lesions pathology Proliferative and polypoid changes, the perineal skin is also the site of the lesions often involved in Crohn's disease, should be paid attention to.
2. Identification of primary ectopic breast tumors and metastatic tumors of the vulva
Metastasis of the genital tract of the breast in the late normal position is rare. The ovary and uterus are the most common metastatic sites, and there are reports of metastasis to the vulva. The primary site of the breast cancer and the vulvar lesions have consistent histological types and certain immunity. The characteristics of histochemical staining will contribute to the diagnosis of metastatic carcinoma of the vulva. There are more than 40 cases of ectopic ectopic breast tissue in the international context. There are ten reports of breast cancer in ectopic breast tissue. In several cases, primary vulvar ectopic breast cancer differs from metastatic cancer in that it has some in situ factors in the absence of cancer in metastatic cancer.
3. Identification of primary tumors of Barthrin's gland and Papillary gland
Breast cancer has metastasis invading the Pap smear. The choriocarcinoma metastasis to the Pap smear can be seen as the first symptom, misdiagnosed as a Pap sac cyst and surgically treated. By careful inquiry of the history and local biopsy, patients with choriocarcinoma It can also be differentiated from Papillary gland cysts and primary Pap smear tumors by examination of blood hCG.
