Vulvar verrucous carcinoma

　　1、Etiology

　　Vulvar verrucous carcinoma is a variant of squamous cell carcinoma, unrelated to HPV infection, and immunohistochemical staining shows a unique distribution of cell keratin proteins AE1 and AE3.

　　Second, Pathogenesis

　　The tumor mass is large, with the maximum diameter reaching 10 cm, appearing grayish red or grayish white. Under gross examination, the surface is a huge cauliflower-like tissue, soft in consistency, and the verrucous carcinoma mass becomes hard in case of secondary infection. The mass usually protrudes on the surface, and the cross-section width is several centimeters or more. One of the characteristics is that the base of the mass is clearly and neatly demarcated from the stroma below.

　　Under the microscope, it is well-differentiated squamous epithelium, growing in papillary form, with the papillary center lacking connective tissue. Nuclear division is rare. The surface of the papillae is hyperkeratosis and parakeratosis, with large, polygonal cells. The pedicles are blunt or arched, with fusion, extending into the stroma and compressing the stroma, indicating push-in infiltration. Therefore, the tumor base and stroma are clearly and flatly demarcated, without obvious destructive infiltration. Keratin pearls are mostly located in the deep part of the tumor, with rare nuclear division. There is severe chronic inflammation in the stroma, with numerous lymphocytes and plasma cells infiltrating, which is a characteristic accompanying lesion. Verrucous carcinoma initially presents as verrucous or fungiform growth, and finally invades deep tissue, causing regional lymph node metastasis only in the late stage.

　　Verrucous carcinoma is divided into 3 types:

　　1. Oral verrucous carcinoma, also known as oral florid papillomatosis, has lesions resembling the head of a cauliflower, pale white, and can invade most of the oral mucosa.

　　2. Vulvar and anal genital verrucous carcinoma, also known as Buschke and Loewenstein giant condyloma acuminatum, is most common in the penis and uncircumcised prepuce, presenting as papillary hyperplasia, and eventually invading the urethra. It can also be seen in the vulva and anal area.

　　3. Plantar verrucous carcinoma, also known as epithelioma macuniculatum, starts like a plantar wart, growing outward on one side, while also growing inward into deep tissue, forming many deep cavities filled with keratin and pus, resembling rabbit holes. Finally, it can penetrate the plantar fascia, even destroy the metatarsal bone, and then invade the skin on the dorsum of the foot.

　　Vulvar verrucous carcinoma is a special type of low-grade squamous cell carcinoma, mostly originating as primary tumors in infiltrative sites (such as the oral cavity, external genitalia, anus, and plantar region), and can also occur on the basis of primary diseases such as chronic ulcers, suppurative sweat gland炎drainage sinuses. The tumor has good differentiation, low malignancy, and slowly develops into a large mass, which can even block the vulva. Although the tumor appears terrifying under gross examination, it is rarely metastatic to regional lymph nodes. To remove the mass cleanly, a large surgical margin is required, which can lead to the inability to reconstruct the vulva and difficult wound healing; with infection of surrounding tissues.

　　The growth of the tumor is slow, half of the patients have a history of 3 to 10 years, so when they go to the hospital, it is quite large. The inguinal lymph nodes are enlarged due to reactive hyperplasia, and the local verrucous carcinoma is destructive, even invading the bone. Vulvar verrucous carcinoma is prone to recurrence and less metastasis, regional lymph node metastasis is rare, and usually the enlargement of the inguinal lymph nodes is caused by reactive hyperplasia.

　　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. Enhance physique, improve immunity: pay attention to the combination of work and rest, participate in more physical exercise, and eat more fresh fruits and vegetables rich in vitamins.

　　Second, prognosis:

　　The prognosis is generally poor, and recurrence is easy after surgical resection.

　　The diagnosis of vulvar verrucous carcinoma, in addition to relying on clinical manifestations, also requires indispensable auxiliary examinations. The examination methods are as follows:

     1. Polymerase chain reaction (PCR) detection, tumor marker detection, secretion examination.

　　2. Histopathological examination: fine needle aspiration cytology or excisional biopsy can be performed.

　　First, dietetic recipe for vulvar verrucous carcinoma

　　1. One bitter gourd, 50 grams of red beans, 20 grams of jujube, appropriate amount of rock sugar and honey. Preparation: wash the bitter gourd clean, take out the flesh, boil it into a concentrated juice, add red beans, cook into a gruel, and finally add jujube, rock sugar, honey, and other seasonings to taste.

　　2. Take 15 grams of Bai Fuling, boil in 300 milliliters of water, and take it in three doses.

　　Second, what is good for the body to eat for vulvar verrucous carcinoma

　　1. Eat more foods with anti-vulvar tumor properties, such as sesame, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, Chinese star snake, porcine pancreas, chrysanthemum, umeboshi, peach, lychee, mallow, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, turtle.

　　2. To relieve pain, it is advisable to eat horseshoe crabs, red crabs, lobsters, oysters, sea cucumber, tiger fish, beets, mung beans, radishes, chicken blood.

　　3. To relieve itching, it is advisable to eat amaranth, cabbage, rapeseed, taro, kelp, seaweed, chicken blood, snake meat, pangolin.

　　4. To enhance the physique and prevent metastasis, it is advisable to eat silver ear, black fungus, mushrooms, hedgehog mushrooms, gizzard, sea cucumber, Job's tears, walnuts, crabs, lizards, needlefish.

　　Three, it is best not to eat certain foods for vulvar verrucous carcinoma

　　1. Avoid foods that can cause eruptions. Such as fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which can worsen the itching and inflammation in the private parts.

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

　　3. Avoid eating fried and greasy foods. Such as oil cakes, butter, butter, chocolate, etc., these foods have the effect of increasing dampness and heat, which can increase the secretion of leukorrhea, which 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, traditional Chinese medicine treatment methods and recipes for vulvar verrucous carcinoma

　　1. 30-50g of dried Shi Shang Bai (or fresh 90-120g) plus 30-60g of lean pork. Take one dose per day, decocted twice and divided for consumption, 15-30 days as one course of treatment, the dosage can be adjusted according to circumstances.

　　2. 62g of Herba Epimedii, 15g of dry toad skin, 31g of Bai You, 31g of Oyster Shell, 31g of Sea Kelp, 15g of Radix Sophorae Flavescentis, 3g of Dazao Ye, 9g of Angelica Sinensis, 15g of Radix Adenophorae, (30g of Polygonum Cuspidatum, 62g of Yang Hai Gen, 62g of Teng Li Gen, first decocted for 3 hours and then decocted with the above medicine).

　　3. Home remedies: 120 grams of Xue Lai Qing (also known as Yan Yao Cao), decocted for tea and taken frequently.

　　Secondly, Western medical treatment methods for vulvar verrucous carcinoma

　　1. Surgical treatment:The only treatment for vulvar verrucous carcinoma is surgical resection. It should be performed as a more extensive radical local resection, even if there is lymph node metastasis in the inguinal region. It should also be performed as a radical vulvar resection and bilateral inguinal lymph node dissection. At least, the superficial and deep lymph nodes on the same side of the inguinal region should be resected. Generally, surgery is successful. Some scholars have found that the corrected 5-year survival rate reached 94% in 17 patients who were only treated with surgery.

　　2. Contraindications to radiotherapy:Radiotherapy is contraindicated. In addition to being insensitive to radiation, radiotherapy will also cause anaplastic transformation, accelerated growth, regional distant metastasis, and promote recurrence. Multiple recurrences can cause atypical hyperplasia to worsen or nuclear division to increase. If recurrence occurs, further resection should be chosen, and sometimes it may be necessary to perform some degree of organ resection.

　　3. Other treatments:Electrocautery, cryotherapy, laser surgery, and local topical cytotoxic drugs such as fluorouracil (5-Fu), even oral methotrexate (MTX) may have good effects. It can also try methotrexate and mercaptopurine. If there is infection, it can be treated with antiseptic at the same time, and Chinese medicine can be taken orally at the same time.