vaginal intraepithelial neoplasia
Introduction
Introduction to vaginal intraepithelial neoplasia Vaginal intraepithelial neoplasia refers to different degrees of atypical hyperplasia lesions confined within the vaginal epithelial layer, which is a precancerous lesion of vaginal invasive carcinoma. Due to the low incidence of vaginal intraepithelial tumors, the understanding of the process of infiltration into invasive cancer is far worse than that of cervical cancer and vulvar cancer. Vaginal intraepithelial tumors can coexist with intraepithelial tumors of the cervix or vulva. basic knowledge Sickness ratio: 0.05% Susceptible people: women Mode of infection: non-infectious Complications: rectal injury
Cause
Vaginal intraepithelial neoplasia
(1) Causes of the disease
The etiology of vaginal intraepithelial neoplasia is still unclear. HPV infection is currently considered to be the most important factor in the development of VAIN. Other possible diseases have been treated with radiation therapy and immunosuppressive therapy for cervical cancer or vulvar cancer. The atrophic epithelium is more likely to develop into VAIN.
(two) pathogenesis
The mucosa of the vaginal lesion can be normal, erosive or slightly elevated and thickened leukoplakia. Under colposcopy, the lesion is flat or slightly elevated, which may be accompanied by a bit or mosaic change, and the iodine test is positive.
The cortical cells of the epidermis can be partially or completely stratified, and the arrangement loses the polar direction and the appearance of the nucleus of the abnormal shape. According to the extent of epidermal cytopathic lesions, the lesion is confined to the epithelium 1/3 for grade I (mild dysplasia). 2/3 of the lower middle is grade II (moderate dysplasia), more than 2/3 or full grade is grade III (severe dysplasia / carcinoma in situ).
Prevention
Prevention of vaginal intraepithelial neoplasia
All lesions must be removed from treatment, otherwise VAIN recurrence and further progression of the lesion may result, followed by regular follow-up after treatment.
Complication
Vaginal intraepithelial neoplasia Complications rectal injury
Concurrent vagina, vulvar infectious disease; complications of vaginal resection are bleeding, bladder and rectal injury.
Symptom
Vaginal intraepithelial neoplasia symptoms Common symptoms Increased vaginal discharge dysplasia vaginal bleeding
Vaginal intraepithelial neoplasia can be asymptomatic or only increased vaginal discharge and (or) contact vaginal bleeding, signs of vaginal mucosa can be no abnormal or only mild erosion, it should be noted that when gynecological examination, voyeurism The device needs to be rotated to see the entire vaginal mucosa, otherwise the tissue under the vaginal blade will be missed and missed.
Examine
Examination of vaginal intraepithelial neoplasia
Vaginal cytology, tumor marker examination.
Colposcopy, histopathological examination.
Diagnosis
Diagnosis and diagnosis of vaginal intraepithelial neoplasia
diagnosis
There are no special symptoms and signs in vaginal intraepithelial neoplasia. The diagnosis depends mainly on:
1. Vaginal exfoliated cell smear examination is an effective method for the initial screening of vaginal epithelial tumors. Any abnormal vaginal cytology smear should exclude whether the abnormal cells are from the cervix or vulva.
2. When vaginal cytology is abnormal, colposcopy is required. Colposcopy often reveals white mosaic, punctate and granular appearance of the vaginal epithelium.
3. Where there are obvious lesions on the vaginal mucosa, the biopsy can be directly sent for pathological examination. If there is no obvious abnormality in the vaginal mucosa, the biopsy can be sent to the pathological examination in the colposcopy or iodine solution. Vaginal intraepithelial neoplasia is diagnosed by pathology and is classified into 3 grades according to the degree.
VAINI: 1/3 layer of cell proliferation under squamous epithelium, mild atypia, polarity, mitotic figures are rare, middle and upper cells differentiate and mature.
VAINII: Cells within 2/3 of the squamous epithelium have moderate atypia, slightly symmetrical, mitotic figures are common, and cells in the upper 1/3 layer mature.
VAINIII: 2/3 layers of squamous epithelium with severe atypia, loss of polarity, more mitotic division, atypical mitosis, unclear cell boundaries, and carcinoma in situ when the entire epithelial layer is dysplasia.
Differential diagnosis
Vaginal intraepithelial neoplasia should be differentiated from the following diseases, but mild dysplasia can occur due to the following diseases, and they are difficult to distinguish between cytological and pathological changes with neoplastic atypical hyperplasia, so differential diagnosis The key is to conduct regular vaginal smear examination or pathological examination, and judge by its development trend.
1. The symptoms and signs of vaginitis or vaginal epithelial atrophy are often the same as those in vaginal epithelial tumors, mainly by pathological examination. The symptoms of the disease are: when the inflammation is seen, the cell proliferation is seen, and the proportion of nucleoplasm is increased due to the decrease of glycogen in the cytoplasm. However, the entire cell polarity is maintained, the nuclear division is less, and it is mostly in the deep layer.
2. The symptoms and signs of human papillomavirus infection are often indistinguishable from those of vaginal intraepithelial neoplasia. The pathological manifestations are that the cell dysplasia is located in the middle, shallow, and hollowed out cells.
