Vaginal leiomyosarcoma

Introduction to vaginal leiomyomas Vaginal leiomyosarcoma is rare. The lesions are located in the submucosal interstitial or vaginal mucosa of the upper vaginal vaginal wall. They are solid nodules, with local expansion and occasional distant metastasis. basic knowledge Proportion of disease: 0.8% to 1% of gynecologic malignancies Susceptible people: women Mode of infection: non-infectious Complications: uremia

Causes of vaginal leiomyosarcoma

Cause:

The cause of the disease is still unknown.

Pathogenesis

The tumor is a solid nodular mass, ranging from 1 to 15 cm in size, usually 4 to 6 cm. The surface is covered with mucosa, no capsule or part of pseudo-envelope, invasive growth, and the cut surface is grayish yellow or light red. It can be seen that hemorrhagic necrosis or softening is myeloid.

Microscopic examination showed that the vaginal leiomyosarcoma cells were arranged in a braided shape. There were three types of round cells, spindle cells and mixed types. Among them, spindle cell sarcoma was the most common, and the cells were round or fusiform, with large nuclei and more chromatin. Deeply stained, occasionally tumor giant cells, there are more than 5 nuclear divisions per 10 high power fields (HPF), mitosis less than 5/10HPF, called cellular leiomy-Oma, because of the identification of the vagina Smooth muscle tumors are good, malignant is judged according to morphology, the number of mitotic divisions of tumors must be carefully evaluated, at least 10 to 15 slices from different planes, and 50 high-power fields are observed at the most active part of nuclear fission, and the average is calculated. In addition, it is still necessary to observe the abnormality of tumor cells.

Electron microscopy shows the longitudinal alignment of the intermediate filaments, dense spots, many swallowing vesicles and a partial or intact basement membrane surrounding each cell.

Masson staining cytoplasmic myofibrils were red, PTAH staining was purple, smooth muscle-specific actin MSA vimentin was positive, most desmin, estrogen receptor SR, progesterone receptor PR Positive, can also be expressed as calponin (calponinhl), calcium binding protein (hcaldesmin) positive.

Vaginal leiomyosarcoma prevention

Pay attention to personal hygiene and public health, do daily care, pay attention to daily maintenance, prevent problems before they occur, improve the body's ability to prevent cancer, and do a good job in preventive cancer. Regular inspections, early detection, early treatment, popularization of disease knowledge, suspicious symptoms as soon as possible to seek medical treatment, to avoid their own use of drugs, disorderly treatment caused by delay treatment makes the condition serious. There are doubts to regular hospital counseling and treatment.

Vaginal leiomyosarcoma complications Complications uremia

Often complicated by uremia and cachexia.

Symptoms of vaginal leiomyosarcoma Common symptoms Urinary urinary urinary frequency rectal pain nodules Vaginal irregular bleeding

Symptom

Early in the submucosal small induration, generally asymptomatic, some patients seeing because of their own touch of the tumor, the tumor is diffuse invasive development, usually manifested as vaginal pain, vaginal clogging, oppression discomfort, some may be associated with vaginal Regular bleeding or sexual intercourse bleeding, increased vaginal discharge, purulent or bloody secretions, may have stench, late vaginal bleeding, and due to oppression, infiltration of the bladder, urinary tract and rectum produce frequent urination, urgency, urinary interruption, poor bowel movements or Constipation and other symptoms, about half of the cases have vaginal rectal pain.

2. Signs

The common site of the tumor is the upper part of the posterior wall of the vagina, followed by the lower part of the posterior wall. Other walls may also appear. The mass often grows locally, and may have a pseudo-envelope. The vaginal examination may touch a hard, nodular mass or infiltrating lumps. The surface may be accompanied by bleeding, ulceration, vaginal wall hardening, stenosis, lymphatic and hematogenous metastasis in the late stage, and distant organs such as the lungs and liver.

Examination of vaginal leiomyosarcoma

Secretory examination, tumor marker examination, histopathological examination. Colposcopy.

Diagnosis and differentiation of vaginal leiomyosarcom

diagnosis

Diagnosis based on clinical manifestations and histopathological examination. If the tumor invades the vaginal mucosa or has grown into the vagina, the tissue may be taken for pathological examination. For example, the surface of the vaginal mucosa is still smooth, and a biopsy may be performed or a biopsy may be performed to confirm the diagnosis. Tavas- Soli et al. have suggested that the diagnostic criteria for vaginal leiomyosarcoma are: tumor diameter 3cm, mitotic image 10/10HPF, such as mitotic image 5 ~ 10/10HPF, cell moderate to severe atypia.

Differential diagnosis

1. Vaginal cancer: mostly originated from the vaginal mucosa, the main lesions in the vaginal mucosa, can be erosive, nodular, papillary, cauliflower-like, tissue crisp, accompanied by infection bleeding, and vaginal leiomyosarcoma The vaginal submucosal tissue, the mucosa is intact, and the mass of the tumor is different.

2. Vestibular large gland malignant tumor: vaginal leiomyosarcoma that occurs near the vaginal canal wall, sometimes difficult to distinguish from vestibular glandular malignant tumor, can be differentiated according to pathological histology, special histological staining to distinguish histology Sources such as Masson's trichrome stain (three-color stain for connective tissue) identify leiomyosarcoma, Laidlaw reticulum staining determines Miller's stromal cell sarcoma and lymphosarcoma, and electron microscopy looks for certain ultra-fine structures to aid in diagnosis, such as smooth muscle The sarcoma has a myofilament of smooth muscle, and the rhabdomyosarcoma has a striated muscle type of filament, a microfilament, a microvilli bulge, and a lack of a basement membrane.

3. Identification of vaginal rhabdomyosarcoma: mainly rely on histopathological examination.

4. Vaginal abscess, cyst or fibroid: clinically misdiagnosed as vaginal abscess, cyst or fibroid, misdiagnosis for up to 16 months reported.

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