Vaginal sarcoma in adolescents and children

　　Embryonal rhabdomyosarcoma is a subtype of mesenchymal mixed tumor, and its origin is controversial. Most believe it originates from the mesenchymal tissue of the mesonephric duct, and it has embryonal and immature characteristics, hence the name embryonal rhabdomyosarcoma.

　　If the lesion of the anterior vaginal wall continues to infiltrate the pelvic organs, it may involve the urethra and bladder, leading to symptoms such as frequent urination, urinary retention, and renal pelvis积水. In the late stage of tumor development, symptoms such as loss of appetite, weight loss, nausea, vomiting, dehydration, and low fever may occur, and death is often due to cachexia, respiratory failure, or uremia. If the mass extends upward to the pelvis, a mass can be palpated within the pelvis, and sometimes abdominal enlargement accompanied by ascites may occur. If the tumor metastasizes to the lymph nodes, enlarged lymph nodes can often be felt in both inguinal areas, or symptoms of pulmonary metastasis may appear.

　　The main symptoms of this disease are vaginal protruding mass and vaginal bleeding. Sometimes, it is occasionally found during baby bathing or changing diapers. Sometimes, when the child coughs or cries, the mass is expelled from the vagina due to increased abdominal pressure. Generally, there is no pain when the mass appears. If the lesion on the anterior vaginal wall continues to infiltrate pelvic organs, it may involve the urethra, bladder, and symptoms such as frequent urination, urinary retention, and renal pelvis hydrops may appear. In the late stage of tumor development, like other malignant tumors, symptoms such as loss of appetite, weight loss, nausea, vomiting, dehydration, and low fever may occur, and death is often due to cachexia, respiratory failure, or uremia. If the mass extends upwards to the pelvis, a mass can be felt in the pelvis, and sometimes the abdomen may increase in size with ascites. If the tumor metastasizes to the lymph nodes, enlarged lymph nodes can often be felt in both inguinal areas, or symptoms of lung metastasis may appear.

　　To prevent or reduce recurrence, attention must be paid to the following:

　　1. Early diagnosis.

　　2. Once diagnosed, emphasize the thoroughness of the first surgery according to the extent of invasion.

　　3. If the marginal tissue of the resected specimen is found to contain tumor cells, radiotherapy must be supplemented.

　　4. Good follow-up is required.

　　The reproductive organs of adolescents and children have not yet matured, especially the internal reproductive organs of children are located deep in the pelvis, making gynecological examination more difficult. Generally, routine abdominal and anal examinations are performed. When performing anal examination on children, it is best to insert the little finger into the rectum. If the condition requires, vaginal examination should still be performed.

　　Genital bleeding, infection, suspicion of foreign bodies in the genitals, tumors, trauma, and other conditions are absolute indications for vaginal examination and must be examined immediately to avoid delaying diagnosis. Congenital malformations, developmental disorders, acute abdomen, anal and rectal diseases, enuresis, and other conditions are relative indications and require cooperation with other specialized departments for examination.

　　The examination of a child's vagina and cervix generally uses a vaginal speculum (vaginoscope). According to the size of the hymen, a vaginal speculum with the corresponding diameter is selected. Generally, infants use a small vaginal speculum, smaller children use a medium one, and larger children use a large one. In addition, when collecting vaginal upper segment secretions, it is not advisable to use cotton swabs, as the cotton may fall off spontaneously during removal and leave behind in the vagina. It is best to use sterile glass pipettes or plastic tubes instead.

　　Before performing a vaginal speculum examination, it is necessary to obtain the consent of the family and cooperation. General anesthesia is not usually used, but if the child cannot cooperate well or the hymen is too small, it can be performed under general anesthesia. The child is placed in a supine position, the assistant fixes the child's hip and knee joints, causing the legs to flex, the abdominal wall to relax, and the vaginal speculum to be inserted slowly. The operation must be gentle to avoid causing injury and bleeding.

　　Adolescent and pediatric vaginal sarcoma should eat more of the following foods in diet:

　　1. Eat more foods that enhance immunity, such as turtle, sea turtle, sandworm, crucian carp, shark, water snake, white flower snake, crucian carp, mulberry, fig, lychee, walnut, loofah, purslane, soy sauce, olive, almond, luffa.

　　2. For infection and ulcers, eat watercress, snails, needlefish, loach, crucian carp, chrysanthemum, brussels sprouts, taro, mung bean, adzuki bean, malan tou.

　　3. Lymph node enlargement should eat taro, hawthorn, lily, water chestnut, mulberry, snails, yellow catfish, and cat meat.

　　In the past 30 years, there has been a great reform in the treatment of vaginal embryonal rhabdomyosarcoma, which has greatly improved the efficacy. In the early 1970s, most scholars believed that the best treatment for highly malignant grape-like sarcoma (embryonal rhabdomyosarcoma) was rapid and timely radical resection, and preoperative histological diagnosis was necessary. Postoperative radiotherapy or chemotherapy should be supplemented for 3-4 weeks.

　　One, Surgical Treatment

　　For surgical treatment, emphasis should be placed on the accuracy and thoroughness of the initial surgery, and efforts should be made to avoid or reduce recurrence as much as possible.

　　Two, Chemotherapy

　　Taking the VAC chemotherapy regimen as an example:

　　For recurrent or refractory childhood rhabdomyosarcoma, cyclophosphamide 250mg/(m2d) and topotecan 0.75mg/(m2d) can also be used intravenously for 30 minutes, with 5 days as one course of treatment (Saylors, 2001).

　　Three, Radiotherapy

　　The indications for radiotherapy are:

　　1. Strengthen radical treatment after combined hysterectomy and vaginal resection.

　　2. Tumor cells can be seen at the edge of the tissue of the first resection specimen.

　　3. Lesions have reached the advanced stage and cannot tolerate surgery or cases that cannot be cured by radical resection due to recurrence.

　　Above cases are all suitable for palliative radiotherapy. The dose of radiotherapy depends on age, the site and extent of the lesion.