Vulvar verrucous xanthoma

　　First, Etiology

　　The etiology of verrucous xanthomas is not yet clear and may be related to inflammation, virus, bacterial, or fungal infection, local irritation, and other factors. Some scholars have found that the condition often coexists with other lesions locally, such as associated with infected epidermoid nevi, squamous cell carcinoma, in situ oral mucosal carcinoma, or even had experienced bullous pemphigus at the lesion site.

　　Second, Pathogenesis

　　The pathogenesis of vulvar verrucous xanthomas includes the epidermal proliferation theory, foam cell infiltration theory, and different theories of mutual enhancement between the two. The former believes that the condition commonly occurs in locally stimulated areas, with neutrophil infiltration in the epidermis and frequent bacterial infection, leading to epidermal proliferation and变性, causing lipid droplets within the epidermal cells to enter the dermal papillae, thus causing foam cell foam cellization of macrophages. The latter believes that certain triggers in the dermal papillae cause foam cell aggregation, followed by papillomatous hyperplasia of the epidermis.

　　The light microscopic characteristics of verrucous xanthoma are: hyperplasia of the epidermis or mucosal epithelium, and the superficial layer of the epithelium often shows three morphologies:

　　1. Papillary hyperplasia;

　　2. Wart-like hyperplasia;

　　The main form of epithelial proliferation is into the deep connective tissue, while the surface is flat. The epithelial surfaces of these three forms have hyperkeratosis, incomplete keratosis, and the keratin layer often sinks deeply into the epithelial deep layer. Surrounding the keratinized epithelium, there are deeply stained degenerative and disintegrated epithelial cell nuclei and scattered neutrophils. The epithelial papillae are widened and grow regularly into the connective tissue, with the dermal papillae upwardly protruding between the papillae. The capillaries and collagen fibers within the dermal papillae are filled with large, round, or polygonal foam cells (also known as xanthoma cells), with clear boundaries, rich foamy cytoplasm, small, condensed, deeply stained nuclei located centrally in the cell, and visible glass-like变性 of collagen fibers. There are rarely foam cells in the tissue below the epithelial papillae, and there may be chronic inflammatory cell infiltration.

         Vulvar verrucous xanthomas primarily affect the labia and vagina in females. They grow slowly, with no discomfort or mild tenderness, and the average course is several months, but can last up to 30 years. They can also be accompanied by infection.

　　Verrucous xanthomas commonly occur on the oral mucosa and vulvar regions. In females, the condition primarily affects the labia and vagina, presenting as solitary chronic growing lesions with a warty, papillary, plaque-like flat elevation, or granular appearance. They may have a peduncle or be sessile, with clear boundaries, and can range in color from normal skin tone to pale red, yellow-brown, pale yellow, or grayish white. The maximum diameter is usually less than 2cm, but can reach up to 4cm. Growth is slow, with no discomfort or mild tenderness, and the average course is several months, but can last up to 30 years.

　　The etiology of external genital warts is not yet clear, and it may be related to inflammation, virus, bacterial or fungal infection, local irritation, and other factors.

　　Prevention:

　　1. Pay attention to the hygiene of the external genitalia, have regular physical examinations, early diagnosis, active treatment, and follow-up care.

　　2. Pay attention to menstrual hygiene, avoid sexual activity during treatment, do not wear too tight underwear, do not use drugs arbitrarily, and rest well.

　　3. Diet should be light, avoid spicy and刺激性 foods.

　　1. Tumor marker examination, blood routine examination. Histopathological examination.

　　1. Histopathological examination: a pathological morphological method used to examine pathological changes in organs, tissues, or cells. To explore the disease process of organs, tissues, or cells, a certain pathological morphological examination method can be adopted to examine the lesions they have, discuss the causes of the lesions, the pathogenesis, and the process of occurrence and development of the lesions, and finally make a pathological diagnosis. The examination methods of pathological morphology first observe the pathological changes of gross specimens, then cut a certain size of the lesion tissue, make pathological sections with pathological histological methods, and further examine the lesions with a microscope.

　　One: Therapeutic diet for external genital warts

　　1. Jieyu Xiangchen Wine: 50g of xiangfu, 5g of Chuanxiong, 30g of Chenpi, 1000ml of white wine. Soak for 7 days and take, 2-3 times a day, 10-20ml each time.杞子香菇瘦肉汤: 150g of lean pork, 50g of mushrooms, 50g of fructus lycii. Cut the lean pork into slices, wash the mushrooms and fructus lycii together, and place them in the pot with appropriate amount of salt, ginger, and pepper. Boil and season to drink the soup and eat the meat, 1-2 times a day, for 3-7 days.

　　2. Foshou Anxiang: 12g of foshou, 12g of yujin, 12g of xiaoxiang, 200g of粳米. First, decoct foshou, yujin, and xiaoxiang in water, remove the dregs, and take the juice 150ml. Cook the rice into porridge, then add the medicine juice and cook for a while. Add appropriate amount of salt, monosodium glutamate, pepper, and ginger for seasoning and eat, once a day.

　　3. Chinese herb and pig liver soup: 9g of Chinese herb, 10g of Shanyao, 200g of pork liver, 50ml of yellow wine. Cut the Chinese herb and Shanyao into pieces. Cut the pork liver into slices and place it in the pot with the Chinese herb and Shanyao. Steam over boiling water and take with warm yellow wine, twice a day, for 3-5 days.

　　4. Turtle shell stewed with pigeon meat: 30g of turtle shell, 200g of pigeon meat, a little rice wine. Remove the feathers and internal organs of the pigeon, crush the turtle shell, and place it in the pigeon's abdominal cavity. Add ginger, pepper, scallion, clear water, and an appropriate amount of rice wine, mix well, and steam in a pot over boiling water. Season and eat, once a day, for 3-5 days.

　　Two: What foods are good for external genital warts?

　　1. It is recommended to consume more foods with anti-external genital tumor effects, such as sesame seeds, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, black snake, pork pancreas, chrysanthemum, black plum, peach, lichee, mallow, chicken blood, eel, abalone, crab, tunicate, sardine, clam, and tortoise shell.

　　2. For pain, eat horseshoe crabs, red crabs, lobsters, sea asparagus, sea cucumber, tiger fish, beets, mung beans, radishes, chicken blood.

　　3. For itching, eat amaranth, cabbage, turnips, taro, kelp, laver, chicken blood, snake meat, pangolin.

　　4. To enhance the body and prevent metastasis, eat tremella, black fungus, mushrooms, monkey head mushrooms, gizzards, sea cucumber, Job's tears, walnuts, crabs, Agama, needlefish.

　　Third, it is best not to eat the following foods for vulvar verrucous xanthoma

　　1. Avoid foods that cause allergies. For example: fish, shrimp, crabs, chicken heads, pork heads, goose meat, chicken wings, chicken feet, etc., which can worsen the itching and inflammation of the female genitals.

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

　　3. Avoid eating fried and greasy foods. For example, fried dough sticks, butter, butter, chocolate, etc., which have the effect of increasing dampness and 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.

　　The light microscopic characteristics of verrucous xanthoma are: hyperplasia of the epidermis or mucosal epithelium, and the superficial layer of the epithelium often shows three morphologies:

　　1. Papillary hyperplasia;

　　2. Wart-like hyperplasia;

　　3. The main growth is towards the deep connective tissue of the epithelium, while the surface is flat.

　　The three forms of epithelial surface all have hyperkeratosis, incomplete keratosis, and the keratin layer often sinks deeply into the epithelial deep layer. Around the keratinization of the epithelium, there are deeply stained degenerated and disintegrated fragments of epithelial cell nuclei and scattered neutrophil infiltration. The epithelial papillae widen and grow regularly into the connective tissue, and the dermal papillae between the epithelial papillae rise upwards. The dermal papillae are filled with large, round, or polygonal foam cells (also known as xanthoma cells) between the capillaries and collagen fibers, with clear boundaries, rich cytoplasm in a foamy state, small nuclei, and a shrinkage and deep staining located centrally. Collagen fibers can be seen with glass-like degeneration. There are rarely foam cells in the tissue below the epithelial papillae, and there may be chronic inflammatory cell infiltration. The Western medical treatment for vulvar verrucous xanthoma can be surgical resection, CO2 laser treatment, or cryotherapy.