Vaginal adenopathy

Introduction to vaginal adenopathy Adenosisvaginae refers to glandular tissue or hyperplastic glandular tissue in the vaginal wall or cervicovaginal surface or in the submucosal connective tissue. Normal vaginal wall and cervical squamous epithelial covering are generally free of glandular tissue. The presence of glandular tissue in the vaginal wall is considered to be a residual of the renal tube in the embryonic period. The lesion glandular epithelium can be transformed into a normal squamous epithelium, and malignant transformation can also occur. basic knowledge The proportion of illness: 3% - 8% Susceptible people: women Mode of infection: non-infectious Complications: abnormal leucorrhea

Cause of vaginal adenopathy

(1) Causes of the disease

The exact cause of vaginal adenosis is unknown. The glandular tissue in the vaginal wall is the residual renal tube in the embryonic period. It is not transformed into the squamous epithelium of the columnar epithelium. Under certain factors, it develops into different types of vaginal adenopathy. Changes may be related to the following reasons.

Drug impact (40%):

Most people think that vaginal adenosis is closely related to the use of non-steroidal synthetic estrogen diethylstilbestrol (DES) or similar synthetic estrogen during pregnancy. The genetic toxicity of DES may be related to a steroidal metabolite. The product can pass through the placenta and cause a series of developmental abnormalities in the fetus. Pregnant women taking DES can cause the mesoderm tissue in the middle and the middle of the fetus to grow below the normal cervix, causing the squamous epithelium and columnar epithelium to move down. It may also interfere with the normal transformation process of urogenital sinus epithelium and accessory renal tubular epithelium during fetal development, so that some glandular residuals cannot be transformed into squamous epithelium in time, and later in female infants or adolescence, subject to certain factors such as inflammation. Hormones, damage and other effects, leading to the proliferation of residual glands to form vaginal adenopathy or even tumors, the occurrence of vaginal adenosis and the early exposure of DES to the embryo, the dose is positively correlated, the earlier the contact time, the longer, the higher the dose, the vagina The higher the incidence of adenosis, the vaginal gland occurs in about 1/3 of the offspring of DES-treated mothers before 18 weeks of gestation. If DES is taken before 8 weeks of gestation, the incidence of vaginal adenosis in female offspring is 70%. After 18 weeks, there is no case of morbidity. Such cases are mostly found in adolescence, but Kaufman follow-up study found that the third Generation female offspring and their mothers were not affected by exposure to DES during the embryonic period.

Chemotherapy may play a role in promoting vaginal adenosis. Goodman (1991) reported that 1 case of vaginal adenosis occurred after 8 months of treatment with vaginal wetness, and developed into vaginal clear cell carcinoma after 40 months, Bornsteinl993 One year after the application of 5-Fu in the treatment of vaginal wetness, a vaginal adenopathy lesion appeared in the vagina.

Vaginal environmental impact (30%):

Before the DES in 1938, Von Pruesohe found that 4 cases of vaginal wall had glandular tissue in 34 women's autopsy. Domestic scholars reported that there were no history of DES exposure in 37 cases of vaginal adenosis, so it is considered that patients without DES exposure history Vaginal adenopathy may also occur. DES exposure is not the only cause. Patients with no history of DES exposure are acquired after puberty, so it is also called acquired Vaginal Adenosis. The normal vaginal epithelium is affected by certain physical and chemical factors such as drugs, lasers. After the damage of the birth injury, or the normal acidic environment of the vagina is changed, the pH in the vagina is increased, so that the vaginal epithelium is like the columnar epithelial metaplasia, the squamous epithelium indicated by the vagina is replaced by the columnar epithelium, and the glandular structure is further formed. Developed into vaginal adenopathy.

(two) pathogenesis

Most of the vaginal adenosis is located in the vaginal upper 1/3, the anterior wall of the vagina is more common, some cases can spread to the 1/3 of the vagina, a few can spread to the lower third of the vagina, and even the hymen, vaginal adenopathy can be divided into 4 Types.

1. Occult (occult) There is no abnormal appearance on the outer surface of the vaginal mucosa, but glandular tissue exists under the epidermis of the vaginal mucosa, often found in tissue biopsy or autopsy.

2. Cystic (cycstic) The vaginal lining contains one or more cystic structures of varying sizes. The sac contains mucus, and the lining of the sac is similar to the cervix glandular epithelium, sometimes forming a low and simple nipple.

3. Adenomatous glandular tissue hyperplasia, outgrowth prominent in the vagina to form a vaginal mass, sometimes polypoid.

4. Spot type (effluent) The vaginal gland tissue hyperplasia, the glandular cavity and the vagina communicate, so that the vaginal changes of the squamous epithelium are replaced by columnar epithelium, the lesions appear red spots, granules, variegated or erosive, iodine Not colored.

The glandular epithelium under the microscope can be expressed in three forms:

(1) Similar to the endocervical glandular epithelium, the glandular epithelium is high-column, and the cells contain mucus, which is the most common.

(2) Similar to the endometrial epithelium, but no endometrial stroma.

(3) Similar to the fallopian tube epithelial cells, this type is rare.

Vaginal gland cells often secrete mucus, which is positive for mucus red or PAS. When the pH of the vagina is low, glandular epithelial cells may have different degrees of squamous metaplasia, and nail-like squamous epithelium may appear. Viscous droplets can be seen as a basis for vaginal adenosis. The squamous epithelium involved in the lesion is mainly composed of basal cells and spine cells lacking glycogen.

Vaginal adenolysis prevention

1, during pregnancy, especially before 8 weeks of pregnancy, avoid the abuse of synthetic estrogen to reduce and prevent the occurrence of vaginal adenopathy.

2. For women who have had DES effects in the uterus, they should be examined according to the above steps and their follow-up should be strengthened.

3, for asymptomatic, biopsy confirmed as benign vaginal adenopathy, no treatment, but should be reviewed once every six months.

4. Increase vaginal acidity. Maintain a vaginal acidic environment with topical rinsing, sitting bath or spreading buffer powder.

5, vaginal adenopathy has developed into clear cell carcinoma or squamous cell carcinoma, should be treated according to the principle of vaginal malignant tumor.

Vaginal adenopathy complications Complications

Sometimes accompanied by cervical adenopathy, cervical dysplasia, cervix diarrhea, wrinkles or crown-like protrusions and other deformities.

Symptoms of vaginal adenopathy common symptoms faecal appearance in the vagina... vaginal discharge increased sexual pain cyst

1. Symptoms: Most patients have no obvious symptoms. The lesions are wide or involve the mucosal surface. There are often leucorrhea symptoms, leucorrhea thin mucus or bloody vaginal discharge, and can also show post-intercourse bleeding, sexual pain and vaginal burning.

2. Gynecological examination: The vaginal adenopathy lesions are mostly located in the vaginal foramen, the vagina, the posterior side of the middle segment, and the vaginal mucosa is smashed like a plaque, red granules, red spots, superficial ulcers, bleeding Some may be polypoid-like protuberances, some may be single or multiple cyst-like protrusions on the vaginal wall, and some may be expressed as a vaginal mucosa folded into a ring around the cervix, and vaginal palpation sometimes touches the vaginal submucosa. Or sand-like lesions, the diameter is generally 0.5 ~ 5cm, if the lesion is in the cervix, you can find cervical diaphragmatic or wrinkled or cervical dysplasia, cervical crown-like protrusion or cervical valgus.

Examination of vaginal adenopathy

1. Biopsy: Multi-point biopsy of the lesion under direct vision or colposcopy is a method for the diagnosis of vaginal adenopathy.

2. Colposcopy and biopsy: usually under the colposcopy, there is a columnar epithelial change similar to the transition zone of the cervix. After the acetic acid is applied, typical grape-like tissue can be seen. The squamous epithelial metaplasia, columnar epithelial island, gland can be seen in the transformation area. Openings and small glandular cysts, sometimes visible white epithelium, leukoplakia, punctate blood vessels, mosaic and other colposcopy images, 90% colposcopy in the vaginal adenosis affected by DES can see the above different images, vascular signs usually require green filter Microscopic observation, but usually the shape has not changed significantly, the acetic acid and iodine in the lesion area are often not colored, and the use of colposcopy to diagnose vaginal adenopathy has higher reliability.

Cytological examination: smear directly on the surface of the suspected lesion, or cytological examination from the vaginal fornix and upper and middle vaginal mucosa. If mucus epithelial cells or squamous cells are found, it may indicate vaginal adenopathy, but most The lesion is located under the mucosa, so the cytological examination results of the smear are more negative, and are susceptible to vaginal inflammation. It has limited significance for the diagnosis of vaginal adenosis, but for follow-up, epithelial dysplasia and early detection of malignant transformation is a simple and economical kind. means.

No special performance.

Diagnosis and differentiation of vaginal adenopathy

diagnosis

The pathological diagnosis standard is that the vaginal mucosa has a gland similar to the cervical mucosa, endometrium or fallopian tube mucosa, or the vaginal normal stratified squamous epithelium is replaced by glandular epithelium, which can be diagnosed as vaginal adenopathy. Especially if you have a history of DES before 8 weeks of gestation, you should be highly alert to those with a history of this disease, even if you are asymptomatic.

1, detailed medical history: to understand the history of DES (acetol), can be used as a reference for diagnosis. For the symptoms of increased vaginal discharge, vaginal blood secretions or sexual pain, the cause should be traced.

2, gynecological examination: a careful examination of the entire vagina and cervix, pay attention to the vaginal wall with erythema, ulcers, nodules and polypoids. Palpation is an important examination that confirms the induration and ulceration of the vaginal transverse ridge and its back, as well as the induration under the vaginal mucosa.

3, cytological examination: for suspicious patients, in the vaginal wall lesions as a scraping, in the upper part of the vagina as a circular scraper or four-phase scraper. The cervical scraper should be taken separately. If mucus columnar cells or squamous cells are found, it indicates vaginal adenosis.

4, colposcopy: generally considered this is a reliable method for the diagnosis of vaginal adenopathy. For colposcopy, the diagnosis rate of vaginal adenosis was 91%. Colposcopy for the follow-up observation of vaginal adenosis, early detection of epithelial dysplasia and carcinogenesis is more helpful.

5, biopsy: is the basis for the diagnosis of vaginal adenopathy. If the above abnormal lesions are found in the vaginal examination, multiple biopsies should be performed.

Differential diagnosis

1. Endometriosis: The vaginal wall endometriosis lesions protrude from the surface of the vaginal wall, may be dark red, erosive, or localized nodular or polypoid mucosal protrusions, similar to spots or adenomas Vaginal adenopathy, but the former often have dysmenorrhea and dyspareunia. There may be dark red bleeding points in the lesions before and after menstruation. The endometrial glands and interstitial components are seen under the microscope. There are often old bleeding in the glandular cavity, while the latter only has a diagnosis. Endometrial glands, no endometrial stromal cells.

2. Middle renal cyst

(1) vaginal renal cyst: similar to cystic vaginal adenosis, but the former is mostly located in the anterior wall of the vagina. The epithelial cells of the cyst wall are deficient in glycogen and mucus, and the mucin histochemistry is negative.

(2) inclusion cysts: due to childbirth, surgery or trauma caused by vaginal wall damage, a small part of the mucosa is involved in the vaginal mucosa during the wound healing process to form a cyst, mostly single, located in the lower part of the vaginal wall, similar to the vaginal gland cyst However, it is asymptomatic, and the cyst is covered with a stratified squamous epithelium and no glandular tissue.

3. Vaginal grape sarcoma: This disease also occurs in baby girls and young girls, early manifestations of vaginal discharge or vaginal bleeding, but the tumor is more translucent, shaped like embryoid, pathological examination of sarcoma can be found in sarcoma .

4. Vaginal clear cell carcinoma: Early manifestations of bloody vaginal discharge, sexual intercourse bleeding or irregular vaginal bleeding, lesions can form nodules, erosions, ulcers, etc., bleeding, vaginal clear cell carcinoma can coexist with vaginal adenopathy, also There may be malignant changes of vaginal adenopathy, mainly based on pathological examination to confirm the diagnosis.

5. Vaginal squamous cell carcinoma: Most of the patients are postmenopausal women. The vaginal lesions are nodules, erosions, ulcers or polyps, hard and easy to hemorrhage. They can be identified by biopsy.

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