Vaginal melanoma

Introduction to vaginal melanoma Vaginal melanoma is less common than vulvar melanoma. The degree of malignancy and prognosis are worse than vulvar melanoma. The biological characteristics are similar to those of other mucosal melanomas. The prognostic factors are difficult to determine. The treatment methods are controversial. Therefore, large-scale prospective treatment is needed. the study. Vaginal melanoma has a typical clinical manifestation. It is easy to obtain a clinical diagnosis of vaginal lesions in gynecological examinations. For suspects, pathological examination can be performed by perforating biopsy or resection of full-thickness lesions. basic knowledge The proportion of illness: 0.005% Susceptible people: women Mode of infection: non-infectious Complications: vaginal malignancy

Vaginal melanoma cause

Melanocytes (30%):

Vaginal melanoma is thought to be a melanocyte derived from the vaginal mucosa. Melanocytes are evolved from the embryonic neural crest cells. Melanocytes can be found in the vaginal mucosa of 3% of adult women. The melanocytes migrate from the neural crest to the epidermis. Lost in the vaginal mucosa, these ectopic melanocytes later became the source of vaginal melanoma development.

Genetic factors (20%):

It can be caused by malignant transformation of black sputum and malignant freckles, or it can occur directly in normal mucosa. The cause of melanoma may be related to endocrine and local stimuli. Immune status and genetic factors also have an impact on the onset. Some people think that immunodeficiency and family history The incidence rate is relatively high.

There are three main types of vaginal melanoma growth: superficial spreading type, nodular type and freckle type. According to the morphology, melanoma cells can be divided into sputum-like cells, epithelioid cells, spindle cells or mixed cells, tumor cells or diffuse distribution. Or agglomerated into a mass, some can invade the mucosal epithelium, the tumor cells are diverse in morphology, large in nucleus, obvious in nucleoli, common atypical mitotic figures and giant cells in the tumor, dark brown pigment particles can be seen in the cytoplasm, for non-pigmented Tumors can be diagnosed by means of Fontana staining, S-100 and HMB-45 histochemical staining, and the junctional activity of vaginal malignant melanoma cells can be seen. This phenomenon suggests a primary vaginal mucosal tumor.

Vaginal melanoma prevention

1. Actively treat diseases such as vaginal leukoplakia, chronic inflammation and ulcers.

2. Anyone with irregular vaginal bleeding, abnormal leucorrhea, early diagnosis and active treatment.

3, reasonable diet can eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including protein, sugar, fat, vitamins, trace elements and dietary fiber and other essential nutrients, meat and vegetables, diversified food varieties, Giving full play to the complementary role of nutrients in food is also helpful in preventing this disease.

Vaginal melanoma complications Complications vaginal malignancy

Vaginal melanoma often has bleeding, infection, and vaginal malignancy.

Vaginal melanoma symptoms Common symptoms Vaginal bleeding dark spots vaginal discharge is black watery purulent discharge

1. Tumor site and general view: Melanoma can occur in any part of the vagina. Most of the literature reports that the tumor is often located in the lower third of the vagina (58% to 66%), and the anterior wall is more common (45%). The diameter of the tumor varies from 0.2 to 10 cm. The single lesion is more common. The color of the lesion varies from brown to black. There are also no pigments. The lesions are various in shape and can be flat black spots, nodular, polypoid, cauliflower. Papillary or surface ulceration.

2. Clinical symptoms: The most common symptoms are vaginal bleeding (80%), vaginal discharge (7%) or vaginal mass (13%). A small number of patients are asymptomatic. During the physical examination, abnormalities in the vagina are found, and some vaginal discharges are found. It is a black water sample called "black belt". The time from symptom onset to visit examination is from 2 days to 4 months, with an average of 2.4 months. There may be bloody odorous purulent secretions in the case of infection. There may be pain in the abdomen, and it is difficult to have a bowel movement.

Vaginal melanoma has typical clinical manifestations. It is easy to obtain clinical diagnosis of vaginal lesions in gynecological examination. For suspicious patients, pathological examination can be performed by perforating biopsy or resection of full-thickness lesions. The margin includes 1~2cm of normal vaginal mucosa. Anti-tumor spread during biopsy, resection of tissue rapid frozen examination confirmed the scope of surgery according to the situation, vaginal cytology smear examination can help the rapid diagnosis of the disease, smear visible non-epithelial malignant cells, no melanin Particles can be diagnosed by HMB-45 histochemical staining.

Examination of vaginal melanoma

Tumor markers, immunohistochemistry, histopathology, electron microscopy.

X-ray, ultrasound, CT, MRI and other examinations to understand the involvement of the pelvic cavity, whether the combination of lung, liver, brain and other common parts of the transfer.

1. Anti-human melanoma serum is indirectly immunofluorescent labeled melanin tissue, when the antiserum is diluted to 1:2, the highest positive rate can reach 89%.

2. Using the Vacca double PAP immunoenzyme labeling assay, when the antiserum dilution was 1:400, 82.14% was positive.

3. Examination of chromogen: The melanin is oxidized after being excreted by the kidney, so that the urine is dark brown, called black urine. If ferric chloride, potassium dichromate or sulfuric acid is added to the urine, it can promote its oxidation, and then add sodium nitrate, the urine is purple; first add acetic acid, then add sodium hydroxide, the urine is blue.

Diagnosis of vaginal melanoma

diagnosis

After the diagnosis of melanoma is determined, X-ray, ultrasound, CT, etc. should be performed to understand the pelvic condition, whether there is a combination of common sites such as lung, liver, brain, etc., in order to determine the stage of the tumor and take appropriate treatment.

At present, the staging of vaginal melanoma is mainly based on the FIGO staging system. Keid reports summarized 130 cases of vaginal melanoma, with 31% in stage I, 50% in stage II, 19% in stage III and stage IV, and 71% in diagnosis. The patient is in stage II or above.

Differential diagnosis

Vaginal melanoma should be distinguished from other rare melanoma-containing tumors such as pigmented neurofibroma and malignant schwannomas. Vaginal melanoma cells are diverse in type, especially non-pigmented vaginal melanoma and vaginal squamous cell carcinoma. Misdiagnosis of vaginal adenocarcinoma and sarcoma, misdiagnosis rate of 20%, mainly by means of immunohistochemical staining and electron microscopy to distinguish from other diseases, electron microscopy is more accurate than HMB-45 staining, but also should be thought of with rare vaginal mucosa melanin Identification, and exclusion of metastases from other sites and invasion of malignant melanoma in adjacent organs, changes in the mucosal junction are the most reliable basis for proving the primary.

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