Vaginal endodermal sinus tumor
Introduction
Introduction to vaginal endogenous sinus tumor Vaginal endodermal sinus tumors occur mainly in the vagina of infants and young children. Endodermal sinus tumors can occur in the ovaries, vulva, vagina and cervix. Vaginal endodermal sinus tumors may originate from embryonic cells. The tumors are polypoid or fragile. Grape-like mass. Early cases can be asymptomatic. With the development of tumors, painless abnormal vaginal bleeding, diaper blood staining or vaginal discharge may occur. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: lung metastases
Cause
Cause of vaginal endogenous sinus tumor
Causes:
Vaginal endodermal sinusoma may originate from embryonic cells, which Norris calls a kidney cancer. It is speculated that this tumor may be a tissue conductor lacking embryos during the determined phase of germ cell migration, resulting in a misplacement of germ cells into the upper vaginal segment.
Pathogenesis:
The tumor is a polypoid or fragile brain-like or grape-like mass. The microscopic histological structure of the vaginal endodermal sinus tumor is the same as that of the endodermal sinus of the ovary. The morphology is diverse. The cells are oval or polyhedral with large nuclei, protrusions, and mitotic figures are cuboidal or flat. The basic features are:
(1) Typical Schiler Dusal (SD) bodies: structures similar to "glomerular vasospasm" or endodermal structures of rodents.
(2) Mesh structure.
(3) Transparent ball.
(4) Anti-amylase PAS-positive and eosinophilic basement membrane-like structure.
Immunohistochemistry can measure AFP, which means that the tumor can secrete alpha-fetoprotein (AFP).
Prevention
Vaginal endodermal sinus tumor prevention
Early detection, early diagnosis, early treatment, and good follow-up work.
Complication
Vaginal endodermal sinus tumor complications Complications
Prone to lymphatic metastasis and lung metastasis.
Symptom
Vaginal endodermal sinus tumor symptoms common symptoms vaginal bleeding polyps vaginal bleeding
Early cases can be asymptomatic. With the development of the tumor, there can be painless abnormal vaginal bleeding, diapers with blood stains or vaginal discharge. Under the anesthesia, vaginal examination can find new organisms in the vagina that are fragile and fragile. The diameter is at least 2cm and the maximum is 10cm. The base is mostly located in the posterior wall of the upper vagina, and 10% to 15% is from the cervix, and the malignancy is high.
Clinical stage:
Due to the different origins, it is difficult to establish a staging system suitable for all germ cell tumors. Although there is no staging system for vaginal endodermal sinus tumors, the germ cell staging system established by Brodeur is often used clinically. Staging is based on the resectability of the primary tumor, the extent of regional lymph node metastasis, and whether there is distant spread. At the time the system was established, the tumor markers have not been routinely detected, so the system does not include tumor markers, however, the facts Upper AFP is helpful for the staging of vaginal endodermal sinus tumors. Because of the current emphasis on organ protection, chemotherapy is used, and the staging system based on tumor resectability is somewhat outdated.
Examine
Examination of vaginal endodermal sinus tumor
Determination of serum AFP
Serum AFP containing asparagine linked to a sugar chain is the most reliable tumor marker for malignant tumors, especially hepatocellular carcinoma and endodermal sinus tumors. It has been found that AFP produced by different tumors can be used due to their different sugar chain structures. Lectin affinity electrophoresis is divided into different isomers. The reagents include conA, LCA, E-PHA and alloA. The serum AFP is divided into two parts by ConA, namely conA unreacted (C1) and conA reactive (C2). C1 and C2 can be detected in uterine hepatic adenocarcinoma, vaginal endodermal sinus tumor and ovarian endodermal sinus tumor, while only a small amount of C1 is detected in cord blood, which is divided into 3 parts by LCA, namely L1, L2 and L3. Vaginal endodermal sinus tumors contain L2 and L3. The isomers of the four tissue-derived AFPs are different. E-PHA can detect P2, P3, P4, P5 and a subtype P3f, while vaginal endodermal sinus tumors The performances of P2, P3f, P4 and P5 are similar to those of ovarian endodermal sinus tumors. Two main parts can be detected by alloA, namely A1 and A3 and one subtype A1s, vaginal endogenous sinus tumors. For A3, A1 and A1s, the performance is significantly different from that of other sources, so it can be detected by Lectin affinity electrophoresis. AFP clear isomers spectrum to determine the source site of AFP, AFP serum can be assessed in relapse after treatment and monitoring treatment.
1. B-ultrasound: can show the size and shape of the vaginal mass, but the positive rate is not high, 2 of the 3 cases reported by Handel are negative.
2. CT examination: It can show whether there is a lesion in the vagina and whether there is metastasis in the bladder, rectum, lymph nodes or distant organs.
3. MRI examination: MRI provides more accurate and comprehensive images than CT and B-ultrasound. It can better display the location, size and extent of the tumor, and can accurately display the edge of the tumor. It has no damage and no ionizing radioactivity. Especially suitable for pelvic examination of infants and young children, the contrast of soft tissue is better than CT examination.
4. Cystoscopy: It can show whether the bladder and urethra are invaded by tumors.
5. Colposcopy: Regardless of whether the imaging test results are positive or not, vaginal bleeding should be performed for infants with unexplained vaginal bleeding. Exogenous, sclerosing masses originating from the vaginal wall, vaginal examination and colposcopy During the examination, the tumor should be examined by tissue biopsy.
Diagnosis
Diagnosis and diagnosis of vaginal endodermal sinus tumor
This disease occurs mostly in young girls under 3 years of age. When the lesions are extensively involved in the vagina, the originating site cannot be determined. For new tissues in the vagina, especially in infants and young children, biopsy should be performed to confirm the diagnosis.
Pathologically, endodermal sinusoma is easily confused with clear cell carcinoma, reticular Sertoli-Leydig tumor and vaginal squamous sarcoma, which can pass anti-amylase PAS positive body, Schiller-Duval body and immunohistochemical AFP positive. Characterization, of the 3 patients reported by Handel, two biopsy rapid frozen pathological sections were diagnosed as vaginal grape sarcoma, which was diagnosed as vaginal endodermal sinus tumor by conventional pathological section.
