Vulvar malignant fibrous histiocytoma

　　1. Etiology

　　Vulvar malignant fibrous histiocytoma originates from undifferentiated mesenchymal cells.

　　2. Pathogenesis

　　The tumor presents as nodular or lobulated masses with relatively clear boundaries, without a true capsule, and infiltrates locally. The cut surface is grayish-white, grayish-red, or grayish-yellow, with hemorrhage, necrosis, mucous, or cystic change. Microscopically, the tumor has a strong infiltrative ability, often invading surrounding fat, fascia, muscle, and perivascular tissue. The cell morphology is diverse, mainly composed of fibroblast-like cells and histiocytoma-like cells, and also contains different differentiated mesenchymal cells, myofibroblasts, etc., accompanied by varying numbers of mononuclear and multinuclear giant cells, xanthoma cells, foam cells, and various inflammatory cells. The nuclei and cytoplasm of various tumor cells vary greatly, are irregularly shaped, and nuclear division is often seen. Some areas have fibroblast-like cells arranged in spoke-like or reticulate patterns, occasionally arranged in bundles or diffusely distributed. The main types include spoke-like-polymorphic type, giant cell type, mucinous type, inflammatory type, and hemangioma-like type, etc.

　　Complications of vulvar malignant fibrous histiocytoma include local infection of the lesion, and occasionally both the vulva and vagina are involved simultaneously. With the enlargement of the tumor, symptoms of organ compression by other organs may appear. In addition to local lymph node metastasis, lung metastasis is also common and is a common cause of death.

　　Vulvar malignant fibrous histiocytoma is commonly seen in the labia majora, most of which are asymptomatic, active subcutaneous masses, and can also be manifested as rapidly growing prominent large masses, ranging in size from (2×2.5)cm to (12×5)cm, which may be accompanied by skin ulcers on the surface. It can be divided into two types, namely superficial and deep. The superficial type, although it can reach the fascia, is mostly limited to the subcutaneous tissue, and a very small number can also invade the superficial skin and cause ulceration. Deep tumors are either completely located within the muscle or extend from the subcutaneous tissue through the fascia into the muscle. Deep tumors are twice as common as superficial ones, and the 4-year survival rate of deep tumors is significantly reduced, with 40% and 65% respectively. In addition to local lymph node metastasis, lung metastasis is also common and is a common cause of death. The tumor is usually quite large, and because of its unclear boundaries, it is believed that even if the size of the excision is sufficient, nearly half of the cases still recur.

　　1, Special reminder: Regular physical examinations and the implementation of the three-level prevention for tumor patients.

　　2, Epidemiology: Vulvar malignant fibrous histiocytoma is rare. It is more common in women aged 30 to 79, with a median age of 49. Occasionally, young people aged 17 may develop the disease.

　　3, Prognosis: When the vulvar malignant fibrous histiocytoma is localized in the subcutaneous tissue, the metastasis rate is about 9%. The reported 2-year survival rate is about 60%, and the 5-year and 10-year survival rates are 50% and 43%, respectively. The recurrence rate within 2 years is 44%, and the metastasis rate is 42%.

　　1, Histopathology and immunohistochemistry:The peroxidase staining of α1-antitrypsin protein and α1-antichymotrypsin is positive, the immunohistochemistry has no specific marker, most Vimentin, AACT, CD68, Lysozyme are positive, some Desmin are positive, while S-100 is negative.

　　2, Histopathological examination.

　　First, dietary therapy for vulvar malignant fibrous histiocytoma

　　1, Sophora flavescens egg:2 eggs, 60 grams of brown sugar, 60 grams of Sophora flavescens. Boil Sophora flavescens to extract the juice, add the beaten eggs and brown sugar, and cook until done. Eat the eggs and drink the soup. Once a day, 6 days as one course. It has the effect of clearing heat and detoxifying, drying dampness, and healing sores, and can be used for the prevention and treatment of vulvar ulcers.

　　2, Gentiana macrophylla egg: 10 grams of Gentiana macrophylla, 3 eggs, 30 milliliters of honey. Boil Gentiana macrophylla water, remove the dregs, beat the eggs into omelets, add honey, and eat on an empty stomach, once a day, 5 days as one course. It has the effect of clearing heat, removing dampness, and healing sores.

　　3, Cabbage and mung bean sprout drink: One root of cabbage, 30 grams of mung bean sprouts. Clean the root of cabbage and slice, clean the mung bean sprouts and put them in the pot, add an appropriate amount of water, boil for 15 minutes, remove the dregs and take the juice, drink as tea, at any time. It has the effect of clearing heat and removing dampness, and can be used for the treatment of vulvar ulcers.

　　4, Rock sugar melon soup:30 grams of melon seeds, 30 grams of rock sugar. Clean the melon seeds, grind into coarse powder, add rock sugar, boil with 1 bowl of boiling water, place in a clay pot, and simmer over low heat. Take twice a day, for several days in a row. It has the effect of clearing heat, promoting diuresis, and stopping leukorrhea, and can be used for the treatment of vulvar itching.

　　5, Spleen and Xanthium sibiricum seeds: One pig stomach, 30 grams of Xanthium sibiricum seeds, 10 grams of Chinese angelica root. Clean the pig stomach, add water and boil with the latter two herbs, discard the medicine and eat the stomach. It has the effect of tonifying the kidney, removing wind, and stopping itching. It is used for the prevention and treatment of atrophic vulvar leukoplakia.

　　6, Goji berry porridge:20 grams of goji berries, an appropriate amount of rice. Cook into porridge for consumption.

　　Second, what is good for the body to eat with vulvar malignant fibrous histiocytoma

　　Maintain an ideal weight;

　　Consume a variety of foods;

　　Include a variety of vegetables and fruits in daily meals;

　　Increase the intake of high-fiber foods (such as whole grain cereals, beans, vegetables, and fruits);

　　Reduce the total intake of fat;

　　Limit the intake of alcoholic beverages;

　　Limit the intake of pickled, smoked, and nitrite-containing foods.

　　After surgery for malignant neurilemmoma, consuming Qi and injuring blood, it is advisable to eat foods that replenish Qi and nourish blood, such as jujube, longan, adzuki beans, glutinous rice, lychee, mushrooms, carrots, quail eggs, lotus starch, beans, etc.

　　Radiation therapy after surgery for vulvar malignant neurilemmoma: It consumes Yin and fluid, so it is advisable to eat foods that nourish Yin and fluid, such as spinach, small white vegetables, lotus root, carrots, watermelon, bananas, grapes, sea cucumber, sugarcane, lily, etc.

　　Chemotherapy after surgery for vulvar malignant neurilemmoma: It is easy to damage both Qi and blood, so it is advisable to eat foods that nourish Qi and blood, such as mushrooms, walnuts, lotus seeds, goji berries, millet congee, jujube, longan, sea cucumber, etc.

　　Thirdly, it is best to avoid eating the following foods for vulvar malignant neurilemmoma:

　　1. Avoid stimulants such as coffee.

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

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

　　4. Avoid trigging foods 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.

　　Western treatment methods for malignant fibrous histiocytoma of the vulva:

　　1. Surgical Treatment

　　The malignant fibrous histiocytoma of the vulva is prone to hematogenous and lymphatic metastasis, and the metastasis is significantly related to the depth of tumor infiltration. For deeper lesions, extensive resection should be performed to avoid recurrence and metastasis. The operation should be radical vulvectomy and extensive resection of local lesions. For patients limited to subcutaneous tissue, not involving fascia, and with low malignancy, it is possible to perform extensive resection of local lesions and ipsilateral inguinal lymph node dissection first, and frozen section examination of lymph nodes during surgery to determine whether further surgery is needed. If all lymph nodes have no metastasis, no further radical surgery is needed.

　　2. Drug Chemotherapy

　　The chemotherapy for malignant fibrous histiocytoma is not specific, and commonly used drugs include doxorubicin (adriamycin), ifosfamide, dacarbazine (nitrosourea), cyclophosphamide, and vincristine, etc. Belal et al. (2002) proposed that for patients with highly malignant tumors, it is possible to use doxorubicin (adriamycin) plus cisplatin or neoadjuvant chemotherapy containing high-dose methotrexate to reduce tumor volume, eliminate subclinical metastasis, and increase local control rate and complete resection rate.