Vulvar hemangioma

　　First, Etiology

　　Vulvar hemangioma originates from the mesoderm, like hemangiomas in other parts of the body, which develop from congenital nevus. The cavernous hemangioma is formed by the hyperplasia and expansion of intradermal and subcutaneous blood vessels; the basis of the occurrence of vascular keratoma may be related to the expansion of capillaries.

　　Second, Pathogenesis

　　1. Capillary hemangioma (hemangioma, strawberry hemangioma) is characterized by the hyperplasia of capillaries in the dermis, with obvious hyperplasia of endothelial cells. Endothelial cells are large and multilayered, some areas showing solid strips or nodular masses, with narrow lumens.

　　2. Cavernous hemangiomas have more blood vessels or cavities, are in an expanded state, irregular in shape, and sometimes thrombosis may occur inside. The vessel wall is lined with a single layer of flat endothelial cells, surrounded by fibrous tissue of varying thickness.

　　3. Port-wine stains are clusters of dilated capillaries in the upper and middle dermis, with mature endothelial cells, but without endothelial cell hyperplasia, surrounded by loose collagen fibers.

　　4. Vascular keratoma is a group of diseases characterized by superficial dermal blood vessel expansion and keratinization. The epidermis shows warty hyperplasia, hyperkeratosis, thickening of the stratum spinosum, and an increase and expansion of dermal papillae and papillary layer capillaries. They are lined with a layer of endothelial cells, filled with red blood cells in the lumen. Some expanded capillaries are surrounded by epidermal processes extending downward. Some localized types may be accompanied by capillary hemangioma or cavernous hemangioma in the deep dermis.

　　The etiology of vulvar hemangioma originates from the mesoderm, like hemangiomas in other parts of the body, which develop from congenital nevus. The cavernous hemangioma is formed by the hyperplasia and expansion of intradermal and subcutaneous blood vessels; the basis of the occurrence of vascular keratoma may be related to the expansion of capillaries. Since vulvar hemangioma can be multiple, it is not excluded that deep tissue or internal organs may be associated with hemangioma.

　　1. Capillary hemangioma (hemangioma)

　　Also known as strawberry hemangioma, simple hemangioma, or strawberry nevus, it looks like a strawberry, protruding, red, soft in texture, the diameter of the tumor varies from a few millimeters to several centimeters, this type of hemangioma can appear at birth or within a few weeks after birth, the tumor grows rapidly in the first few months, can reach several centimeters in size, but has a natural regression tendency after several years, the lesion often appears as one or several bright red lobulated masses, the surface is uneven like a strawberry, soft in texture, not easy to fade when pressed, the deep part of this type of tumor can have cavernous hemangioma.

　　2. Cavernous hemangioma

　　Generally asymptomatic, the vulva can swell, the surface skin can also bleed due to破溃, if ulcerated, pain, massive hemorrhage can occur, if the tumor grows rapidly, ulceration, hemorrhage and infection occur, active treatment should be given, cavernous hemangioma often appears a few months after birth and may gradually increase in size, grow rapidly, can be stationary, regress or disappear around the age of 2, grow slowly in adults, rarely spontaneously regress, the tumor is deep purple, with clear boundaries, fades when pressed, recovers when relaxed, the tumor shape is irregular, the surface skin is normal, the size of the tumor area is not uniform.

　　3. Keratotic hemangioma

　　The tumor can appear in a lobular, papular, or irregular wart-like shape, and can merge with each other when multiple, the color can be deep red, bright red, brown, blue, even black, the size is 1-10cm, usually asymptomatic, sometimes ulcers and bleeding can occur.

　　4. Senile hemangioma

　　The diameter is usually 1-3mm, dark red, soft, nodular, slightly higher than the skin.

　　Prevention of vulvar hemangioma: It is necessary to have a detailed understanding of the symptoms and related taboos of the disease; as vulvar hemangioma is a congenital disease, it should prevent the rupture of hemangioma at the urinary opening or vestibular site, and avoid infection. It is not advisable to do strenuous exercise, avoid emotional excitement, prevent sudden rise and fall of blood pressure, which may lead to rupture of hemangioma and massive hemorrhage.

　　The diagnosis of vulvar hemangioma, in addition to clinical manifestations, also depends on relevant examinations, which are indispensable.

     1. Fine needle aspiration of blood for examination, vaginal secretion examination, tumor marker examination.

　　2. Colposcopy, tissue pathological examination.

　　1. Dietetic Recipe for Vulvar Hemangioma

　　1. Radix Polygoni Multiflori Egg Soup

　　Composition: 120 grams of Radix Polygoni Multiflori, 4 eggs.

　　Usage: Boil the Radix Polygoni Multiflori to make a concentrated decoction, boil 4 eggs. This is a daily dose, taken twice a day.

　　2. Sesame Brown Sugar Porridge

　　Composition: 200 grams of black sesame seeds, 30 grams of brown sugar.

　　Usage: Clean the black sesame seeds, slightly fry them, put them in a bottle for later use or crush and put them in a bottle. Use 2 tablespoons with an appropriate amount of brown sugar, dip in steamed buns or serve with hot water.

　　3. Other

　　Composition: 200 grams of walnut kernel, 100 grams of sesame seeds, 100 grams of glutinous rice.

　　Usage: Grind the walnuts and sesame seeds into powder. Boil the glutinous rice with an appropriate amount of water, then add the walnuts and sesame seeds and it can be eaten.

　　4. He Shou Wu Chinese yam lamb soup

　　Composition: 30g of He Shou Wu, 100g of Chinese yam, 500g of lamb meat, 9g of ginger.

　　Second, what foods to eat for vulvar hemangiomas that are good for the body

　　1. Eat more foods with anti-vulvar tumor effects, such as sesame, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, Uroplatus, pig pancreas, chrysanthemum, umeboshi, peach, lychee, horse dent, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, tortoise shell.

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

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

　　4. To enhance physical fitness and prevent metastasis, eat silver ear, black fungus, mushrooms, hedgehog mushrooms, chicken gizzards, sea cucumber, Job's tears, walnuts, crabs, lizard, needlefish.

　　Third, what foods should not be eaten for vulvar hemangiomas

　　1. Abstain from food that causes heat. For example: fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which can exacerbate the itching and inflammation of the vulva after eating.

　　2. Eat less spicy and stimulating foods. For example: onions, pepper, chili, Sichuan pepper, rapeseed, fennel.

　　3. Avoid eating fried and greasy foods. For example: doughnuts, butter, butter, chocolate, etc., which have the effect of promoting dampness and increasing heat, which can increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

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

　　First, treatment

　　Vulvar capillary hemangiomas can be self-controlled or regress over time without active treatment. If it does not regress within a few months, cryotherapy or local radiotherapy can be adopted, or appropriate treatment methods can be selected according to different types and specific clinical conditions. For hemangiomas during the infant period, especially strawberry-like hemangiomas or cavernous hemangiomas, treatment can be temporarily withheld, and observe for several years. If it still does not regress, appropriate treatment methods can be chosen as follows.

　　1. Hardening agent injection

　　Suitable for small strawberry-like hemangiomas, cavernous hemangiomas, or mixed hemangiomas. The syringe is inserted into the tumor, and after pulling back without blood, the drug is injected into the base of the hemangioma. Inject once a week or every other week, the injection volume depends on the size of the tumor. Generally, it takes several times to see the effect. The following commonly used drugs can be chosen:

　　(1) 5% Sodium liver oil solution mixed with 2% lidocaine can be mixed in equal volumes.

　　(2) Anhydrous ethanol or 95% ethanol.

　　(3) 15% to 10% Salicylate solution.

　　(4) Quinine-Ural injection.

　　(5) Xiaozhi Ling Injection mixed with 1% to 2% procaine in a 1:1 to 2:1 ratio.

　　(6) Pingyangmycin (Bleomycin A5): 8mg dissolved and diluted with 2% lidocaine, the dose per time should not exceed 8mg.

　　(7) 9ml of 40% urea physiological saline and 1ml of lidocaine, the injection volume depends on the size of the tumor.

　　(8) Xiaoxing Injection: 250g Dahuang, 25g Mingfan, 100ml each of propylene glycol and glycerin (propylene glycol), 25ml benzyl alcohol, 150ml ethanol, water added to 1000ml. Administer 2-6ml each time, once a week, with 4 times as one course of treatment, for the treatment of cavernous hemangiomas.

　　2. Glucocorticoid hormone therapy

　　(1) Triamcinolone acetonide (Acetate of Triamcinolone Acetonide) injection is used for intradermal injection therapy for strawberry hemangiomas. The dose is determined by the size of the lesion, usually 10mg per session, once a week, with 5 sessions as one course.

　　(2) For children with rapidly growing strawberry hemangiomas, systemic application of glucocorticoid drugs such as prednisone (20-40mg/d) can be used, with continuous treatment for 1-3 months, which can reduce the size of the hemangioma.

　　3. Surgical resection

　　It is suitable for large cavernous hemangiomas.

　　4. Radiation therapy

　　(1) Radioactive isotope 90Sr dressing can be used for port-wine stains and strawberry hemangiomas. The conventional treatment dose of 90Sr dressing is 1.5-2Gy per session, once a day, with 7 sessions as one course, and the total dose is 10.5-14Gy. If not cured, another course can be administered after two courses. Some people also use high-dose 90Sr dressing therapy, with each person receiving 6.5-8.5Gy, once a week, with 3-7 sessions as one course, and the interval between courses is 2 months, with a total dose of 14-34Gy.

　　(2) Radioactive isotope 32P specialized dressing can be used to treat strawberry hemangiomas. The dose used each time is calculated by 37X104Bg (10mci) per square centimeter of tissue. If the condition is not cured in one session, the dressing can be reapplied after 3 months, but it is not recommended to exceed 3 times. Generally, those under 5 years of age are more sensitive.

　　(3) Colloid 32P injection is suitable for cavernous hemangiomas. The total dose is calculated by using 37X104Bg (10mCi) of colloid 32P per cubic centimeter of tissue. The single dose for adults should not exceed 3.7X107Bg (1mCi), and for children, it should not exceed 1.1X107Bg (0.3mCi). It is not suitable for 6-month-old infants. If the tumor is large, it can be divided into sections and injected in stages, with an interval of 3 months between each injection.

　　(4) X-ray irradiation: X-ray can be used for the treatment of port-wine stains, with each session of 800-1000R, irradiated once every 2-3 months, a total of 6-7 sessions, with the total dose not exceeding 6000R as preferred. If there is no significant improvement after 3-4 sessions of treatment, it indicates low sensitivity to X-ray, and further treatment is not necessary. This therapy is painless and suitable for treating children. For strawberry hemangiomas and cavernous hemangiomas, X-rays with a tissue half-value layer equivalent to them should be used for irradiation, with each session of 100-200Rad, once or twice a week. Usually, after 600-800Rad of irradiation, the development of skin lesions can be controlled. At this point, treatment can be paused and observed. More than half of the hemangiomas can gradually regress, but some skin lesions may continue to expand after treatment, and a larger treatment dose is required (1000-1500Rad). Some people also use low-voltage short-distance X-ray therapy for hemangiomas, with the dose chosen according to the tumor size, ranging from 1000-1500Rad, completed in one session. A review after 3 months, and if not cured, a second course of treatment can be considered as appropriate, with a total dose not exceeding 3000Rad, with an overall effective rate of 95.5%, and no sequelae observed.

　　(5) Interventional Radiology: Use angiography machine, first puncture locally for angiography of tumor vessels, and then inject sclerosing agent after angiography.

　　5. Laser Therapy

　　Nd-YAG laser (wavelength 532nm), argon ion laser (488nm and 514.5nm), copper vapor laser (578nm), and other lasers have achieved good effects in the treatment of erythema simplex. Nd-YAG laser and argon ion laser can also be used for the treatment of strawberry hemangioma.

　　6. Photodynamic Therapy

　　Photosensitizer hematoporphyrin (HPD) or cancer porphyrin (PsD-007) is injected intravenously at a dose of 0.8～5mg/kg, then laser照射 (the selected output wavelengths are reported to be 514.5nm and 630nm), multiple spot irradiation once or in stages according to the area of skin lesions, spot area 1～50cm2, laser energy density 50～500J/cm2. This method has good therapeutic effects. Some people have compared the efficacy of photodynamic therapy using frequency-doubled YAG laser (output wavelength 532nm) and copper vapor laser (output wavelength 577nm) as light sources for the treatment of erythema simplex, and found that the efficacy of photodynamic therapy using copper vapor laser as a light source is significantly better than that using frequency-doubled YAG laser as a light source.

　　7. Liquid Nitrogen Cryotherapy

　　It can be used for strawberry hemangioma, but it is often difficult for children and their parents to accept it due to pain.

　　8. Constant Magnetic Field Therapy

　　Mixed hemangioma is treated by applying a neodymium iron boron water magnet with a surface magnetic field strength of 0.1～0.2T daily for 3 months to 1 year.

　　9. External Treatment of Traditional Chinese Medicine

　　Crystal ointment, Wumiao Huoxian ointment, or Jiuxiang Bug treatment can be used for strawberry hemangioma. Binghuang powder can be used to treat cavernous hemangioma.

　　II. Prognosis

　　About 63% of patients will regress or shrink spontaneously within 5 years.