Vulvar sweat gland adenocarcinoma

Introduction to vulvar sweat gland adenocarcinoma Sweat gland cancer is a relatively rare skin accessory malignant tumor, accounting for 2.2% to 8.4% of skin malignant tumors. Most of the sweat gland tumors are benign tumors. Among the 109 cases of sweat gland tumors reported by Tulenko, sweat adenomas account for 88%, and sweat gland cancer accounts for only 12%. basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious complication:

The cause of vulvar sweat gland adenocarcinoma

(1) Causes of the disease

The vulvar gland adenocarcinoma is mostly from the apocrine gland, but also from the small sweat gland. Its tissue morphology is very similar to the normal sweat gland. The cancerous foci invade the epidermis and have a morphological transition with the apocalyptic gland. It can also infiltrate into the deep, sometimes invading the nerve. The sheath, rich in cancer cells, eosinophilic, can produce mucus, and the degree of differentiation of cancer cells is 93%.

(two) pathogenesis

Vulvar gland adenocarcinoma is located in the labia majora. Its volume is <1cm. The tissue structure is cystic papillary growth or substantial. If the tumor is more than 2cm in diameter, ulcers may form. The sweat gland cancer is mostly a solid mass without an envelope. The boundary with the surrounding tissue is unclear; the cut surface is yellowish white or grayish red, which may be accompanied by hemorrhage and point necrosis, and a few are accompanied by hyaline changes and small cyst formation.

According to the biological characteristics and tissue morphology of sweat gland cancer, the Department of Pathology, Shanghai Medical University Cancer Hospital divides sweat gland cancer into 5 types:

Undifferentiated

The cancer tissue consists of small or polygonal cells with cytoplasm translucent or red staining and deep cytoplasmic small spindle cells. The cells are arranged in a strip-like or patchy shape, which has a tendency to form glandular cavities. The mitotic figures are more common, the reticular fibers are nest-like, the reticular fibers around the spindle cells increase, and there is no PAS-positive substance in the cancer tissues.

2. Nodular type (differentiated type)

The cancer tissue consists of large or polygonal cells with cytoplasmic translucent or red staining and spindle-shaped cells deeply stained with cytoplasm. The cells are intertwined into a nodular arrangement, with a tendency to form glandular or cystic spaces; Nested distribution; some cancer cells contain PAS weakly positive substances, which are sometimes indistinguishable from cell-rich sweat adenomas, but nodular carcinoma nests are strip-like invasive growth, and cancer cell atypia significantly contributes to sweat adenomas Identification.

Glandular

The cancer cells are cuboidal or columnar, arranged in a glandular cavity; PAS-positive substances can be seen in the glandular epithelium and the cavity; mitotic figures are common, and sometimes a large amount of mucus is secreted.

4. Mucus epidermis

The cancerous tissue consists of a variable squamous cell nest and granulated cells containing transparent mucus or granule-rich cells with transitional cancer between the two cells.

5.Paget disease type

As a result of sweat epithelial involvement in the epidermis, large ovoid cells with cytoplasmic translucent or light staining appear in the basal layer of the epidermis, ie, Paget cells, and cancerous sweat ducts or cancer nests can be seen under the epidermis.

There are three ways of metastasis: 1 local infiltration: sweat gland cancer mainly shows local invasive growth, and the base is fixed and not easy to push after deep infiltration. 2 lymph node metastasis: metastasis to inguinal lymph nodes via lymphatics, 3 blood transfer: lung metastasis Most seen.

Vulvar sweat gland adenocarcinoma prevention

Regular physical examination, early detection, early treatment, and good follow-up.

Vulvar sweat gland adenocarcinoma complications Complication

Easy to combine infection and bleeding.

Vulvar sweat gland adenocarcinoma common symptoms pruritus eczema purulent secretion subcutaneous nodule pubic mass

Symptom

(1) Course of disease: The development is slow, but a small number of patients have a rapid onset. The disease duration is less than 1% within one year. There are also long-term subcutaneous nodules with slow growth. Sometimes trauma can promote the tumor to increase rapidly.

(2) local itching of the vulva: common symptoms of vulvar sweat gland cancer, but also asymptomatic.

(3) genital mass: the diameter is usually <1cm, even up to 5cm, the surface of the ulcer after infection, it can produce exudate and purulent secretions.

2. Signs

Sweat gland cancer is mostly a single subcutaneous nodule or mass, solid texture; often with adhesion to the skin, the skin color of the surface of the mass is normal or slightly reddish, sometimes accompanied by telangiectasia, occasional serous or bloody discharge; If the cancer is huge, it can often be broken into cauliflower-like pieces, accompanied by secondary infections. Physical examination shows that the tumor is often located in the labia majora, the surface of the skin is intact, and there may be superficial ulcer or eczema-like changes, and the malignancy of sweat gland cancer. Low, slow progress, advanced lesions can infiltrate the muscle layer, or involve the vagina and inguinal lymph node metastasis and lung metastasis.

Examination of vulvar sweat gland adenocarcinoma

Blood routine examination, secretion examination, and tumor marker examination.

X-ray film, B-ultrasound, radionuclide scanning or CT imaging examination; histopathological examination.

Diagnosis and differentiation of vulvar sweat gland adenocarcinoma

diagnosis

Vulvar sweat gland adenocarcinoma can be diagnosed according to histopathology. When the lesion is rapidly enlarged, color changes, pain and ulceration occur, malignant transformation should be considered clinically.

Through the above auxiliary examination when the lesions are wide and suspected of involvement of other tissues and organs, the extent of the tumor and the degree of involvement of adjacent tissues can be determined to facilitate the development of a reasonable treatment plan.

Some tumors can originate from benign lesions, such as ductal adenocarcinoma, cylindrical adenocarcinoma, sweathole cancer, malignant cartilage-like sweat gland cancer, sweat duct cancer, and sweat gland cancer, in benign lesions (such as porokematomas, syringoma, Cylindrical) CEA is negative, and CEA is positive in the corresponding malignant lesion.

Differential diagnosis

Because the sweat glands are located in the dermis, early sweat gland cancers are mostly subcutaneous nodules with good superficial skin. This is not difficult to identify with erythema or papules (the scaly and molting on the surface) of early vulvar cancer. However, it is difficult to distinguish with some benign tumors such as fibroids and neurofibromas. Therefore, when subcutaneous nodules are found in the perineum, biopsy should be performed in time to confirm the diagnosis. It is difficult for the rapidly growing giant sweat gland cancer to be associated with soft tissue sarcoma. Identification, only the lymph node metastasis of sweat gland cancer is more common than soft tissue sarcoma.

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