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Vulvar Malignant Lymphoma

  Vulvar malignant lymphoma usually involves the reproductive tract as part of a systemic disease, but primary vulvar malignant lymphoma has also been reported. Malignant lymphoma is divided into two major categories based on clinical and pathological criteria: Hodgkin's lymphoma (HD) and non-Hodgkin's lymphoma (NHL).

 

Table of Contents

1. What are the causes of vulvar malignant lymphoma
2. What complications can vulvar malignant lymphoma easily lead to
3. What are the typical symptoms of vulvar malignant lymphoma
4. How to prevent vulvar malignant lymphoma
5. What laboratory tests are needed for vulvar malignant lymphoma
6. Diet taboos for patients with vulvar malignant lymphoma
7. Routine methods of Western medicine for the treatment of vulvar malignant lymphoma

1. What are the causes of vulvar malignant lymphoma

  1. Causes of Disease

  The occurrence of vulvar malignant lymphoma may be related to local infection. EB virus and HIV virus infection can be found in patients with vulvar malignant lymphoma, and the incidence of non-Hodgkin's lymphoma (NHL) is higher. The occurrence of the disease is closely related to immunosuppression, and some congenital immune deficiencies often accompany malignant lymphoma. Certain bacterial infections such as Helicobacter pylori (HP) and environmental factors such as the use of pesticides and agricultural chemicals can also lead to the occurrence of the disease.

  Second, pathogenesis

  The tumor cells of malignant lymphoma, including lymphocytes, lymphoblasts, reticular cells, and so on, have varying degrees of anaplasia. The tumor cells are scattered or dense, and there are nuclear division figures. The tumor is not clearly demarcated from the surrounding tissue.

  1. Histological classification

  According to the tissue cell morphology, it is divided into non-Hodgkin's lymphoma and Hodgkin's disease. The main histological classification of non-Hodgkin's lymphoma includes Rappaport classification (1966), Lukes and Collins classification (1975), International NHL working classification (1981), and clinical classification of the National Cancer Institute (NCI) of the United States (1989). However, these classifications do not include important prognostic features such as immunophenotype, nor do they include new types such as mantle cell lymphoma and anaplastic large cell lymphoma. Therefore, in 1995, the International Lymphoma Collaborative Group proposed a new classification system - 'Revised European-American Lymphoma Classification'.

  2. Immunohistochemistry

  The common leukocyte antigen CD45 is positive. The B cell type also shows CD20, CD45RA, CD45RB, CD74, and CD79a positive. The T cell type is mostly CD3, CD4, CD45RO positive. CD30 is a diagnostic marker for Hodgkin's disease and anaplastic large cell lymphoma.

  3. Vulvar malignant lymphoma

  Kaplan et al. summarized 16 patients with 5 cases of reticulum cell sarcoma, 1 case of lymphosarcoma, and according to the NHL working classification criteria, 8 cases were diffuse large cell type. Macleod et al. reported 14 cases of primary vulvar malignant lymphoma, 13 cases were NHL, 10 cases (77%) were diffuse large cell type, 1 case was small cell type, and 2 cases were diffuse large and small cell mixed type. Among them, 6 cases underwent immunotyping, 4 cases were B cell type. Vang et al. reclassified the patients according to the 'Revised European-American Lymphoma Classification' criteria, and found that 7 cases of primary vulvar NHL were diffuse large cell type, in addition, 1 case of diffuse mixed type, peripheral T cell lymphoma, follicular large cell type. Among them, 8 cases underwent immunotyping, 6 cases were B cell type; 4 cases (50%) of secondary vulvar NHL were diffuse large cell type, peripheral T cell lymphoma, follicular small cleaved cell type, small lymphocytic type, and mycosis fungoides each 1 case. In 9 patients without stage information, 5 cases were diffuse large cell type, and there were also Burkitt lymphoma, angiocentric cell lymphoma, lymphoplasmacytic lymphoma, and so on.

2. What complications can vulvar malignant lymphoma easily lead to?

  1. The occurrence of vulvar malignant lymphoma may be related to local infection. EB virus and HIV virus infections can be found in patients with vulvar malignant lymphoma, and the incidence of non-Hodgkin's lymphoma (NHL) is relatively high. The occurrence of the disease is closely related to immunosuppression, and some congenital immune deficiencies often accompany malignant lymphoma. Certain bacterial infections such as Helicobacter pylori (HP) and environmental factors such as the use of pesticides and agricultural chemicals can also lead to the occurrence of the disease.

  2. Vulvar malignant lymphoma is prone to ulceration and bleeding due to local friction, combined with decreased resistance, pathogenic bacteria entering the body, which may lead to concurrent infection.

3. What are the typical symptoms of vulvar malignant lymphoma?

  1. Medical history

  The incidence of non-Hodgkin's lymphoma in patients with HIV infection is 20 times higher than that in patients without infection, so routine HIV testing is recommended for patients with vulvar non-Hodgkin's lymphoma. In addition, 2 patients have a history of immunosuppression, 1 taking azathioprine due to dermatomyositis, and the other receiving azathioprine and prednisone after renal transplantation. In 8 cases of secondary vulvar NHL, 4 had a history of NHL, and 1 had a history of chronic lymphocytic leukemia (Vang 2000).

  2. Symptoms and signs

  The course of the disease varies from 1 to 39 months. Common symptoms include swelling of the vulvar skin or subcutaneous nodular masses, accompanied by pain, difficulty in sexual intercourse, and at the same time, there may be skin itching, vaginal bleeding, and discharge. The size of the mass ranges from 3 to 14 cm, with an average of 5.5 cm, and it is明显 painful. The surface skin may show erythema or edema, ulceration, or it may only manifest as lower limb edema. Occasionally, there may be fever and weight loss. Some patients may present with anemia, often accompanied by enlargement of bilateral inguinal lymph nodes. They often seek medical attention due to masses, bleeding, and pain, and some cases may show no change in the mass for several years.

4. How should vulvar malignant lymphoma be prevented?

  Some scholars have reported that the age of onset of vulvar malignant lymphoma ranges from 21 to 89 years, with an average of 58 years. Vang et al. reported that the age of onset of primary vulvar NHL was 25 to 79 years, with an average of 59 years, while the age of onset of secondary vulvar NHL was 66 to 89 years, with an average of 75 years.

  The course of the disease varies from 1 to 39 months. Common symptoms include swelling of the vulvar skin or subcutaneous nodular masses, accompanied by pain, difficulty in sexual intercourse, and at the same time, there may be skin itching, vaginal bleeding, and discharge. The size of the mass ranges from 3 to 14 cm, with an average of 5.5 cm, and it is明显 painful. The surface skin may show erythema or edema, ulceration, or it may only manifest as lower limb edema. Occasionally, there may be fever and weight loss. Some patients may present with anemia, often accompanied by enlargement of bilateral inguinal lymph nodes. They often seek medical attention due to masses, bleeding, and pain, and some cases may show no change in the mass for several years.

  Prognosis after treatment: Since the follow-up period for most cases is short, it is impossible to evaluate the indicators for predicting prognosis. Kaplan et al. reported that 8 out of 16 patients had local recurrence. The follow-up period was 0 to 60 months (average 14 months), with 8 patients surviving, and the best case had been tumor-free for 5 years. Vang et al. reported that 4 out of 10 cases of primary vulvar NHL died within 1 year, with 1 case surviving tumor-free for 3 years; while 5 out of 8 cases of secondary vulvar NHL died within 1 to 7 months after the diagnosis of vulvar NHL.

 

5. What laboratory tests are needed for vulvar malignant lymphoma?

  The diagnosis of vulvar malignant lymphoma relies not only on clinical manifestations but also on relevant examination methods, which are indispensable. The examinations include the following:

     1, Immunohistochemical detection.

  2, Histopathological examination.

6. Dietary taboos for patients with vaginal malignant lymphoma

  First, Fruit and vegetable therapy

  1, Pumpkin 150 grams, appropriate amount of water, a little seasoning. Boil until there is no water and serve.

  2, Sugar cane 2 pieces, squeezed for juice to drink.

  3, Asparagus 200 grams, stir-fried with appropriate seasonings and served.

  Second, Dietotherapy

  1, Goat bone congee

  Ingredients: Goat bone 1000 grams, glutinous rice 100 grams, a little fine salt, 2 scallion stalks, 3 slices of ginger.

  Preparation: Clean the fresh goat bone, break it, add water to boil the soup, use the soup as water, cook the glutinous rice together, add fine salt, ginger, and scallion stalks as seasonings when the congee is about to be done, and boil for a few boils.

  Indications: Yin deficiency in the liver and kidney after radiotherapy for malignant lymphoma. Administration: Eat 1-2 times a day.

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  Ingredients: Minced meat 100-150 grams, goji berries and pine nuts each 100 grams.

  Preparation: Add minced meat to yellow wine, salt, and spices, fry over high heat until half-cooked, then add goji berries and pine nuts, and fry together.

  Indications: Yin deficiency and internal heat after radiotherapy for malignant lymphoma. Administration: Take once a day, as a side dish.

  3, Pork kidney and Chinese yam soup

  Ingredients: Fresh Chinese yam 30 grams, pork kidney and testicles each 1, a little salt, scallions, and ginger.

  Preparation: Soak the fresh Chinese yam in water for 2 hours, then decoct the soup, filter the liquid, wash the pork kidney and testicles clean, remove impurities, cut into block shape, add the filtered liquid of the Chinese yam, and cook together with salt, scallions, and ginger over low heat until cooked.

  Indications: Deficiency of essence and blood after chemotherapy for malignant lymphoma. Administration: Drink the soup and eat pork kidney and testicles as a side dish every day, which can be taken regularly.

  4, Chinese yam and goji berry and Chinese yam soup

  Recipe: Chinese yam 17g, Chinese yam 32g, goji berries 26g, longan meat 25g, pork ribs 300g. Salt and black pepper in appropriate amounts.

  Preparation: Wrap Chinese yam and other traditional Chinese medicine in a cloth bag and place them together with pork ribs, add 4 bowls of clear water. Boil over high heat and then low heat, simmer for 2-3 hours. Add salt and black pepper to taste. It can be cooked into 3 small bowls. Eat 1 small bowl each time, eat the meat and drink the soup. Eat once every 1-2 days.

  Effectiveness: Generate and nourish blood, stimulate the appetite and invigorate the spleen. This diet is suitable for patients with malignant lymphoma whose tumors increase rapidly and have dark purple spots on the tongue.

  5, Mung bean sprout cold noodles

  Recipe: Mung bean sprouts 150g, thin noodles 300g, lean meat shreds 75g, 1 egg, 1 cucumber, a little minced garlic, soy sauce and sesame oil each 4-6 milliliters. Salt, scallions, sesame paste, salad oil, ice water, cold water in appropriate amounts. Preparation: Boil the noodles, rinse with ice water twice, mix with sesame oil, place in a bowl, store in the refrigerator for later use. Mix sesame paste with vinegar and salt, add minced garlic, sauté the lean meat shreds with salad oil and scallions, add soy sauce and cold water, and boil into meat juice. Scramble the egg into thin slices and cut the cucumber into shreds. Boil the mung bean sprouts briefly with hot water. Mix the above seasonings and vegetables with the noodles, mix well, and it is ready to eat. Those who like vinegar can add a little rice vinegar.

  Effectiveness: Clear heat and detoxify, promote the circulation of the Sanjiao. This diet is mainly suitable for patients with lymphosarcoma with severe heat-toxin.

  Three, Vaginal malignant lymphoma: What foods are good for the body

  1, It is advisable to eat more foods with anti-vulvar tumor and leukoplakia effects, such as sesame, almond, wheat, barley, loofah, black-bone chicken, cuttlefish, green mamba, pork pancreas, chrysanthemum, black plum, peach, lychee, Portulaca oleracea, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, turtle, etc.

  2, Lymph node enlargement should eat water chestnut, taro, walnut, lychee, yellow catfish,螺蛳, sheep stomach, cat meat, oyster.

  3, 发热宜吃豆腐渣、无花果、大麦、绿豆、苦瓜、节瓜、菱、水蛇。

  4,盗汗宜吃猪心、羊肚、燕麦、高粱、豆腐皮。

  5, After surgery, it consumes Qi and injures blood, and it is advisable to eat more foods that tonify Qi and nourish blood, such as jujube, longan, adzuki bean, glutinous rice, lychee, mushroom, carrot, quail egg, lotus root powder, beans, etc.

  6, Radiotherapy after surgery: It consumes Yin and fluid, and it is advisable to eat more nourishing Yin and fluid products, such as spinach, vegetable greens, lotus root, loofah, watermelon, banana, grape, sea cucumber, sugarcane, lily, etc.

  7, Chemotherapy after surgery: It is easy to damage both Qi and blood, and it is advisable to often eat foods that nourish Qi and blood, such as wood ear, mushroom, walnuts, mulberries, Job's tears congee, jujube, longan, sea cucumber, etc.

      Fourthly, the foods that should not be eaten for vulvar lymphoma:

  1, Avoid stimulating drinks such as coffee.

  2, Avoid spicy and刺激性 foods such as scallion, garlic, ginger, cinnamon, etc.

  3, Avoid greasy, fried, moldy, and preserved foods.

  4, Avoid stimulants such as rooster and pork head meat.

  5, Avoid seafood.

  6, Avoid warm foods such as mutton, dog meat, chive, pepper, etc.

  7, Avoid smoking and drinking.

7. Conventional methods of Western medicine for the treatment of vulvar lymphoma:

  Clinical practice has proven that for patients in the middle and advanced stages, large doses of radiotherapy and chemotherapy, or rechemotherapy for patients with drug resistance, can only lead to the life of weakness becoming more dangerous, accelerating the death of patients. Clinically, it is often seen that the cause of death of patients is not due to cancer itself, but due to unscientific and inappropriate killing treatment. For example, after multiple interventional treatments for liver cancer, ascites and jaundice occur, leading to liver failure and death; after chemotherapy for pleural effusion in lung cancer, respiratory failure occurs and death; after chemotherapy for gastric cancer and colorectal cancer, nausea and vomiting occur, and the patients become more exhausted and die; with decreased leukocytes, the patients die from infection, etc.

  Firstly, do a good job in the three-level prevention of tumors.

  1, Syndrome of Phlegm-heat Retention:

  Swelling nodes in the neck or inguinal region, or with feeling of fullness in the epigastrium and abdomen, severe fever, often with night sweats, dry mouth and thirst, swelling and pain in the throat, irritability and insomnia, or with skin itching, or yellowing of the body and eyes, dry stools or hematochezia, oliguria, red tongue with dry and yellow fur or red and绛 without fur, thin and rapid pulse or thin and slippery.

  Treatment method: Clear heat and detoxify, resolve phlegm and consolidate. Principal formula: modified Lianqiao Detoxification Decoction. Medicines: Scrophularia ningpoensis, Forsythia, Pueraria lobata, Talcum, Prunella vulgaris, Sagina japonica, Curcuma phaeocaulis, Scutellaria baicalensis, Paeonia lactiflora, Gardenia jasminoides, Sophora tonkinensis, Glycyrrhiza uralensis, etc.

  2, Syndrome of Qi stagnation and Phlegm retention (including Qi-stagnation Phlegm retention):

  Feeling of oppression in the chest, swelling in the hypochondria, feeling of fullness in the epigastrium and abdomen, multiple lumps in the neck, axilla, or inguinal region, without change in skin color, or with local swelling, or accompanied by low fever and night sweats, pale red tongue with thin white or thin yellow fur, wiry and slippery pulse, or thin and wiry.

  Method of treatment: Soothe the liver, relieve depression, resolve phlegm and disperse knots. Main formula: Chaihu Shugan San combined with Xiaoluo Wan. Adjuvant drugs: Shengmuli, Xuan Shen, Xiakucao, Maozhua cao, Chaihu, Baishao, Zhiqua, Xiangfu, Yujin, Zhubei Mu, Zhigancao. For firm or large abdominal masses, add Sanlie, Yike; for multiple lymph nodes in the neck or other areas, add Luhufang, Tuber fuscum; for phlegm-heat, add Tianhuafen, Zhaoxiu; for low fever and night sweats, add Digenpi, Yin Chaihu; for concurrent spleen deficiency, add Dangshen, Fuling.

  3. Syndrome of spleen deficiency and phlegm dampness:

  General malaise, pale or slightly yellow complexion, pale lips, lymphadenopathy in the neck or inguinal region or peritoneal cavity, poor appetite, thin or loose stools, thin white or greasy tongue coating, pale tongue, thin pulse. This type is common after chemotherapy.

  Method of treatment: Strengthen the spleen, replenish Qi, transform dampness and eliminate phlegm. Main formula: Liujunzi Decoction. Adjuvant drugs: Dangshen, Baizhu, Fuling, Chenpi, Banxia, Gancao, Maozhua cao, Luhufang. For white greasy tongue coating, add Huoxiang, Peilan, Cangzhu, Houpu. For enlarged and hard lymph nodes, add Sanlie, Yike, Luoshiteng, etc.

  4. Syndrome of deficiency of both Qi and blood:

  Common in advanced stages or after multiple courses of radiotherapy and chemotherapy, with lymph nodes or masses in the neck or inguinal region, or abdominal masses, pale or sallow complexion, dizziness and dizziness, palpitations, palpitations, shortness of breath, fatigue, loss of appetite, pale tongue, thin white fur, thin pulse, or weak and large pulse.

  Principle of treatment: Invigorate the Qi, nourish the blood, soften hardness and disperse knots. Main formula: Bashen Decoction. Adjuvant drugs: Dangshen, Shudihuang, Jixueteng, Maozhua cao, Xiakucao, Baizhu, Fuling, Danggui, Baishao, Chuanxiong, Zhigancao. For obvious Qi deficiency, add Huangqi; for anorexia and loose stools, add Shentao, Biandou; for concurrent Yang deficiency, add Shuhuixi, Rougui. For large masses, add Sanlie, Yike.

  5. Syndrome of Yin deficiency in liver and kidney (including Yin deficiency with fire):

  Common in advanced stages or those with inherent Yin deficiency, or after multiple courses of radiotherapy, with lymph nodes or masses in the neck or inguinal region, or abdominal masses, afternoon feverishness, restlessness of the five interiors, insomnia and night sweats, dry mouth and sore throat, dizziness and dizziness, red tongue with little or no fur, wiry and thin pulse, or deep and thin pulse.

  Principle of treatment: Tonify the liver and kidney, soften hardness and disperse accumulation. Main formula: Zhibai Dihuang Wan combined with Erzhi Wan. Adjuvant drugs: Shengdi, Shengmuli, Shanyao, Nuzhenzi, Hanliancao, Kunnan, Fuling, Zexie, Mudanpi, Zhimu, Huangbai. For severe fever and night sweats, add Baiwei, Digenpi; for dry mouth and constipation, add Yuju, Xuan Shen; for distension in the two sides of the chest, add Chuanlianzi, Yanhusuo; for anorexia and abdominal distension, add Shanzha, Jijin; for large masses, add Sanlie, Yike.

  The treatment of external genital malignant lymphoma in Western medicine includes chemotherapy (radiotherapy): malignant lymphoma is sensitive to chemotherapy and radiotherapy. Macleod et al. proposed that for low-grade malignant focal external genital NHL, simple radiotherapy with a dose of 30 to 40 Gy (2 Gy per fraction) can be given. For moderately and highly malignant NHL, due to a high rate of systemic recurrence, chemotherapy or chemotherapy combined with radiotherapy is generally used. Bai Ping et al. suggested the sequential treatment of chemotherapy-radiotherapy-chemotherapy for malignant lymphoma of the external genitalia. The first 1 to 3 courses of chemotherapy are given to achieve complete remission of the tumor, followed by radiotherapy at the tumor site (18 to 30 Gy) to prevent local recurrence, and then consolidation chemotherapy for 2 to 3 courses.

  II. Common chemotherapy regimens include

  1. COP regimen:

  Cyclophosphamide 800mg/, intravenous injection, on the first and 15th days; Vincristine 1.4mg/, intravenous injection, on the first day; Prednisone (prednisone) 100mg, oral, on the first to fifth day. Repeat one course every 3 weeks. The effective rate is over 80%.

  2. CHOP regimen:

  Cyclophosphamide 750mg/, intravenous infusion, on the first day; Doxorubicin (adriamycin) 50mg/, intravenous infusion, on the first day; Vincristine 1.4mg/, intravenous injection, on the first day; Prednisone (prednisone) 100mg, oral, on the first to fifth day. Repeat one course every 3 weeks. The effective rate is over 90%.

  3. In addition, there are other regimens such as BACOP regimen (bleomycin, doxorubicin, cyclophosphamide, vincristine, and prednisone), MBACOD regimen (methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone), and so on.

  Bai Ping et al. used BACOP regimen chemotherapy for 4 courses and added local radiotherapy to treat vulvar malignant lymphoma. The tumor was completely relieved, but after 2 months, there was metastasis in the nasal cavity and left orbital, and PECB (cisplatin, etoposide, cyclophosphamide, and pingyangmycin) regimen was used for 5 courses after that, and complete remission was achieved. Follow-up for 4 years with no tumor recurrence. Complications include tumor ulceration and infection. Prognosis and prevention: Because most of the cases have a short follow-up period, it is impossible to evaluate the indicators for predicting the prognosis. Kaplan et al. reported that 8 of the 16 cases had local recurrence. Follow-up for 0 to 60 months (average 14 months), 8 cases survived, and the best case had 5 years of tumor-free survival. Vang et al. reported that 4 of the 10 primary vulvar NHL cases died within 1 year, and 1 case survived for 3 years without tumor recurrence; while 5 of the 8 secondary vulvar NHL cases died within 1 to 7 months after the diagnosis of vulvar NHL.

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