Vulvar leiomyoma

　　1. Etiology

　　Vulvar leiomyoma originates from the smooth muscle of the vulvar erectile tissue or round ligament smooth muscle.

　　2. Pathogenesis

　　The size of the tumor varies, with literature reporting leiomyomas with a diameter of 1-11 cm, hard texture, and a capsule. The texture depends on the amount of fibrous tissue and whether there is any change. It is generally solitary, located under the labia or the labial frenulum, with a broad base and no pedicle, and is movable. The tumor size varies, and the cross-section is a solid tumor. Under the microscope, the fusiform smooth muscle cells are arranged in a crisscrossing, parallel, or whorl-like pattern. The nucleus size and shape are basically consistent, with a haloid gap around the nucleus and fibrous interstitium between the muscle bundles. The cytoplasm is呈伊红梭长形, with blunt ends in the shape of a dumbbell, the muscle fiber bundles are arranged closely, and they appear grayish white with luster. Occasionally, focal hemorrhagic necrosis can be seen. During pregnancy, vulvar leiomyomas are particularly prone to mucinous degeneration.

　　Pathology can classify it into types such as cellular richness, epithelioid, neurilemmomatous, and syncytial, among which the epithelioid type of leiomyoma has invasive and easy-to-relapse characteristics. It is often accompanied by degenerative changes.

　　About 20% of vulvar basal cell carcinomas are associated with other carcinomas, such as vulvar squamous cell carcinoma, malignant melanoma, breast cancer, cervical cancer, or skin cancer. 0.4%-0.8% of uterine fibroids may transform into uterine sarcoma. The sarcoma transformation of uterine fibroids often occurs in women aged 40-50, with symptoms such as rapid enlargement of the fibroid or vaginal bleeding. The sarcoma transformation manifests as a vulvar mass, which can be large but with clear boundaries, and venous dilation can be seen on the skin surface.

　　The sarcoma transformation of the vulvar leiomyoma may be related to the following factors:

　　1, The size of the leiomyoma:

　　The leiomyoma in the vulva is generally not large, the diameter rarely exceeds 5 cm. According to Tavassoli's data, if the diameter of the leiomyoma exceeds 5 cm, the chance of sarcoma transformation or recurrence is higher.

　　2, Whether the outline of the leiomyoma is clear:

　　If the pseudocapsule around the leiomyoma is clear, the chance of malignant transformation is not high. On the contrary, if there is infiltration around, the boundaries of the leiomyoma are unclear, the chance of malignant transformation increases.

　　3, The frequency of nuclear division:

　　The more cell division, the greater the chance of malignant transformation. If there are more than 5 mitotic figures in 10 high-power fields, it can be definitely considered as sarcoma transformation.

　　4, The degree of rich cells:

　　The rich cell type leiomyoma often manifests as heavy menstrual bleeding or prolonged menstrual periods, abdominal pain, rapid growth of the leiomyoma. Rich cells do not necessarily mean malignant transformation of the leiomyoma, but they can indicate active cell proliferation, which can be considered as a precursor change to sarcoma, and must be treated with caution.

　　Patients generally have no discomfort, sometimes they may feel a sense of descent in the vulva, and some patients may go to the hospital because they have found a vulvar mass themselves. The most common site is the labia majora, and the clitoris and labia minora can also be affected. The surface is smooth, hard, protruding from the vulvar skin surface or presenting as a pedunculated exostosis. Gynecological examination finds a solid mass in the vulva, with clear boundaries, movable, and without tenderness. There are two forms in clinical practice: one is hidden in the tissue as a nodule, often without symptoms, only the patient feels a small mass locally; the other is a pedunculated or protruding mass on the skin surface, causing difficulties in sexual intercourse, inconvenience in movement, etc. Literature reports that the maximum diameter of vaginal leiomyoma can reach 10 cm.

　　One: Prevention:

　　1. Regular physical examination: to achieve early detection, early diagnosis, and early treatment.

　　2. Do a good job of follow-up: prevent the transformation of vulvar leiomyoma into sarcoma.

　　3. Pay attention to personal hygiene, especially the hygiene of the vulva during the menstrual period and postpartum period.

　　4. Strengthen the body and improve the immune system: Pay attention to the combination of work and rest, participate in physical exercise more often, and eat more fresh fruits and vegetables rich in vitamins.

　　Two: Before treatment:

　　It is necessary to have a detailed understanding of the symptoms of the disease and related contraindications.

　　The diagnosis of vulvar leiomyoma, in addition to relying on clinical manifestations, also requires indispensable auxiliary examinations.

      1, Secretion examination, cervical cytology examination, tumor marker examination.

　　2, Histopathological examination.

　　I. Dietetic recipe for vulvar leiomyoma

　　1, Senna leaf egg: 2 eggs, 60 grams of brown sugar, 60 grams of senna leaf. Boil the senna leaf to get the juice, add the beaten eggs and brown sugar, cook until done, eat the egg and drink the soup. Once a day, 6 days as a course of treatment. It has the effects of clearing heat and detoxifying, drying dampness, and healing boils, which can be used for the prevention and treatment of vulvar ulcers.

　　2, Dragon bile herb egg: 10 grams of dragon bile herb, 3 eggs, 30 milliliters of honey. Boil the dragon bile herb and remove the residue, beat the eggs to make a nest egg, add honey, take on an empty stomach, once a day, 5 days as a course of treatment. It has the effect of clearing heat, removing dampness, and healing boils.

　　3. Cabbage and mung bean sprout drink: one cabbage root, 30 grams of mung bean sprouts. Clean the cabbage root and slice it, clean the mung bean sprouts and put them in a pot together, add an appropriate amount of water, boil for 15 minutes, remove the dregs and take the juice, drink it as tea, without time restrictions. It has the effect of clearing heat and eliminating dampness, and can be used for the treatment of vulvar ulcer.

　　4. Rock sugar winter melon soup: 30 grams of winter melon seeds, 30 grams of rock sugar. Clean the winter melon seeds, grind them into coarse powder, add rock sugar, pour a bowl of boiling water, put it in an earthen pot, and simmer over low heat. Take two doses a day, for several days in a row. It has the effect of clearing heat and eliminating dampness, and can be used for the treatment of vulvar pruritus.

　　5. Siler and pork stomach: one pork stomach, 30 grams of siler seed, 10 grams of dibenzylideneacetone. Clean the pork stomach, add water, and boil with the latter two herbs together. Discard the medicine and eat the stomach. It has the effect of kidney tonifying, wind dispelling, and itching relief. 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 and eat as porridge.

　　Two: Foods that are good for vulvar leiomyoma patients

　　1. Eat more foods that have anti-vulvar tumor and leukoplakia effects, such as sesame, almond, wheat, barley, loofah, black chicken, cuttlefish, Urosaurus, pig pancreas, chrysanthemum, black plum, peach, lychee, portulaca, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, tortoise shell.

　　2. For pain, eat horseshoe crab, red, lobster, clam, sea cucumber, tiger fish, beetroot, mung bean, radish, chicken blood.

　　3. For itching, eat amaranth, cabbage, rapeseed, taro, kelp, purple kelp, chicken blood, snake meat, pangolin.

　　4. To enhance the body and prevent metastasis, eat silver ear, black fungus, mushroom, hedgehog mushroom, gizzard, sea cucumber, Job's tears, walnut, crab, lizard, needlefish.

　　5. After the surgery for vulvar leiomyoma, due to consumption of Qi and blood, it is advisable to eat more tonifying Qi and nourishing blood foods, such as jujube, longan, mung bean, glutinous rice, lychee, mushroom, carrot, quail egg, lotus root powder, beans, etc.

　　Three: Foods that should not be eaten by vulvar leiomyoma patients

　　1. Avoid stimulants such as coffee.

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

　　3. Avoid fatty, 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.

　　Precautions before the treatment of vulvar leiomyoma

　　One: Prevention:

　　1. Regular physical examination: to achieve early detection, early diagnosis, and early treatment.

　　2. Do a good job of follow-up: prevent the transformation of vulvar leiomyoma into sarcoma.

　　3. Pay attention to personal hygiene, especially the hygiene of the vulva during the menstrual period and postpartum period.

　　4. Strengthen the body and improve the immune system: Pay attention to the combination of work and rest, participate in physical exercise more often, and eat more fresh fruits and vegetables rich in vitamins.

　　Two: Before treatment:

　　It is necessary to have a detailed understanding of the symptoms of the disease and related contraindications.

　　Traditional Chinese medicine treatment methods for vulvar leiomyoma

      Three: Internal administration of traditional Chinese medicine:

　　Tumor patients often show symptoms of blood stasis and toxicity inside:

　　1. Symptom Presentation:

　　Local nodules are of different sizes, elevated, round or elliptical, clear boundaries, yellow-brown or grayish-white with luster; accompanied by low fever, dry mouth and throat, turbid leukorrhea like millet gruel or yellowish turbidity, abnormal smell, etc.

　　2. Treatment Principle:

　　Clear heat and detoxify, resolve blood stasis and soften hardness.

　　3. Formula:

　　Lianqiao Sanjian Decoction with modifications: Forsythia 20 grams, Three Notches, Ophiopogon, Chinese radish (King radish) root, Red Peony, Atractylodes, Gentiana, Bupleurum, Scutellaria, Coptis, Raw Licorice each 9 grams. Add Bamboo Shoot 9 grams and Loquat Leaf 9 grams for those with nausea and vomiting; add Prunus humilis seed and Hemp seed each 30 grams for those with constipation.

　　FourExternal treatment of traditional Chinese medicine:

　　1. Treatment Principle:

　　Contemporary famous physician Xiao Zirong applies his self-prescribed experience formula Wuhu Dan preparation to the tumor lesion, after 1-3 weeks it will necrose and fall off, then apply Hongsheng Dan, which has the effect of removing gangrene and promoting pus, to promote the healing of the wound surface, and has a certain therapeutic effect on the treatment of tumors.

　　2. Formula:

　　Wuhu Dan: Mercury, Alum, Qingfan, Niter, each 180 grams, Salt 90 grams.

　　Hongsheng Dan: Mercury 30 grams, Alum 24 grams, Fire Nitrate 21 grams.

　　V. Western Medical Treatment Method for Vulvar Leiomyoma: Surgical Treatment

　　The surgical incision usually adopts a梭形 incision parallel to the small labia minora, the size of which is determined by the ability to completely resect the mass. Local resection can be performed for superficial or pedunculated myomas.

　　Since the clitoris skin is a common site for vulvar tumors, but young patients often do not have the clitoris removed to preserve sexual function, this point should be carefully considered, and the operation should be based on the need for surgery, and frozen tissue sections should be made at the incision margins. If the myoma is in a deeper location, it can be cut open to excise the myoma, which results in less bleeding and does not require the removal of the capsule. However, if the capsule is unclear, there is infiltration around the myoma, or the frozen section cells are actively dividing, suggesting a vulvar infiltrative tumor cancer, extensive vulvar resection should be performed, and the depth should reach the fascia layer, and the superficial and deep inguinal lymph nodes should be cleaned, pelvic lymph node dissection is not included in the routine, because generally they transfer from the inguinal lymph nodes to the pelvis.

　　For those with epithelial-like changes in smooth muscle cells, whether focal or extensive changes, and regardless of the size of the myoma, there must be sufficient resection, and it cannot be just a myoma excision, because such myomas are prone to recurrence. The resected tissue should be sent for pathological examination.