Vulvar mesonephric duct cyst

　　One, Etiology

　　The paramesonephric duct cyst of the vulva is a cyst derived from the remnants of the mesonephric duct, which is rare in the vulvar region because the terminal part of the mesonephric duct remnants only reaches the hymen and vaginal orifice. Therefore, this cyst occurs in the vicinity of the hymen, adjacent to the clitoris or around the urethra.

　　Two, Pathogenesis

　　The renal cyst originates from the remnants of the female mesonephric duct in the vaginal part. During the normal process of embryonic development, the mesonephric structure regresses and atrophies, losing its glandular lining. If these small tubes continue to retain their secretory function, cysts may form due to the accumulation of secretions.

　　It is difficult to distinguish between the paramesonephric cyst and the renal cyst clinically, as it occurs in the remnants of the paramesonephric duct. In the early stages of embryogenesis, the vaginal cavity is occupied by glandular epithelium of the paramesonephric structure. Later, due to the upward growth of stratified squamous epithelium of the urogenital sinus, it replaces the original paramesonephric duct epithelium. In this process, some paramesonephric epithelial islands may be left behind, which, due to their glandular epithelial structure and secretory function, form paramesonephric cysts.

　　In pathological examination, the inner wall of the renal cyst is lined with cuboidal or low columnar epithelium without cilia, with a clear basement membrane. Occasionally, squamous epithelium can be seen in the lumen. The paramesonephric cyst has two types, namely, cervical canal epithelium and fallopian tube epithelium. The cervical canal epithelium has a high columnar epithelium that secretes mucus, with the nucleus located at the bottom and clear cytoplasm, sometimes referred to as picket cells. The fallopian tube epithelium is mainly characterized by an irregularly columnar lining, with some having cilia and others not, with larger nuclei and unclear basement membranes.

　　The renal and paramesonephric cysts differ not only in the morphology of their epithelial cells but also in the presence or absence of smooth muscle fibers around them. The renal cyst has smooth muscle fibers on the outer side of its epithelium, while the paramesonephric cyst usually does not. The most reliable method for differentiation is PAS staining, as the renal cyst does not contain mucus and is PAS-negative, whereas the paramesonephric cyst is positive.

　　Vulvar mesonephric cysts are often located around the small labia, clitoris, and hymen. From the perspective of histogenesis, mesonephric cysts should appear in the lateral anterior part of the vestibule, while paramesonephric cysts can occur in any part of the vestibule. These cysts are thin-walled, semi-transparent, often pedunculated, and asymptomatic in smaller cysts. Larger cysts may cause a sense of坠坠不适. These cysts are usually solitary, and bilateral occurrence is rare. The cysts are generally small, with a diameter of 1-2 cm, but some can reach 10 cm, protruding from the vaginal orifice, with a very thin wall and a fluctuating sensation. Sometimes the cyst cavity can extend upward along the vaginal side into the peritoneal cavity outside the abdomen. If the cyst occurs below the urethra, it may cause symptoms such as frequent urination or urinary retention.

　　Vulvar mesonephric cysts are often located around the small labia, clitoris, and hymen. From the perspective of histogenesis, mesonephric cysts should appear in the lateral anterior part of the vestibule, while cysts derived from paramesonephric structures can occur in any part of the vestibule. These cysts are thin-walled, semi-transparent, often pedunculated, and asymptomatic in smaller cysts. Larger cysts may cause a sense of坠坠不适. These cysts are usually solitary, and bilateral occurrence is rare. The cysts are generally small, with a diameter of 1-2 cm, but some can reach 10 cm, protruding from the vaginal orifice, with a very thin wall and a fluctuating sensation. Sometimes the cyst cavity can extend upward along the vaginal side into the peritoneal cavity outside the abdomen. If the cyst occurs below the urethra, it may cause symptoms such as frequent urination or urinary retention.

　　1. Pay attention to hygiene: Pay attention to health education, keep the external genitalia clean and dry.

　　2. Strengthen physical fitness, prevent infection: Pay attention to the combination of work and rest, eat more fresh fruits and vegetables rich in vitamins, exercise more, and rest more.

　　3. Regular physical examination: Early prevention and treatment can improve survival rate, and regular observation and follow-up can be arranged.

　　Epidemiology: Vulvar mesonephric cysts are relatively rare. Prognosis: No obvious adverse prognosis.

　　The diagnosis of vulvar mesonephric cysts relies not only on clinical manifestations but also on related examinations, which are indispensable. Common examinations include:

     1. PAS staining examination, tumor marker examination.

　　2. Histopathological examination.

　　Firstly, what is good for the body to eat with vulvar mesonephric cysts

　　1. The diet should be fresh, light, and rich in nutrition, with an emphasis on eating more fruits.

　　2. For kidney cysts, eat more high-quality protein foods, pay attention to the supplementation of high-fiber and high-vitamin foods, and have a low-fat, moderate sugar diet.

　　Secondly, it is best not to eat those foods for vulvar mesonephric cysts

　　1. Avoid eating trigger foods. Such as fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which can worsen the itching and inflammation of the vulva after eating.

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

　　3. Avoid eating fried and greasy foods. Such as fried dough sticks, butter, butter, chocolate, etc., these foods have the effect of moistening 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 alcohol have a strong irritative effect and can worsen inflammation.

　　5. Avoid salty foods, especially preserved ones;

　　6. Avoid contaminated foods such as unhygienic foods, rotten and deteriorated foods, leftover meals, etc.

　　7. Avoid barbecued foods.

　　1. Precautions before the treatment of vaginal mesonephric cysts

　　Prevention:

　　1. Pay attention to hygiene: Pay attention to health education, keep the external genitalia clean and dry.

　　2. Strengthen physical fitness, prevent infection: Pay attention to the combination of work and rest, eat more fresh fruits and vegetables rich in vitamins, exercise more, and rest more.

　　3. Regular physical examination: Early prevention and treatment can improve survival rate, and regular observation and follow-up can be arranged.

　　2. Traditional Chinese medicine treatment methods for vaginal mesonephric cysts

　　1. Internal administration:

　　2. Er San:

　　(1) Composition: Erbao San is a powder prepared from traditional Chinese medicine Huang Bai and Cang Zhu. Composition: Huang Bai (fried), Cang Zhu (soaked in rice water, fried). The two ingredients are ground into powder, decocted with boiling water, and served with ginger juice.

　　(2) Main Ingredients: 'Berberine hydrochloride'.

　　(3) Effects: It has the effect of lowering serum uric acid, which can reduce the damage to the kidney caused by hyperuricemia. It can also be used for the treatment of arthritis, scrotal eczema, vaginitis, and other diseases.

　　3. External use:

　　(1) Function and Indications: Clear heat and detoxify, reduce swelling and relieve pain. Used for throat pain due to heat toxin accumulation, gum swelling and pain, sore mouth and tongue; clear heat and detoxify, remove gangrene and promote muscle growth.

　　Mainly for laryngopharyngitis, laryngitis, tonsillitis, heavy tongue, wooden tongue, purple tongue, sore mouth and tongue, and can also treat toothache. Now used for oral cavity, throat; purify and remove toxins.

　　Main symptoms: tongue swelling, throat erosion, toothache, tongue dryness, and cracked lips.

　　(2) Composition: 50g of borneol, 500g of borax (calcined), 60g of cinnabar, 500g of alkaline sulfate; Dosage and Administration: Blow on the affected area, use a small amount each time, several times a day. It can be cured.

　　3. Western medical treatment methods for vaginal mesonephric cysts

　　1. If the cyst is not large and there are no symptoms: surgery is not necessarily required, and regular follow-up can be arranged to closely observe the development of the cyst.

　　2. If there is enlargement or symptoms: surgery can be performed to remove.

　　4. Precautions:

　　If the cyst is large, special attention should be paid to protect the urethra and rectum during surgery to avoid injury.

　　If the cyst extends upwards to the fornix or enters the parauterine area, more attention should be paid to avoid injury to the ureter and bladder.

　　If it is difficult to remove all, you can cut open the cyst wall and peel off the inner lining of the epithelium.