Vulvar Schwannoma

　　1. Etiology

　　Currently, it is generally believed that vulvar schwannoma originates from Schwann cells (Schwann cells) of the ectoderm. In the past, some people believed that it originated from the mesoderm nerve sheath.

　　2. Pathogenesis

　　Vulvar schwannoma is a solitary, slowly growing benign tumor, mostly round, with a diameter of about 4 cm, a few reaching 10 cm. The tumor can have a complete capsule and solid section, white ligament, common light yellow macular areas, and can be accompanied by a few cysts containing light yellow fluid. There are also those with cystic nature. The tumor surface has abundant blood vessels and a complete capsule.

　　Under the microscope, there are many small blood vessels within the capsule, and some tumor cells are arranged in disorder. The connective tissue is in a fine reticular pattern, and small cysts formed by tissue degeneration can be seen, filled with fluid. Another part of the tumor cells is arranged more densely, with long nuclei and spindle-shaped, arranged in a lattice pattern, similar to the anucleate area. Another characteristic of the tumor is that there is a thick collagenous sheath around many blood vessels.

　　Most vulvar schwannomas are considered to be tumors formed by the Schwann sheath of peripheral nerves, which can be primary or secondary to trauma or other stimuli, often associated with neurofibromatosis. Schwannomas occurring in the vulva are often round, grow slowly, and have the characteristic of paroxysmal pain. Vulvar schwannomas are very rare, mostly occurring in women aged 40-50. Generally, there are no subjective symptoms, and sometimes accompanied by pain and tenderness.

　　Vulvar schwannoma is common in the limbs and perineum, usually presenting as round subcutaneous nodules. It is solitary, but can also be multiple, presenting as soft, scattered masses of varying sizes, generally without subjective symptoms, and sometimes accompanied by pain and tenderness.

　　1. Early detection, early diagnosis, early surgery, and good follow-up work.

　　2. Do a good job of follow-up: prevent the deterioration of the disease.

　　3. Pay attention to personal hygiene, especially the hygiene of the genital area during menstruation and puerperium.

　　4. Prognosis: Factors significantly related to the prognosis of the mass include the size of the mass, the completeness of radical surgical resection, whether there is associated neurofibromatosis, and the number of mitotic figures, etc.

　　The diagnosis of vulvar schwannoma depends not only on clinical manifestations but also on related examinations, which are indispensable.

     1. Immunohistochemical examination, tumor marker examination.

　　2. Histopathological examination.

　　The benefits of diet for vulvar schwannoma patients

　　1, Eat more foods with anti-vulvar tumor properties, such as sesame, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, black snake, pork pancreas, chrysanthemum, black plum, peach, lychee, horse齿苋, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, turtle shell.

　　2, To relieve pain, eat horseshoe crab, red, lobster, sea cucumber, tiger fish, beetroot, mung bean, radish, chicken blood.

　　3, To relieve itching, eat amaranth, cabbage, mustard, taro, kelp, seaweed, chicken blood, snake meat, pangolin.

　　4, To enhance physique and prevent metastasis, eat silver ear, black fungus, mushrooms, monkey head fungus, gizzard, sea cucumber, Job's tears, walnuts, crabs, agama, needlefish, etc.

　　5, After vulvar schwannoma surgery, consumes Qi and injures blood, it is advisable to eat more Qi-nourishing and blood-nourishing foods, such as jujube, longan, adzuki bean, glutinous rice, lychee, mushrooms, carrots, quail eggs, lotus root powder, beans, etc.

　　6, Radiotherapy after vulvar schwannoma surgery: consumes Yin and fluid, it is advisable to eat more Yin-nourishing and fluid-nourishing foods, such as spinach, minor spinach, lotus root, loofah, watermelon, banana, grapes, sea cucumber, sugarcane, lily, etc.

　　7, Chemotherapy after vulvar schwannoma surgery: easily damages both Qi and blood, it is advisable to often eat foods that nourish Qi and blood, such as black fungus, mushrooms, walnuts, mulberries, Job's tears congee, red dates, longan, sea cucumber, etc.

　　Two, The best foods to avoid for vulvar schwannoma

　　1, Avoid foods that activate the body. Such as fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which will exacerbate itching and inflammation in the genitals after eating.

　　2, Try to eat less spicy and stimulating foods. For example: onions, pepper, chili, Sichuan pepper, mustard, fennel.

　　3, Avoid eating fried and greasy foods. Such as doughnuts, butter, butter, chocolate, etc., these foods have the effect of promoting dampness and increasing heat, which will increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

　　4, Quit smoking, drinking, coffee, and other stimulating beverages.

　　Three, Classification of anti-tumor foods

　　1, Softening-hardening food such as sea products like jellyfish, kelp, seaweed, sea cucumber, abalone, and sea urchin. River products like water shield can also soften and harden. Turtle and tortoise also have softening-hardening effects, and also have certain cooling and nourishing Yin effects.

　　2, Blood-activating food in traditional Chinese medicine believes that many tumors can manifest as blood stasis. Treatment uses blood-activating and blood-breaking herbs. Crab can dissolve nodules and disperse blood, is very suitable for cancer masses with blood stasis. Crab claws and crab shells also have blood-breaking functions. Hawthorn can help digestion and also has blood-activating effects.

　　3, Qi-regulating food such as orange peel, tangerine peel, finger citron, and lemon peel.

　　4, Digestive food such as radish can dissolve food and phlegm, is suitable for use during abdominal distension. Ginger can open the appetite and also stop vomiting. Hawthorn can also digest meat.

　　5, Cooling food such as mung bean, cools and detoxifies, can be eaten during cancerous fever. Luffa, cools blood and detoxifies.

　　6, Spleen-nourishing food such as Job's tears, has the function of invigorating the spleen, benefiting the stomach, and nourishing the lung. It can also break up boils, treat lung fistula, and phlegm accumulation with blood. Adzuki bean, invigorates the spleen and promotes diuresis, can be eaten during edema due to spleen deficiency. Crucian carp, invigorates Qi and can be eaten during ascites.

　　7, Yang-yang food such as lamb, warms and invigorates Qi, but should be avoided during Yin deficiency or heat syndrome. Eel, warms and invigorates. Chicken, a food that greatly replenishes Qi, but should be avoided during warmth, heat syndrome, or Yin deficiency.

　　8. Nourishing Yin foods such as fresh pear, which moistens the throat and lungs.甘蔗汁, moistens the throat and nourishes Yin, and can stop vomiting. Honey, nourishes Yin and moistens the dryness. Watermelon, moistens the throat and clears heat. Duck, nourishes Yin, but is greasy and difficult to digest. Pork skin also has a nourishing Yin effect.

　　9. Other beneficial foods such as various mushrooms are suitable for patients with various tumors. Garlic may be beneficial for cancer prevention. Asparagus, kiwi, and other foods are also beneficial.

　　First, Prevention

　　1. Regular physical examination: to achieve early detection, early diagnosis, and early treatment.

　　2. Do a good job of follow-up: prevent the deterioration of the disease.

　　3. Pay attention to personal hygiene, especially the hygiene of the genital area during menstruation and puerperium.

　　Second, Before Treatment

　　It is necessary to have a detailed understanding of the symptoms of the disease and related contraindications.

　　Third, Western Treatment Methods for Vulvar Schwannoma

　　1. Surgical Treatment

　　(1) Indications:

　　Early-stage patients: Surgery is the first choice, including radical vulvectomy according to the site of onset, unilateral vulvectomy, radical clitoridectomy, or anterior pelvic exenteration.

　　Metastatic patients: If gynecological examination or imaging suggests the possibility of lymph node metastasis, lymph node biopsy can be performed.

　　(2) Limitations:

　　Routine lymph node dissection is not recommended because the tumor is mostly spread by blood.

　　2. Radiotherapy

　　(1) Efficacy:

　　The role of radiotherapy is not yet clear. Some studies have shown that when the external genitalia mass is huge and cannot be resected radically, preoperative external irradiation can reduce the mass by about 50%.

　　(2) Limitations:

　　Patients with neurofibromatosis should be used with caution, as it may increase the possibility of secondary tumors.

　　3. Chemotherapy

　　(1) Indications: For patients who cannot be surgically removed or cannot be completely removed to achieve radical cure, chemotherapy can be administered.

　　(2) Efficacy: Chemotherapy has a better effect on metastatic lesions than on locally recurrent lesions.

　　(3) Chemotherapy Regimen: VAC (Vinblastine, Actinomycin D, and Cyclophosphamide), doxorubicin (adriamycin), and ifosfamide.

　　But some scholars believe that there is no difference in overall survival rate and disease remission survival rate between the use of doxorubicin (adriamycin) alone and the combination of doxorubicin (adriamycin) with other drugs. Lambrou et al. suggest that patients with high risk of recurrence due to factors such as tumors >5cm, located in deep tissues, and highly malignant should receive postoperative doxorubicin (adriamycin) treatment.