Vulvar liposarcoma

　　1. Etiology

　　The etiology of vulvar liposarcoma may be related to gene mutation.

　　2. Pathogenesis

　　The tumor is often large, with a diameter of 5-10 cm, and some can reach 15 cm. It presents as nodular or lobulated, with a pseudocapsule on the surface, and the cross-section shows a lipid yellow color, mucinous or fishy-like texture, often with hemorrhage and necrosis.

　　Microscopic examination shows lipoblasts of different differentiation degrees with varying shapes and sizes, such as stellate, fusiform, round, and 'signet ring' shapes. The boundary of lipid droplet vacuoles is clear, round, smooth, and completely transparent. When the vacuoles are large, they often squeeze the nucleus to the edge or form a scallop shape. Giant atypical multicystic lipoblasts are common in pleomorphic liposarcomas. In addition to lipoblasts and mucinous stroma, fine tufted capillary networks can be seen in mucinous liposarcomas. There may be faint blue mucus and lipid droplets between tumor cells. Fat staining (Oil Red O, Sudan,猩红, etc.) is often positive. Immunohistochemical staining S-100 is irregularly positive.

　　Characteristic chromosomal translocation t(12;16)(q13;p11) can be detected in mucinous liposarcoma, partially well-differentiated and pleomorphic liposarcomas, or chimeric transcription FUS/TLS-CHOP formed due to chromosomal translocation can be detected by RT-PCR and DNA dot hybridization.

　　The etiology of vulvar liposarcoma may be related to gene mutation. Initially, the mass of vulvar liposarcoma is small, located under the skin, and may have no symptoms. As the mass gradually increases, it invades the skin to form an ulcer. Infection may cause pain and bleeding. Patients often seek medical attention due to the mass, bleeding, and pain. Some cases may remain unchanged for several years and then rapidly increase. Ultimately, lung metastasis may occur.

　　1. Symptoms

　　Initially, the mass is small, located under the skin, and may have no symptoms. As the mass gradually increases, it invades the skin to form an ulcer. Infection may cause pain and bleeding. Patients often seek medical attention due to the mass, bleeding, and pain. Some cases may remain unchanged for several years and then rapidly increase.

　　2. Signs

　　Vulvar masses are often located on the labia majora, with other sites less common. The size of the mass is 1 to 5 cm, round or oval, solitary or multiple. In the early stage, the surface skin of the mass is intact. As the tumor progresses, the skin is involved, leading to congestion, ulceration, infection, and bleeding. In the late stage, the tumor may invade deep tissues, become fixed on the pubis, ischium, or metastasize to distant sites.

　　Prevent and treat according to the three levels of tumor prevention. Prognosis: Local recurrence of well-differentiated liposarcoma is rare, with no distant metastasis. The prognosis is better than that of mucinous and pleomorphic types, with a 5-year survival rate of 80% to 88% and a 10-year survival rate of about 50%. Multifocal liposarcoma has a 5-year survival rate of only 20% to 56%. Donnellan et al. (2001) proposed that well-differentiated liposarcoma is a type of liposarcoma that can be cured. Among the 13 patients, 1 case of mucinous liposarcoma died only 5 months after diagnosis, and the rest were followed up for 9 months to 7 years after surgery, all of whom survived without tumor.

　　The diagnosis of vulvar liposarcoma relies not only on clinical manifestations but also on relevant auxiliary examinations, which are indispensable. Common examinations include the following:

     1. Needle aspiration biopsy, tumor marker examination.

　　2. Histopathological examination.

　　Firstly, dietetic therapy for vulvar liposarcoma

　　1. Peanut and Adzuki Bean and Jujube Soup

　　Formula: Peanuts with skin 90 grams, adzuki bean, jujube each 60 grams; garlic 30 grams.

　　Preparation: Boil all the ingredients together to make a soup.

　　Effect: Nourish Qi and blood, remove dampness and detoxify.

　　Usage: Take in the morning and evening.

　　2. Chrysanthemum and Luffa Clam Soup

　　Formula: Clam meat 30 grams, chrysanthemum 15 grams, luffa 10 grams.

　　Preparation: Boil the above three ingredients with an appropriate amount of water to make a decoction, and add salt for seasoning.

　　Effect: Nourish Qi and yin, clear heat and unblock meridians.

　　Usage: Drink the soup and eat the meat, once a day, take for 10 days consecutively.

　　3. Herba Houttuyniae and Kelp Soup

　　Formula: Mung bean 30 grams, kelp 20 grams, herba houttuyniae 15 grams.

　　Preparation: Boil the above three ingredients with water, remove the herba houttuyniae, and add an appropriate amount of sugar for seasoning.

　　Effect: Clear heat and detoxify.

　　Usage: Drink the soup and eat the beans and kelp. Once a day, take for 7 days consecutively.

　　4. Mung Bean and Lily Job's Tears Porridge

　　Formula: Job's tears 50 grams, mung bean 25 grams, fresh lily 100 grams.

　　Preparation: Separate the lily into petals, remove the inner membrane, add lotus seeds and Job's tears to the water and cook until five-thirds done, then add the lily and cook the porridge over low heat, add sugar for seasoning.

　　Effect: Nourish yin and clear heat, remove dampness and detoxify.

　　Usage: Once or twice a day.

　　5. Amaranth and Water Spinach Soup

　　Formula: Horse-tail amaranth, fresh water spinach each 30 grams.

　　Preparation: Boil the above two ingredients with water, and then make a decoction.

　　Effect: Clear heat and dampness, cool blood and detoxify.

　　Usage: Drink, once a day.

　　6. Turmeric Root and Jujube Decoction

　　Formula: Jujube, turmeric root each 30 grams.

　　Preparation: Boil the above two ingredients with water to make a decoction.

　　Effect: Clear heat, detoxify, and cool blood.

　　Usage: Drink the soup, twice a day.

　　7. Lotus Leaf Porridge

　　Formula: Fresh lotus leaf 20 grams, sticky rice 200 grams.

　　Preparation: Boil lotus leaf for 20 minutes first, then remove the dregs and cook with sticky rice to make porridge.

　　Effect: Clear heat and expel dampness.

　　Usage: Eat as desired in the morning and evening.

　　8. Lotus Node Soup

　　Formula: Lotus node 30 grams.

　　Preparation: Boil the lotus node with water to make a decoction.

　　Effect: Clear lung heat, cool blood and remove blood stasis.

　　Usage: Drink the soup, twice a day, can be used for 7 to 10 days.

　　9. Celery and Tofu

　　Formula: Celery 20 grams, tofu 30 grams.

　　Preparation: Wash and chop celery, cook with tofu together, add salt for seasoning and eat.

　　Effect: Clear heat and detoxify.

　　Usage: Take one dose per day, the frequency of administration is determined according to the condition.

　　Secondly, what is good for the body with vulvar liposarcoma

　　1. Preferably eat sesame seeds, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, black snake, pork pancreas, chrysanthemum, black plum, peach, lychee, horse-tail amaranth, chicken blood, eel, abalone, crab, tunicate, sardine, clam, and hawksbill turtle.

　　2. Consume foods rich in starch and fiber: eat more fruits, vegetables, dried beans, whole grain foods, beans, and their products. This can increase the intake of starch and fiber, which can reduce the risk of colon cancer and rectal cancer.

　　3. Eat more fresh vegetables and fruits.

　　Third, it is best to avoid eating certain foods for vulvar liposarcoma

　　1, Drink alcoholic beverages in moderation: Excessive drinking is harmful to health, and cancer of the mouth, throat, esophagus, and liver is related to excessive drinking. The risk of cancer is even greater for those who drink a lot and smoke.

　　2, Avoid excessive cholesterol intake: Low-fat diet can reduce the risk of breast cancer, prostate cancer, colon cancer, and rectal cancer.

　　3, Avoid eating too much sugar.

　　The main method of Western medicine for the treatment of vulvar liposarcoma is surgery, and the efficacy can be improved by using anti-cancer chemotherapy or radiotherapy.

　　First, Surgical Treatment

　　Radical vulvectomy and inguinal lymph node dissection are used. The range of resection of the primary tumor must be sufficient; insufficient resection often leads to local recurrence. If the inguinal lymph nodes are positive, pelvic lymph node dissection is performed. Tumor excision or conservative surgery is used, and 80% of local recurrences occur.

　　Second, Anti-cancer Chemotherapy

　　For sarcomas with slightly later stages and active nuclear division in the tissue, the prognosis can be improved by combining radical surgery with chemotherapy before and after treatment. At present, the commonly used anti-cancer chemotherapy regimens for treating soft tissue sarcomas include:

　　1, VAC regimen:

　　1.5mg of vincristine, intravenous injection, on the 1st and 8th days; actinomycin or actinomycin D (neomycin) 400-600g/d, intravenous injection, on the 1st to 4th days; cyclophosphamide (cyclophosphamide) 300mg/d, intravenous injection, on the 1st, 4th, and 8th days. Repeat every 3-4 weeks, but it depends on the recovery of bone marrow function. There are reports that this regimen can extend the survival time of pelvic sarcoma by 4-5 times when treating it (Rivard, 1975).

　　2, ADIC regimen:

　　60mg of doxorubicin (adriamycin), intravenous infusion, on the first day; 250mg of dacarbazine (thiotepa, DTIC), intravenous infusion, on the first to 5th days. The effective rate is 42% (Beretta, 1983).

　　3, CYVADIC regimen:

　　500mg of cyclophosphamide, intravenous infusion, on the second day; 1.5mg of vincristine, intravenous injection, on the 1st and 8th days; 250mg of dacarbazine (thiotepa), intravenous infusion, on the second day. The interval between treatment courses is 4 weeks. The effective rate is 47%.