Vaginal adenocarcinoma

Vaginal adenocarcinoma Vaginal adenocarcinoma is a rare vaginal malignant tumor, accounting for 4% to 9% of primary vaginal tumors. Vaginal adenocarcinoma can occur at any age. Most vaginal adenocarcinomas are metastatic, such as endometrial cancer, cervical adenocarcinoma, ovarian cancer, bladder cancer, and rectal cancer. basic knowledge The proportion of illness: 0.0003% Susceptible people: women Mode of infection: non-infectious Complications: abnormal leucorrhea

Causes of vaginal adenocarcinoma

Causes

The cause of vaginal adenocarcinoma has not yet been clarified. The vagina itself has no glands. The vaginal adenocarcinoma can be derived from the residual middle kidney tube, the eutopic endometrial tissue of the secondary renal tube and the vagina.

Human vaginal maturation in the third trimester of pregnancy, the use of diethylstilbestrol in pregnancy has a certain effect on the fetal genital tract, diethylstilbestrol allows the vaginal glandular epithelium to remain vaginal adenopathy, the mother in the early pregnancy using diethylstilbestrol in women with increased vaginal clear cell carcinoma Part of the reason is because the vagina has a large area of ectopic glandular epithelium, vaginal clear cell carcinoma and vaginal adenosis of the fallopian tube endometrial cells, the mother in the early pregnancy with diethylstilbestrol in the female vaginal fallopian tube intima-type epithelial area increased, increased with Unexplained opportunities for the role of co-carcinogens, these women in the body after the menarche as a promoter to promote the occurrence of cancer, the mother uses diethylstilbestrol to enter the fetus through the uterine placental barrier, in the early pregnancy, the fetus has vaginal estrogen Body development, diethylstilbestrol is not a steroid hormone, it can not be metabolized in the fetus like steroidal estrogen, therefore, it will affect the development of the fetal vagina.

Pathogenesis

1. The primary vaginal adenocarcinoma diethylstilbestrol causes the histological mechanism of vaginal clear cell carcinoma: the vagina originates from the Mullerian tube and the genitourinary sinus, and the pair of secondary kidney tubes makes the body cavity epithelial invagination close to the urogenital ridge, continuing to the tail The direction is stretched and then fused at the genitourinary sinus. The columnar epithelium originating from the Mullerian tube is replaced by the squamous epithelium originating from the vaginal plate. The squamous epithelium is formed into a vagina and the vagina is covered with a flat epithelium.

Vaginal adenocarcinoma can be derived from residual renal tubules, secondary renal tubules that have not been converted into vaginal mucosa, urethral gland and endometriotic lesions, and vaginal adenocarcinoma with a history of intrauterine diethylstilbestrol exposure can be developed by vaginal adenosis The vaginal adenocarcinoma with no history of exposure to intrauterine diethylstilbestrol is similar to adenocarcinoma in other areas. Clear cell carcinoma associated with diethylstilbestrol exhibits three basic histological features: cystic, papillary and solid, tumor The cells are hub-shaped and columnar, with a transparent cytoplasm and a clear cell membrane, or a short, short spike-like shape with large nuclei, atypical, protuberances and a small amount of cytoplasm around.

(1) vaginal clear cell carcinoma:

1 General: 2/3 occurs at the upper end of the vagina, most of which are polypoid, but also nodular, and some are flat or ulcerated, hard and granulated.

2 microscopic examination: under the microscope, the cancer cells are translucent, and the cell structure is arranged in a substantial one. It can be glandular, saclike, papillary and cystic. Under electron microscope, the cancer cells contain glycogen particles, and the cells have microvilli. Short and blunt, rich in mitochondria and Golgi.

(2) vaginal renal ductal adenocarcinoma: located in the vaginal part of the middle kidney tube, that is, the vaginal side wall and the top wall, the tumor grows deeper, the surface is covered with vaginal mucosal epithelium, the cancer cells are glandular or nipple The cells are typically pin-shaped, with deep nuclear staining, large and heterogeneous, histochemical examination, and negative for PAS and mucopolysaccharide staining.

(3) Endometrial adenocarcinoma: from ectopic endometrium, cancer cells can be associated with clear cell carcinoma, or glandular epithelial cells without mucus secretion, showing obvious abnormalities.

(4) rare adenocarcinoma: such as mixed intestinal adenocarcinoma and pro-silver cell carcinoma, under the light microscope, there are pseudo-stratified columnar cells in the cancer cells, there is mucus secretion, there are undifferentiated small cell nests under the adenocarcinoma, small cells are pro- Silver staining was positive, and histochemistry was positive for serotonin antibody. Electron microscopy showed small cells with neurosecretory granules.

2. Histopathological examination of secondary vaginal adenocarcinoma The appearance of vaginal lesions is generally polypoid, papillary or cauliflower-like, with irregular nodular infiltration of the vaginal wall. Microscopically, the recurrent lesions in the vagina are compared with the original site. The tumors are more poorly differentiated, often forming solid areas, showing more obvious cell atypical and epithelial hyperplasia, and often grow vigorously around the blood vessels. The histological type of secondary adenocarcinoma is the most mucinous adenocarcinoma, which is mainly derived from the stomach. Metastasis of the intestine, cervix and ovarian tumors.

Vaginal adenocarcinoma prevention

Long-term follow-up of vaginal adenocarcinoma is necessary. Patients with recurrence are reported to have relapsed after 20 years of treatment within 3 years of treatment. About 1/3 of relapsed patients first found lesions in distant areas, mostly in the lungs.

Mothers have taken DES (diethylstilbestrol) during pregnancy, and female offspring who have abnormal vaginal bleeding before the age of 24, fluid, cervix with extensive columnar epithelial eversion, or extensive epithelial extension of the vagina should be classified as "high risk population". Should be closely followed, once every six months or 1 year, in order to early detection of cancer, doctors found abnormal vaginal discharge, vaginal bleeding and physical examination of vaginal polypoid nodular neoplasms, should be alert to the presence of vaginal adenocarcinoma Carefully check the relevant medical history, and identify it. According to the condition of the lesion, direct biopsy or colposcopy biopsy should be performed according to the condition of the lesion. Older women should be diagnosed as primary vaginal adenocarcinoma before cervical and endometrial biopsy.

Vaginal adenocarcinoma complications Complications

Invade surrounding tissues and organs.

Vaginal gland cancer symptoms common symptoms lumbosacral pain urinary frequency vaginal bleeding bowel movement difficult pus and leucorrhea polyp nodules

1. Symptoms Early cancer can be asymptomatic, with the development of the disease, vaginal discharge, vaginal bleeding, some vaginal adenocarcinoma can produce mucus, make vaginal secretions more viscous, urinary frequency, urgency, hematuria or Difficulties in urinating; invading the rectum, urgency and weight, difficulty in defecation; invading the vagina, main ligament, uterine ligament, may have pain on both sides of the basin or lumbosacral.

2. Most of the signs of vaginal lesions are polypoid or nodular, but also can be flat plaque or ulcer, the texture is hard, the surface has small granulation, the growth position is shallow, can spread on the vaginal surface and even affect most of the vagina.

The clinical symptoms of vaginal adenocarcinoma without a history of contact with intrauterine diethylstilbestrol are similar to those of vaginal squamous cell carcinoma. Symptoms have reached a more advanced stage. It is difficult to diagnose. It must be identified as primary vaginal cancer or transferred from other parts. Occasionally, the original Cancers that originate in the kidneys, breast, colon or prostate are first manifested as vaginal cancer.

The age of vaginal clear cell adenocarcinoma with a history of exposure to intrauterine diethylstilbestrol is 19 years old. Small tumors are usually clinically asymptomatic and can be found by palpation or Pap smear. Large tumors may have irregular vaginal bleeding or secretion. Symptoms of increased substances, vaginal clear cell carcinoma can occur in any part of the vagina, the most common in the 1/3 of the anterior wall of the vagina, the size of the tumor from 1 to 30cm, most of which are exogenous growth and infiltration, 97% Patients with vaginal clear cell carcinoma have vaginal adenopathy, and the typical macroscopic appearance of vaginal adenosis is red, velvety, like grape string lesions.

Clinical manifestations of secondary vaginal adenocarcinoma: irregular vaginal bleeding is about 58.2%; bloody vaginal discharge and intravaginal mass is about 18.2%, and the site of recurrent intravaginal lesions: 72.8% of recurrent lesions are located at the apex of the vagina, and the posterior wall is 18.2%. 5.4% of the double side wall and 3.6% of the anterior wall. The lesions occurring at the apical or iliac crest site are mainly from the genital tract system adenocarcinoma, accounting for 92.5%; the lesions occurring in the posterior wall of the vagina are mainly transferred from the gastrointestinal tumor. , accounting for about 90.0%.

Examination of vaginal adenocarcinoma

Tumor marker examination, secretion examination, all vaginal mass or more obvious erosion should be vaginal cytology and biopsy to confirm the diagnosis, the lesion is more limited, superficial, small, can be observed and biopsy under colposcopy Or use Lu Ge liquid to smear, do biopsy in the uncolored area to confirm the diagnosis, if necessary, fine needle acupuncture or lymph node removal of the supraclavicular lymph nodes, and pathological examination, vaginal double examination and rectal examination.

Because clear cell adenocarcinoma is more prone to lung and supraclavicular lymph node metastasis, chest X-ray examination should be performed on suspected patients.

Diagnosis and differentiation of vaginal adenocarcin

diagnosis

Vaginal adenocarcinoma is often located under the mucosa and cannot be diagnosed early. It is necessary to perform vaginal double examination and rectal examination. Vaginal adenocarcinoma can be metastasized from colon, endometrium, ovary, prostate and stomach, because vaginal metastatic adenocarcinoma is more than primary. Sexual vaginal cancer is common, and the lesions of these organs should be ruled out before the diagnosis of primary vaginal cancer.

Differential diagnosis

Vaginal adenocarcinoma is rare, so when vaginal adenocarcinoma is found, the primary cancer outside the vagina should be excluded from the vagina. The common endometrial adenocarcinoma, paraurethral adenocarcinoma and vestibular adenocarcinoma.

1. Endometrial adenocarcinoma vaginal metastasis is mostly in the lower left or right side of the vagina or under the urethra, isolated nodules, located in the mucosa or submucosa, tumor nodules can be ulcerated, ulcers, infection, may be accompanied by uterine enlargement , uterine cavity diagnosis is positive.

2. Paraurethral adenocarcinoma mostly involves the vestibule of the vagina, which may have frequent urination, dysuria or dysuria.

3. The vestibular gland adenocarcinoma mostly affects the lateral wall of the lower vagina, and the position of the mass is deeper.

4. Vaginal endometriosis is rare, often occurs in the iliac crest, with the increase in the number of menstrual cycles, inflammatory infiltrates around, often combined with pelvic endometriosis, often dysmenorrhea or sexual pain When the endometriosis of the vagina is cancerous, the transitional morphology between normal endometrium and endometrial adenocarcinoma must be seen histologically.

5. Vaginal adenopathy is usually distributed in the anterior and posterior wall of the upper vagina and the two sides of the iliac crest, can spread to the cervix, rarely involving the lower third of the vagina, only in the upper third of the segment is only in the lower 1/3 segment .

6. Vaginal metastasis of malignant trophoblastic tumors tends to be purple-blue nodules under the mucosa. When collapsed, it can cause massive hemorrhage, abortion, normal or hydatidiform history, uterus usually increases, or ovarian flavin cysts, urine Positive pregnancy test or abnormal increase in blood -HCG.

7. Vaginal tuberculosis ulcers can be expressed as vaginal bleeding secretions, but tuberculous ulcers are rare, lesions develop slowly, initially limited small nodules, superficial ulcers after ulceration, irregular shape, local lymph node enlargement The secretion smear may find tubercle bacillus, other parts of the body may have tuberculosis symptoms or signs, biopsy at the vaginal ulcer can confirm the diagnosis.

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