Vaginal adenosis

　　The occurrence of vaginal adenosis is related to the use of hormonal drugs by the mother and the increase of vaginal pH. The specific etiology and mechanism of action are described as follows.

　　1. Etiology

　　The exact cause of vaginal adenosis is unknown. The appearance of glandular tissue in the vaginal wall is due to the residual mesonephric ducts during embryonic development, which have not been converted into squamous epithelium and are columnar epithelium. Under the action of certain factors, it develops into different types of vaginal adenosis. The change may be related to the following reasons.

　　1. Drug effects

　　Most believe that the occurrence of vaginal adenosis is closely related to the use of non-steroidal synthetic estrogens such as diethylstilbestrol (DES) or similar synthetic estrogens during the mother's pregnancy. The genotoxicity of DES may be related to one of its quinone metabolites, which can pass through the placenta and lead to a series of developmental abnormalities in the fetus. The use of DES by pregnant women can cause the mesodermal tissue of the fetal mesonephric ducts to grow below the normal cervix external os during fetal development, causing the junction of squamous epithelium and columnar epithelium to move downward. It may also interfere with the normal transformation process of the urogenital sinus epithelium and mesonephric duct epithelium during fetal development, resulting in some glands remaining and not being converted into squamous epithelium in time. In women infants or adolescents, affected by certain factors such as inflammation, hormones, and injury, the residual glands may proliferate and form vaginal adenosis or even tumors. The occurrence of vaginal adenosis is positively correlated with the time and dose of early embryonic exposure to DES, with the earlier and longer the exposure time, the higher the dose, and the higher the incidence of vaginal adenosis. About 1/3 of the offspring of mothers who were treated with DES before 18 weeks of gestation develop vaginal adenosis, and if DES is taken before 8 weeks of gestation, the incidence of vaginal adenosis in female offspring reaches 70%, but no cases occurred after 18 weeks of gestation. Such cases are often discovered during adolescence. However, Kaufman's follow-up study found that there is no effect on the third-generation female offspring of those exposed to DES in the embryonic period compared to their mothers.

　　Chemotherapy drugs may play a certain promoting role in the occurrence of vaginal adenosis.

　　2, Vaginal environmental factors

　　Patients without a history of DES contact may also develop vaginal adenosis, and DES contact is not the only cause. Patients without a history of DES contact are more likely to occur after puberty, and are therefore also known as acquired vaginal adenosis (acquired Vaginal Adenosis). The normal vaginal epithelium is destroyed by certain physical and chemical factors such as drugs, laser, and birth trauma, or the normal acidic environment of the vagina is changed, causing the vaginal pH to rise, leading to the replacement of the vaginal surface squamous epithelium with columnar epithelium, and further forming glandular structures, eventually developing into vaginal adenosis.

　　Second, Pathogenesis

　　Most of the vaginal adenosis is located in the upper third of the vagina, and the anterior vaginal wall is more common. In some cases, it can spread to the middle third of the vagina, and a few can spread to the lower third of the vagina, even to the hymen. Gross examination of vaginal adenosis can be divided into four types.

　　1, Occult type: The outer surface of the vaginal mucosa has no abnormal manifestations, but there is glandular tissue beneath the vaginal mucosal epidermis, which is often found in tissue biopsy or autopsy.

　　2, Cystic type: The vaginal endometrium contains one or more cystic structures of different sizes, with the cysts containing mucus. The lining of the cyst wall is similar to cervical glandular epithelium, and sometimes can form low and simple papillae.

　　3, Adenomatous type: The glandular tissue proliferates excessively, grows outwardly, and protrudes into the vagina to form vaginal masses, sometimes appearing polypoid.

　　4, Spot type (effluent): The vaginal glandular tissue proliferates. The gland cavity is connected to the vagina, causing the vaginal mucosal squamous epithelium to be replaced by columnar epithelium. During examination, the lesion site shows red spots, granular, macular, or erosive changes, and does not stain with iodine.

　　Under the microscope, glandular epithelium can show three morphologies:

　　(1) Similar to cervical endometrial glandular epithelium, with glandular epithelium being tall columnar. The cells contain mucus, and this type is the most common.

　　(2) Similar to endometrial epithelium, but without endometrial stroma.

　　(3) Similar to fallopian tube epithelial cells, this type is less common.

　　Vaginal adenosis glandular cells often secrete mucus, showing a positive reaction to mucus carmine or PAS. When the vaginal pH is low, glandular epithelial cells can show varying degrees of squamous metaplasia, and may appear with acanthotic squamous epithelium, which sometimes shows mucous droplets, which can be used as the basis for diagnosing vaginal adenosis. The superficial squamous epithelium involved in the lesion is mainly composed of basal cells and prickle cells lacking glycogen.

　　If the lesion is located in the cervix, it can be found that the cervix has transverse ridges or folds, or the cervix is underdeveloped, with the cervix having a chicken crest-like projection or cervicitis, and other manifestations. Vaginal adenosis sometimes accompanies cervical adenosis, resulting in underdeveloped cervix, and the cervix showing transverse ridges, folds, or chicken crest-like projections, and other malformation manifestations.

　　Most patients with vaginal adenosis have no obvious自觉 symptoms. If the lesion range is wide or involves the mucosal surface, there are often symptoms of increased leukorrhea, thin mucous leukorrhea, or bloody leukorrhea. It can also manifest as post-coital bleeding, dyspareunia, and vaginal burning sensation.

　　Gynecological examination of patients with vaginal adenosis often finds that the lesions are located in the vaginal fornix, the posterior wall of the upper and middle segment. Scope examination shows that the vaginal mucosa is eroded,呈糜烂状，red granular, red spotted, superficial ulcerative, palpation can be bleeding. Some may present as polypoid protuberances, some as single or multiple cystic protuberances on the vaginal wall, and some may manifest as the vaginal mucosa folding into a ring around the external os of the cervix. Vaginal palpation can sometimes feel hard nodules or sand-like lesions under the vaginal mucosa, with a diameter generally ranging from 0.5 to 5 cm. If the lesion is located in the cervix, the transverse ridge or pleat or poor development of the cervix, the cervix's rostral process or cervical inversion may be found.

　　The occurrence of vaginal adenosis is related to the use of estrogen during pregnancy, therefore, pregnant women should avoid the abuse of estrogen during pregnancy to reduce and prevent the occurrence of vaginal adenosis. For women who have been affected by DES (diethylstilbestrol) intrauterinely, regular gynecological examinations should be carried out to strengthen follow-up. For patients with a history of local treatment for vaginal lesions, especially those who apply fluorouracil and laser therapy, regular follow-up should be carried out. For those with small lesions and no symptoms, and those confirmed to be benign by histological examination, follow-up observation can be performed, with regular follow-up examinations every six months to one year. The examination should include routine leukorrhea examination, scraping cytological examination of the original lesion area, colposcopy. If suspicious or the range of the original lesion is expanded, or the nature changes, a repeat histological examination should be performed to clarify the diagnosis and exclude malignancy.

　　The examination of vaginal adenosis includes medical history, gynecology, cytology, colposcopy, and histological examination. The specific examination methods are described as follows.

　　1. Detailed medical history

　　Understanding the history of DES (diethylstilbestrol) can be used as a reference for diagnosis. For symptoms such as increased leukorrhea, vaginal bloody discharge, or dyspareunia, the cause should be investigated.

　　2. Gynecological examination

　　A thorough examination of the entire vagina and cervix is performed, paying attention to whether there are erythema, ulcers, nodules, and polypoid protuberances on the vaginal wall. Palpation is an important examination, which can confirm the vaginal transverse ridge and the hard nodules and ulcers behind it, and can also palpate the hard nodules under the vaginal mucosa.

　　3. Cytological examination

　　For suspected patients, scraping should be performed at the site of vaginal wall lesions, and circular or four-phase scraping should be performed at the upper part of the vagina. Cervical scraping should be taken separately. If mucus columnar cells or squamous cells are found, it indicates vaginal adenosis.

　　4. Vaginal colposcopy

　　It is generally considered a reliable method for diagnosing vaginal adenosis. Vaginal colposcopy has a diagnostic rate of 91% for vaginal adenosis. Colposcopy is of great help in the follow-up observation of vaginal adenosis, early detection of epithelial atypical hyperplasia and carcinoma.

　　5. Histological examination

　　The diagnosis of vaginal adenosis is based on. If abnormal lesions are found during vaginal examination, multiple biopsies should be performed.

　　Patients with vaginal adenosis should pay attention to the choice of diet and the supplement of nutrition during radiotherapy and chemotherapy. Patients with this disease should eat more foods that have anti-myelopathy and osteosarcoma properties; eat more foods that enhance immune function, etc. Avoid smoking, drinking, and spicy刺激性 foods; avoid foods such as mutton, goose meat, and pork head meat that cause heat. The specific dietary precautions are as follows.

　　First: Chemotherapy dietary therapy

　　1. Chinese wolfberry turtle lean meat soup: 30g of Chinese wolfberry, one turtle (about 500g), 150g of lean pork. Put the turtle in hot water to swim, make it urinate, then kill and cut it open, remove the internal organs, wash and cut into pieces, add an appropriate amount of water, stew with Chinese wolfberry and lean pork until tender, and take in 2 to 3 doses.

　　2. Chinese wolfberry sea cucumber lean meat stew: 15g of Chinese wolfberry, 250g of sea cucumber, 100g of lean pork. Soak the sea cucumber first, clean it, then cut the sea cucumber and lean pork into slices, add an appropriate amount of water to cook until tender, season and eat, and take in several doses.

　　3. Mushroom Cordyceps stewed chicken: 20g of mushrooms, 15g of Cordyceps sinensis, one chicken that has not laid eggs. Remove the mushroom stem, and remove the feathers, head, feet, and internal organs of the chicken, put the mushrooms and Cordyceps sinensis into the chicken abdomen, seal with bamboo skewers, add an appropriate amount of water, simmer slowly for 2 hours, season and eat, and can be taken in 2 to 3 doses.

　　4. Milk egg white lotus seed paste: 250ml of fresh milk, 2 fresh eggs, 50g of lotus seed. Grind the lotus seed into powder, add an appropriate amount of water to cook the lotus seed powder into a paste, add rock sugar or white sugar for seasoning, then add milk and egg white and mix well, boil and serve. Once or twice a day.

　　5. Chicken gizzard and ginger rabbit meat soup: 12g of chicken gizzard, 30g of sprouted barley, 3 slices of ginger, 100g of rabbit meat. Add an appropriate amount of water to cook the soup together, season with a little salt, drink the soup and eat the meat. Once or twice a day.

　　6. Amomum and Chinese yam stewed pork stomach: 15g of amomum, 50g of Chinese yam, one pork stomach. Break the amomum, wash and remove the fat from the pork stomach. Put the amomum and Chinese yam into the pork stomach, add an appropriate amount of water, simmer slowly until the pork stomach is tender, season with a little salt, drink the soup or eat with food.

　　Second: Radiotherapy dietary recipe

　　1. Bird's nest and American ginseng stew: 6g of bird's nest, 9g of American ginseng. Soak the bird's nest in warm water, remove the bird's nest hair, slice the American ginseng, add an appropriate amount of water, steam for 12 hours, and then take.

　　2. Pear juice sugarcane water chestnut syrup: 1 part pear juice, 2 parts sugarcane juice, 1 part water chestnut. Mix the three ingredients evenly and serve cold, or heat and serve warm.

　　3. Astragalus and Chinese yam water fish stew: 30g of astragalus, 20g of Chinese yam, one water fish (about 500g). Wrap the astragalus in gauze, remove the scales and internal organs of the fish, wash and cut into pieces. Add an appropriate amount of water, stew until tender, remove the astragalus residue, add a little oil and salt for seasoning, and take in several doses.

　　4. Turtle and pork trotter ginseng soup: One turtle (about 150g to 250g), 250g of pork trotter, 10g of ginseng. First, blanch the turtle in boiling water to expel urine, cut off the head and feet, remove the internal organs, wash and cut into pieces. Add an appropriate amount of water, simmer slowly until tender, and take in several doses.

　　Three: What is good for patients with vaginal adenosis

　　1. It is recommended to consume more foods that have anti-myelopathy and osteosarcoma properties, such as kelp, nori, sea asparagus, clam, wakame, almonds, peach kernels, and plums.

　　2. Pain should eat turtle shell, turtle meat, rhinoceros horn, oyster, crab, shrimp, walnut.

　　3. Liver enlargement should eat turtle, eel, eel, clam, kelp, kombu.

　　4. Anemia should eat pork liver, mushroom, sesame, bee milk, yellowfish, peanut, sea cucumber, grass carp, abalone.

　　5. Eat more foods that enhance immunity, such as turtle, tortoise, sea turtle, sandworm, crucian carp, shark, water snake, shrimp, white snake, crucian carp, mulberry, fig, lychee, walnut, loquat, hawthorn, almond, luffa.

　　6. Infection and ulcers should eat bok choy, snails, needlefish, eels, smelt, golden needle, rapeseed, taro, mung bean, red bean, malan tou.

　　7. Lymph node enlargement should eat taro, hawthorn, lily, lotus root, mulberry, snails, yellowfish, cat meat.

　　4. What to eat is bad for vaginal gland disease patients

　　1. Avoid smoking, alcohol, and spicy刺激性 foods.

　　2. Avoid moldy, salted, fried, greasy foods.

　　3. Avoid mutton, goose meat, pork head meat, and other stimulants.

　　The treatment of vaginal gland disease includes etiological treatment, drug treatment, physical and chemical treatment, and surgical treatment. The specific treatment methods are described as follows.

　　1. Vaginal Inflammation

　　Vaginal inflammatory lesions can induce the appearance of symptoms of latent vaginal gland disease, so positive etiological treatment should be given to various vaginal inflammations.

　　2. Increase Vaginal Acidity

　　Highly acidified vaginal environment (pH 1.8-2.4) can promote squamation of glandular epithelium. Local sitz baths and vaginal flushing can be used, such as 0.5% acetic acid vaginal flushing, 8-10g boric acid powder sitz bath, etc.

　　3. Physical and Chemical Treatment

　　For superficial and small lesions, laser, cryotherapy, electrocoagulation and other treatments can be adopted, with a depth of generally 3-5mm, causing the lesion to necrose, vaporize, and fall off. It can also be locally coated with 10%-20% silver nitrate or potassium dichromate solution, twice a week, for three consecutive months, causing the lesion to necrose and fall off.

　　4. Surgical Treatment

　　For solitary focal lesions under the mucosa, surgical complete resection of the lesion can be adopted. For those found to have severe atypical hyperplasia or have already become malignant, the treatment principle is the same as that for vaginal cancer, with tumor resection or total vaginal resection, followed by vaginal plastic surgery.