Vulvar Ewing's sarcoma

　　1. Etiology

　　The peripheral primitive neuroectodermal tumor of vulvar Ewing's sarcoma is a primitive tumor derived from the neural crest.

　　2. Pathogenesis

　　The tumor is lobulated with clear boundaries. The cut surface is grayish white, friable, elastic, with central hemorrhage, necrosis, and cystic change visible.

　　Microscopic examination shows uniform small round cell nests distributed in a dense arrangement. Cell boundaries are unclear, cytoplasm is scarce, nuclei are round, chromatin is granular, nucleoli are small and not clear. Nuclear division can be seen, ranging from 1 to 3/10 HPF. Some may be accompanied by focal Homer-Wright (H-W) rosette structures or flower-like structures. The stroma is scarce, and there is no reticular fiber. The tumor cells' cytoplasm is PAS positive and not digestible by amylase. Under the electron microscope, undifferentiated mesenchymal cells are seen, with uniform distribution of nuclear chromatin, granule-like, and glycogen aggregates are seen, and some neuroendocrine granules are visible.

　　The cell O13 (HBA71 antigen; P30/32, MIC2) is positive, and vimentin, CD99 are positive. Neurospecific enolase (NSE), synaptophysin (SY38), chromogranin (CgA), and keratin may be positive.

　　EWS gene rearrangement is present in all Ewing's sarcomas. About 95% of Ewing's sarcomas have a specific EWS/FLI-1 fusion gene caused by chromosomal translocation-t(11;22)(q24;q12), and a small number have an EWS/ERG fusion gene caused by t(21;22)(q21;q12). Whether using reverse transcriptase polymerase chain reaction (RT-PCR) to detect the transcription of EWS/FLI-1 or fluorescence in situ hybridization (FISH) to detect the rearrangement of EWS gene, both can assist in confirming the diagnosis.

　　Vulvar Ewing's sarcoma is relatively rare, with an onset age of 10 to 45 years, with a median age of 23 years. Through recent studies from multiple angles such as immunohistochemistry, electron microscopy, cell culture, and molecular biology, it has been found that Ewing's sarcoma is a type of primitive neuroectodermal tumor (primitiveneuroectodermal-tumor). Therefore, it is also known as peripheral primitive neuroectodermal tumor. Late-stage tumor metastasis.

　　The main clinical manifestations of vulvar Ewing's sarcoma are slowly growing masses in the vulva, which are active, painful, and have a fluctuating sensation, with sizes ranging from 0.5 to 4 cm. They are often misdiagnosed as lipomas or Bartholin's gland cysts before surgery.

　　Vulvar Ewing's sarcoma is relatively rare. The onset age is 10-45 years, with a median age of 23 years. Prognosis after treatment: there was one case that only used radiotherapy and chemotherapy, and died 10 months after diagnosis; one case recurred 3 years after local lesion resection, and 12 months after partial vulvar resection without tumor; there were 3 cases of surgery plus chemotherapy and/or radiotherapy, followed up for 7 months, 8 months, and 18 months, all without tumor.

　　1, Laboratory examination: tumor marker examination, tumor molecular marker detection.

　　2, Other auxiliary examinations: histopathological examination.

　　3, Tumor screening is an important way to early detect cancer and precancerous lesions. Various blood examination indicators in physical examinations, such as B-ultrasound, X-ray, anal and rectal examination, and Papanicolaou smear in gynecological examinations, as well as mammography, are commonly used methods for tumor screening.

　　First, nutritional therapy for vulvar Ewing's sarcoma

　　Nutritional therapy after chemotherapy:

　　1, He Shou Wu Egg Soup

　　Composition: 120 grams of He Shou Wu, 4 eggs.

　　Usage: Boil He Shou Wu to get a concentrated decoction, boil 4 eggs. This is a daily dose, taken twice a day.

　　2, Black Sesame Brown Sugar Porridge

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

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

　　3, Walnut and Sesame Seed Porridge

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

　　Usage: Grind the walnuts and sesame seeds into powder. Cook 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 Yam Lamb Soup

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

　　Second, what is good for the body to eat with vulvar Ewing's sarcoma

　　1, It is advisable to eat more foods with anti-vulvar tumor and leukoplakia effects, such as sesame, almond, wheat, barley, loofah, black-bone chicken, cuttlefish, black mamba, pork pancreas, chrysanthemum, umeboshi, peach, lychee, portulaca, chicken blood, eel, abalone, crab, cuttlefish, sardine, clam, tortoise shell, etc.

　　2, It is advisable to eat cuttlefish, red, lobster, mussel, sea cucumber, tiger fish, beetroot, mung bean, radish, chicken blood for pain.

　　3, It is advisable to eat amaranth, cabbage, rapeseed, taro, kelp, nori, chicken blood, snake meat, pangolin, etc. for itching.

　　4, To enhance physical fitness and prevent metastasis, it is advisable to eat silver ear, black fungus, mushroom, truffle, gizzard, sea cucumber, Job's tears, walnut, crab, lizard, needlefish, etc.

　　5, After vulvar Ewing's sarcoma surgery, consumes Qi and injures blood, it is advisable to eat more Qi-tonifying and blood-nourishing foods, such as jujube, longan, mung bean, glutinous rice, lychee, mushroom, carrot, quail egg, lotus root powder, beans, etc.

　　6, Radiotherapy after vulvar Ewing's sarcoma surgery: consumes yin and fluid, it is advisable to eat more yin-nourishing and fluid-preserving foods, such as spinach, green vegetables, lotus root, radish, watermelon, banana, grape, sea cucumber, sugarcane, lily, etc.

　　7. Chemotherapy after vulvar Ewing's sarcoma surgery: it is easy to damage both Qi and blood, and it is advisable to eat foods that nourish Qi and blood regularly, such as black fungus, mushrooms, walnuts, mulberries, Job's tears congee, jujube, longan, sea cucumber, etc.

　　Thirdly, vulvar Ewing's sarcoma should not eat those foods

　　1. Avoid foods that cause itching and inflammation in the vulva. For example: fish, shrimp, crabs, chicken heads, pork heads, goose meat, chicken wings, chicken feet, etc., which can exacerbate the itching and inflammation of the vulva after eating.

　　2. Eat less spicy and irritating foods. For example: onions, black pepper, chili, Sichuan pepper, mustard, fennel.

　　3. Avoid eating fried and greasy foods. For example: fried dough sticks, butter, butter, chocolate, etc., these foods 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 and drinking. Smoking and drinking are very irritating and can exacerbate inflammation.

　　Firstly, surgical treatment:

　　Early surgery resection, most of which adopt extensive resection of local lesions.

　　Secondly, combined radiotherapy and chemotherapy:

　　Postoperative administration of vinblastine, doxorubicin (adriamycin), and ifosfamide combined with chemotherapy and (or) radiotherapy.

　　1. Vinblastine:

　　It can fight cancer, with an efficacy about 10 times higher than vincristine, and can be used to treat acute lymphocytic leukemia with good efficacy. It also has efficacy for other acute leukemias, Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma, and breast cancer.

　　It has the effect of stopping cell division (mitosis) at the metaphase, which is similar to colchicine, but its effect is stronger than colchicine.

　　2. Doxorubicin:

　　Doxorubicin is an antitumor antibiotic that can inhibit the synthesis of RNA and DNA, with the strongest inhibition on RNA, a broad antitumor spectrum, and effects on various tumors. It is a non-specific cycle drug that has killing effects on tumor cells in all growth cycles.

　　3. Ifosfamide:

　　Different from cyclophosphamide, ifosfamide has increased solubility, which also enhances its metabolic activity. The cytotoxic effect of ifosfamide is cross-linking with DNA. Ifosfamide is a non-specific cell cycle drug. After administration of ifosfamide, the G2+M phase ratio of the cell cycle increases, delaying the cell cycle through the G2 phase.