Vulvar tumor
Introduction
Introduction to vulvar tumors Vulvar tumors refer to various tumors that grow in the genital area. According to the nature of the tumor can be divided into two categories of benign and malignant. Benign vulvar tumors mainly include leiomyomas, fibroids, lipomas, papilloma, sweat adenomas, neurofibromas, lymphangiomas and hemangioma; malignant tumors are the most common squamous cell carcinoma, accounting for 90% of vulvar cancer. %, the rest are vulvar melanoma, vulvar basal cell carcinoma, vestibular large adenocarcinoma. Treatments generally include drugs, lasers, radiation, and surgical procedures. The drug treatment was applied to the lesion with 5% 5-fluorouracil ointment, but the failure rate was 50%. Laser treatment mainly uses carbon dioxide, which can maintain the appearance of the vulva, and the curative effect is good, but there is also a recurrence rate of 1/3. For patients with surgical contraindications or advanced surgery, radiotherapy may have a certain effect. basic knowledge The proportion of illness: 0.08% Susceptible people: no special people Mode of infection: non-infectious Complications: edema, varicose veins, vulvar elephantiasis
Cause
Vulvar tumor cause
Tumor is one of the common symptoms of vulvar disease, which can be caused by local or systemic factors. The top ten common causes are:
(1) vulvar infections such as sexually transmitted diseases, vulvar inflammation caused by menstruation such as viruses, bacteria, trichomoniasis, and fungi. The vulva is the initial site and the predilection site.
(2) Mechanical stimulation such as poor hygiene, vulva dirt, tight underwear, sweat stimulation.
(3) Allergic vulvitis is caused by detergents, cosmetics, condoms and medicines.
(4) Foreign body in the vagina for a long time to place the pessary, foreign body residual vagina and infection stimulate the vulva, swelling and pain.
(5) Urine and feces stimulate urinary tract, feces, diabetes, diabetes, diabetes.
(6) Systemic diseases such as diabetes, systemic lupus erythematosus, papular psoriasis, etc.
(7) vulvar cancer, vulvar cancer, vulvar Paget's disease, vaginal cancer, etc.
(8) Vulvais abscess.
(9) Unexplained vulvar pain vulvar vestibular swelling accompanied by frequent urination, urgency, urinary syndrome, the pathogenesis is unclear.
(10) Hematoma after trauma can also cause more serious swelling and pain.
Prevention
Vulvar tumor prevention
Surgical treatment is the main treatment for vulvar tumors. The scope of surgery depends on the clinical stage, the location of the lesion, the degree of differentiation of the tumor cells and the depth of the infiltration, the physical condition of the patient, and due consideration of the age of the patient. It is currently accepted that vulvar orthotopic tumors can only be used for simple vulvectomy. Invasive cancer should be considered in consideration of the patient's physical condition and the stage of the disease. Radical vulvar resection and regional lymphadenectomy are generally required. Because even if the lesion only invades 3 to 5 mm, the cells are immature or the blood vessels are found to be invaded, and there is already a metastasis. Local simple resection is limited to those who cannot undergo major surgery in individual physical conditions.
Vulvar in situ tumors have multi-center (Wilkinson EJ et al., 1981) or multifocal (diSaiaPJ et al., 1981), and the lesions are often wide. Most patients have lesions accounting for 3/4 of the vulva area and 20 lesions. Above, and in a large fusion. Therefore, the scope of vulva resection is wider. However, because the lesion is carcinoma in situ, the lesion is confined to the epidermis, so the depth of resection can be limited to the epidermis and dermis, while retaining most of the subcutaneous fat (the margin of invasive cancer may have carcinoma in situ). It is worth noting that the atypical lesion of the epithelium often exceeds the scope of the general lesion, so it is necessary to make a frozen section at the edge of the excised specimen. If there is an atypical lesion on the edge, the margin tissue should be enlarged, or there will be a recurrence in the future.
Because the clitoris skin is a good site for vulvar tumors, young people do not remove the clitoris and foreskin in order to preserve sexual function. This should be carefully considered. The surgical needs should be taken, and frozen tissue sections should be made. As mentioned before.
Surgical treatment of vulvar invasive tumor cancer should be extensively vulvar resection, the depth of the fascia should be reached, and the deep inguinal lymph nodes should be cleaned. The pelvic lymphadenectomy is not included in the routine because it is usually transferred to the pelvic cavity through the inguinal lymph nodes. Second, the condition of the inguinal lymph nodes can predict the possibility of pelvic metastasis. Of the 85 patients, 11 were pelvic lymph node-positive, 10 were in the inguinal group with clinical suspicion (N2) or palpation (N3) for metastases, and 1 patient with deep-seated (Cloquet) lymph nodes were positive; in this group of patients Of the 55 deep lymph node tissues, 5 were positive, 2 had pelvic lymph node metastasis; 50 were negative, and none had pelvic lymph node metastasis.
Vulvar tumors with low malignancy can grow very large, but without metastasis, can be cured after thorough treatment. In the operation of the vulvar invasive cancer, first bilateral or / and pelvic lymphadenectomy, followed by extensive vulvectomy. The operation strives to complete the first phase. If you are unable to win any period due to frail age, you should do extensive vulvectomy, and then perform inguinal lymph node dissection after healing of the vulva incision; or in patients without clinical metastasis, only vulvar radical surgery.
Complication
Vulvar tumor complications Complications edema varicose vulvar elephantiasis
1. Vulvar edema : vulvar edema can be divided into two types: primary and secondary edema, the former caused by congenital lymphatic dysplasia, the latter due to systemic diseases such as malignant tumor metastasis to lymph nodes or filariasis block lymphatics cause. Vulvar edema can be caused by groin or pelvic lymphadenectomy, lymphatic reflux obstruction, and bronchitis caused by inflammation.
2. Vulvar varicose veins: It is the most common disease of the venous system. The venous varicose veins can be seen in the subcutaneous veins. If they are standing for a long time or in the late pregnancy, the veins are raised, such as a scorpion. Causes of the disease: mainly due to circulatory disorders, long-term expansion of blood vessels. Generally no special treatment is needed. If necessary, rest properly, raise the lower limbs, and bandage with elastic bandage to prevent rupture, bleeding and infection.
3. Vulvar elephantiasis: After the vulva is infected with the filaria, the female continuously produces microfilariae in the lymphatic vessels of the human body. The parasitic lymphatic system causes lymphangitis, lymphatic obstruction, and finally the obstructed lymphatic vessels are varicose. The skin is malnourished, the skin is chronically thickened, and the vulva is formed into a skin. In addition, repeated episodes of vulvar cellulitis, chronic inflammation of the vulva, such as tuberculosis, syphilis, can cause connective tissue fibrosis, venous and lymphatic drainage blocked, and finally lead to vulvar elephantiasis.
Clinical manifestations: The genital skin (the clitoris, the size of the labia majora) is limited or diffusely thickened. The clitoris is hypertrophy and has a rough surface and can be in the shape of a sausage, a barrel or a breast. Can be uneven, nodular, braided or papillary. Skin color can be changed to light brown, purple, sometimes with white lesions. With desquamation, it is easy to secondary infection. Severe rubber disease on one side or the entire vulva is swollen, sometimes shaped like a tumor, hanging between the two strands.
Symptom
Vulvar tumor symptoms Common symptoms Vulvar ulcers urinating vulva burning... Vulvar leukoplakia nodules appear in the urethra...
There are four early signs of female vulvar cancer:
White spot: The genitals have tiny, smooth white spots or streaks, which then fuse into a thick, lustrous milky white spot with a hard, rough feel when touched.
Nodules: There are soy-like nodules or papillary masses in the vulva, accompanied by itching around them.
Ulcer: If the female genital area has a long-lasting depression, it is accompanied by pain and bleeding, and it is mostly a female vulvar cancer signal.
Itching: After excluding Candida infection, pubic lice, acne, vaginal trichomoniasis and other female genital pruritus, if the genital itching is not cured for a long time and can not find the cause, it is intractable and itchy, should consider female vulvar cancer .
Benign tumor
Vulvar benign tumors are rare, mainly including papilloma, fibroids, lipoma, and sweat adenoma.
Papilloma---a single mass that occurs mostly in the labia majora or haze. The surface has fine, dense nipples and the texture is slightly hard. The rate of malignant changes is high.
Fibroids --- multiple hard nodules in the labia majora, and gradually grow into a substantial tumor with pedicle.
Lipoma - a layer of fat from the pubic and labia, varying in size, slow in growth and softer. Generally asymptomatic, the possibility of malignant transformation is small. However, due to its large size, it may be inconvenient for movement or difficulty in sexual intercourse.
Sweat adenoma - a large sweat gland from the labia majora and perineum, usually 1-2cm in size. The tumor grows slowly and is asymptomatic. A few may have cancer.
Malignant tumor
About 4% of female genital tumors. The overall 5-year survival rate was 68.9%. Vulvar squamous cell carcinoma is the most common malignant tumor of the vulva, with an average age of onset of 60 years. More often in the labia, clitoris and perineum. The etiology is still unclear, but it has a high coexistence rate with sexually transmitted diseases (such as condyloma acuminata, gonorrhea, syphilis and vaginal trichomoniasis); it develops into a invasive cancer by viral infection (human papilloma virus); it has low immunity or damage to the body. Related, such as kidney transplantation, lupus erythematosus, etc.; vulvar malnutrition and vulvar genital warts can develop into vulvar squamous cell carcinoma.
Small and hard nodules, lumps or ulcers in the early stage, often accompanied by pain or itching; late stage is a typical erosion, mass or irregular papilloma, the color can be white, gray, pink or melanin, one The lateral or bilateral inguinal lymph nodes are enlarged and hard and fixed. When the tumor is broken or secondary infection, frequent urination, dysuria, difficulty in urinating, and difficulty in defecation may occur. However, most patients have had a history of genital itching for many years before the lesion, and it is heavy at night; white lesions of the vulva.
Examine
Examination of vulvar tumors
Conventional vaginal cytology smear examination can help to find out whether patients with vulvar tumors are associated with vaginal cancer, cervical cancer or uterine body cancer. The cytology smear examination of the diagnosis of vulvar tumors is about 50% positive rate, directly from the lesion site scraping materials or local tissue prints for cytological examination can increase the positive rate. Intravenous injection of 32P (700 millicuries in saline), due to the higher concentration of lesions, higher counts of intraepithelial and invasive cancers, is helpful for diagnosis.
Diagnosis
Diagnosis and diagnosis of vulvar tumors
diagnosis
The diagnosis of vulvar tumors focuses on clinical prodromal symptoms and local lesions. For general treatment of genital itching, leukoplakia, genital warts, etc., especially small nodules, ulcers or papillary sputum, should be alert to the possibility of developing or becoming a vulvar tumor. Therefore, local biopsy must be performed in time to confirm the diagnosis. Pathological tissue biopsy is the main basis for the diagnosis of vulvar tumors. It must be taken when taking the material. It is advisable to perform biopsy at the non-necrotic area of the suspected tumor tissue to avoid missing diagnosis. For those who are suspicious of the biopsy results, a deeper tissue examination should be taken again. In order to improve the positive rate of biopsy, the genital area was applied with 1% toluidine blue solution at home and abroad. After drying for 2 to 3 minutes, it was decolorized with 1% acetic acid. If there is atypical hyperplasia, in situ tumor or invasive carcinoma, toluidine Blue binds to DNA in the active cell nucleus, leaving the lesion area purple-blue without discoloration. Biopsy in the non-decolorized area can improve the positive rate of early diagnosis and multiple central tumor diagnosis. However, this method can cause false positive for benign ulcers; and for patients with hyperkeratosis of atypical lesions, it can be decolored after washing with acetic acid to obtain false negative results.
Differential diagnosis
Vulvar white lesions, vulvar ulcers, vulvar papilloma, vulvar sclerosing atrophic moss, vulvar granuloma, vulvar tuberculosis, etc., are generally difficult to distinguish between vulvar tumors, biopsy after toluidine blue staining, clear diagnosis to identify .
