Bartholin adenocarcinoma
Introduction
Introduction to vestibular large adenocarcinoma Carcinoma of the vestibular gland is rare. More than 50% of the primary vestibular gland cancer (carcinoma of Bartholinsgland) is adenocarcinoma, and squamous cell carcinoma accounts for about 30%. The age of onset is usually 10 years younger than vulvar squamous cell carcinoma. ~60 years old is the peak age of onset. basic knowledge The proportion of sickness: 0.01% Susceptible people: women Mode of infection: non-infectious Complications: pelvic inflammatory disease
Cause
Vestibular large adenocarcinoma
(1) Causes of the disease
The cause of vestibular large adenocarcinoma is unknown. 10% of patients have a history of vestibular gland inflammation. Some people think that it may be related to vulva and vestibular gland infection. The Chinese Academy of Medical Sciences Cancer Hospital reported 12 cases of vestibular large adenocarcinoma. There are 5 years, 15 years of medical history, and gradually enlarged in recent years, may be secondary infection of the Pap sac cyst, and finally cancer.
(two) pathogenesis
Clinically seen as a solid lumps, it occurs on the left side, deep inside the labia minora. When grown up, it can extend to the labia and the lower part of the vagina. Sometimes it is a cystic mass of lumps. The vestibular large adenocarcinoma is usually limited. The cut surface is pale, lobulated, ulcerated in the late stage, often combined with infection, mucus and pus in the lobes.
There are many types of tissue in the vestibular gland under the microscope. Because the cancer can occur from the acinar or ductal part, the epithelium of the duct is diverse. The small duct is a stratified columnar epithelium, the large duct is a stratified transitional epithelium, and the opening is Squamous epithelium, so there are many types of vestibular large adenocarcinoma, including adenocarcinoma, squamous cell carcinoma, transitional cell carcinoma, adenoid keratinosis, adenoid cystic carcinoma and undifferentiated carcinoma, including adenocarcinoma and squamous Cell carcinoma is more common, and histological gland and cells are mostly poorly differentiated. Tumors usually produce a lot of mucus, papillary, low-division mesh-like and substantial structure. Most cells have mucus secretion, and most of them are also in cells. Outside the cell, adenocarcinoma tissue can also have squamous metaplasia, and the well-differentiated cancer cells under electron microscope can be seen with rich rough endoplasmic reticulum, Golgi, intracellular secretory vacuoles or large mucus vacuoles. Glandular granules, tight junctions and other glandular epithelial features, poorly differentiated glandular cavities, and less secretory granules.
There are three ways to transfer:
1. Local infiltration of the tumor to the surrounding infiltration involving the vaginal rectum or perineum.
2. Lymph node metastasis of vestibular large adenocarcinoma can occur lymph node metastasis, the path is the same as vulvar cancer, the lower third of the vagina, can involve bilateral inguinal lymph nodes or only contralateral lymph nodes, in addition to inguinal lymph node metastasis, can also Direct access to the pelvic lymph nodes, the occurrence of closed-cell lymph node metastasis.
3. Hematogenous metastasis to the lungs, bones or liver after recurrence of hematogenous metastasis.
Prevention
Vestibular large adenocarcinoma prevention
Regular physical examination, early diagnosis, early treatment, and good follow-up.
Complication
Vestibular large adenocarcinoma complications Complications pelvic inflammatory disease
Concomitant infection after ulceration.
Symptom
Vestibular glandular cancer symptoms Common symptoms Perineal ulcers Menopausal abscess vaginal mouth local redness and heat pain nodules
Because the vestibular large adenocarcinoma is deep, it is often asymptomatic and often misdiagnosed as vestibular gland inflammation. If the vestibular gland enlargement occurs in postmenopausal women, the malignant tumor must be excluded first. The most common symptom of vestibular large adenocarcinoma is vaginal pain. And swelling, induration, vestibular glandular mass in the middle and late stage, ulceration, co-infection can occur with abscess, exudate or bleeding, the infiltration of the tumor into the surrounding vaginal rectum or perineum, may have vagina or Pain and swelling of the perineum.
At the time of physical examination, swelling can be seen in the lower third of the labia, which can reach deep and solid, nodular mass, and the surface skin is intact. As the tumor develops, the tumor collapses and invades the vagina or perineum, and the inguinal lymph node metastasizes due to cancer. The enlargement of the bilateral primary vestibular large adenocarcinoma is extremely rare.
Examine
Examination of vestibular large adenocarcinoma
Blood routine examination, secretion examination, and tumor marker examination.
Histopathological examination, CT scan of pelvic lymph nodes, lymphography examination.
Diagnosis
Diagnosis and differentiation of vestibular large adenocarcinoma
diagnosis
The diagnostic criteria are:
1. The anatomy of the tumor is deep in the labia minora.
2. Tumor surface epithelium is often intact.
3. The vestibular glandular tissue can be found in the tissue surrounding the tumor under the microscope. If it sees its transition to cancerous tissue, the evidence is conclusive.
4. The tumor is an adenocarcinoma, especially an adenocarcinoma that secretes mucus.
5. The tumor affects most of the vestibular gland and is histologically consistent with the vestibular gland.
6. There is no primary tumor in other places, the surface of the advanced tumor is ulcerated, and the surrounding normal gland structure is not found, so it is difficult to confirm its source.
If the vestibular gland is swollen and there is bleeding, it must be carefully examined. If the vestibular gland enlargement occurs in postmenopausal women, the malignant tumor must be considered first. For women over 40 years old, if the vestibular gland is found, If there is bleeding, it must be carefully examined; if the vestibular gland enlargement occurs in postmenopausal women, the malignant tumor must be considered first. The primary vestibular large adenocarcinoma should be examined by CT scan or lymphography for pelvic lymph nodes to see if there is any Lymph node metastasis.
Differential diagnosis
Vestibular large adenocarcinoma should be identified as follows:
1. Vestibular gland inflammation due to the deep position of the vestibular large adenocarcinoma, so early asymptomatic, often misdiagnosed as vestibular gland inflammation.
2. Vaginal metastases of endometrial cancer usually vestibular large adenocarcinoma is located deep in the labia majora, while vaginal metastases of endometrial cancer usually appear in the vaginal opening, and the lesion is shallow; endometrial biopsy is positive.
3. The vestibular gland cyst is a common benign cystic lesion. The cyst boundary is clear and remains unchanged for many years. When the infection is complicated, local redness and heat pain occur, or the pus is discharged. The antibacterial treatment is effective. The chronic inflammation of the vestibular gland increases the surrounding tissue. Thick, local tough, often difficult to diagnose, often need to be diagnosed.
