Vulvar fibrosarcoma

　　1. Etiology

　　The etiology is not fully understood. Some scholars have reported that after 7 years of radiotherapy and chemotherapy for low-differentiated vulvar squamous cell carcinoma, fibrosarcoma was found at the original radiotherapy site.

　　2. Pathogenesis

　　The tumor is round, lobulated, and has a pseudocapsule. The cut surface is grayish white or grayish red, tough, and most often accompanied by hemorrhage and necrotic foci. Microscopically, the abundant spindle-shaped fibroblasts are arranged in a cruciform or 'fishbone' structure, with cells of similar morphology and size, less cytoplasm, and unclear boundaries. The nuclei have certain atypicalities and can show nuclear division. Most have focal necrosis and contain an unequal amount of collagen fibers and reticular fibers. According to the pleomorphism of tumor cells, the number of nuclear divisions, and pathological nuclear divisions, it is divided into well-differentiated and poorly differentiated types. Immunohistochemistry shows vimentin positivity and S-100 and cytokeratin negativity.

　　Complications of vulvar fibrosarcoma: associated with regional lymph node enlargement and metastasis. The following will introduce the complications of neurofibromas:

　　1. When a tumor invades the skeletal system due to a fracture or dislocation, it can cause fractures, dislocations, and spinal deformities. It may also lead to scoliosis, congenital pseudarthrosis of the tibia, and congenital pseudarthrosis of the clavicle. Compression of the common peroneal nerve may result in foot drop and epilepsy.

　　2. When the tumor invades the central nervous system, it may cause seizures, and precautions should be taken to prevent injuries.

　　3. Neurofibromas can sometimes spontaneously溃溃出血or cause massive bleeding within the tumor, which can lead to shock in severe cases.

　　4. Large tumors on the limbs can often break down, leading to infection, suppuration, and even amputation.

　　5. Pulmonary damage: A few patients may develop diffuse interstitial pneumonia.

　　6. Malignant peripheral nerve sheath tumors can occasionally develop into neurofibrosarcoma and malignant schwannoma. There are also reports of patients with Wilms tumor, rhabdomyosarcoma, and chronic myeloid leukemia accompanying neurofibromatosis. The above is the introduction of the complications of neurofibromatosis.

　　It commonly occurs on the large labia or clitoris, with or without pain, a clear boundary, varying hardness, fibrous tissue, and low malignancy, which is hard in quality. Conversely, it is softer, with sizes ranging from (1.5×1.5)cm to (10×8)cm. When the mass is small, it is mobile, and when it grows larger, it is often adherent and fixed. The local temperature of the mass may be higher, and the surface may show dilated capillaries. It can also be accompanied by regional lymph node metastasis enlargement, and it can also spread through blood to the lungs, occasionally seen in the liver and ribs, and local lymph node metastasis is rare. For those with more malignancy, the tumor is larger and softer, and the progression is more rapid.

　　1. Develop good living habits, quit smoking and limit alcohol. Eat some cancer-preventing foods and alkaline foods with high alkaline content, and maintain a good mental state.

　　2. Maintain a good attitude towards stress, combine work and rest, and avoid overexertion.

　　3. Pay attention to the hygiene of the vulva, avoid long-term stimulation of secretions. If vulvar itching occurs, treatment should be sought actively, and it is noted not to use strong irritant drugs to clean the vulva.

　　4. Strengthen physical exercise, enhance physical fitness, and exercise more often in the sun. Excessive sweating can expel acidic substances from the body through sweat, preventing the formation of an acidic constitution.

　　5. If nodules, ulcers, and white lesions on the vulva are found, medical attention should be sought promptly.

　　The diagnosis of vulvar fibrosarcoma relies not only on clinical manifestations but also on related examinations, which are indispensable. The examination methods are as follows:

     1. Tumor marker examination, needle aspiration biopsy or puncture biopsy.

　　2. Histopathological examination.

　　One: Therapeutic recipe for vulvar fibrosarcoma

　　1. Polygonum multiflorum Egg Soup

　　120 grams of Polygonum multiflorum, 4 eggs. Boil Polygonum multiflorum to make a concentrated decoction, then boil 4 eggs. This is a daily dose, taken twice a day.

　　2. Sesame Brown Sugar Porridge

　　200 grams of black sesame seeds, 30 grams of brown sugar. Clean the black sesame seeds, slightly fry them, and store them in a bottle for later use or crush and store them in a bottle. Use 2 tablespoons with an appropriate amount of brown sugar, dip it in steamed buns or use boiling water to serve.

　　3. Other

　　30 grams of Polygonum multiflorum, 100 grams of yam, 500 grams of lamb lean meat, 9 grams of ginger. First, boil the lamb lean meat and ginger with an appropriate amount of water to remove the smell, then add prepared Polygonum multiflorum and yam to cook together. It can be eaten after the meat is tender.

　　4. Lamb and Fish Radish Soup

　　300 grams of lamb, 1 fresh river fish (500 grams), and 1 white radish. Cut the lamb into large pieces and put it into boiling water, then cook with sliced radish for 15 minutes, discard the soup and radish. Put the lamb into the pot, add water (about 2/3 of the pot capacity), scallion, ginger, and wine, and cook until tender. If the soup is too little, add some boiling water. After the fish is fried with soybean oil, put it into the pot with lamb and cook for 30 minutes. Add salt, coriander, green onion, and chopped green onion to the soup, and it becomes a delicious and delicious lamb and fish soup.

　　Two: What is good for the body when consuming vulvar fibrosarcoma

　　1. It is recommended to consume more foods that have anti-external genital tumor properties, such as sesame seeds, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, blacksnake, pork pancreas, chrysanthemum, black plum, peach, lichee, horse radish, chicken blood, eel, abalone, crab, tetrodotoxin fish, sardine, clam, clam, and tortoise. For pain, it is advisable to eat tetrodotoxin fish, red, lobsters, oysters, sea cucumber, tiger fish, beetroot, mung beans, radish, and chicken blood. For itching, it is recommended to eat amaranth, cabbage, rapeseed, taro, kelp, nori, chicken blood, snake meat, and pangolin.

　　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 physical fitness and prevent metastasis, eat silver ear, black fungus, mushrooms, monkey head fungus, gizzard, sea cucumber, Job's tears, walnuts, crabs, Agama, needlefish, etc.

　　5. After vulvar fibrosarcoma surgery, it consumes Qi and injures blood, so it is advisable to eat foods that tonify Qi and nourish blood, such as jujube, longan, mung beans, glutinous rice, lychee, mushrooms, carrots, quail eggs, lotus root powder, beans, etc.

　　6. Radiotherapy after vulvar fibrosarcoma surgery: it consumes Yin and fluid, so it is advisable to eat foods that nourish Yin and fluid, such as spinach, green vegetables, lotus root, carrots, watermelon, bananas, grapes, sea cucumber, sugarcane, lily, etc.

　　7. Chemotherapy after vulvar fibrosarcoma surgery: it can damage both Qi and blood, so it is advisable to eat foods that nourish Qi and blood, such as black fungus, mushrooms, walnuts, mulberries, Job's tears congee, jujube, longan, sea cucumber, etc.

　　Thirdly, foods that should not be eaten for vulvar fibrosarcoma

　　1. Avoid foods that cause itching. For example: fish, shrimp, crab, chicken heads, pork heads, goose meat, chicken wings, chicken feet, etc., which can worsen itching and inflammation in the genital area.

　　2. Eat less spicy and stimulating foods. For example: onions, black pepper, chili, Sichuan pepper, rapeseed, fennel.

　　3. Avoid eating fried and greasy foods. For example, fried dough sticks, butter, butter, chocolate, etc., which have the effect of increasing dampness and heat, can increase the secretion of leukorrhea and are not conducive to the treatment of the disease.

　　4. Quit smoking, drinking, and caffeine and other stimulating beverages.

　　Firstly, precautions before the treatment of vulvar fibrosarcoma

　　1. Develop good living habits, quit smoking and limit alcohol. Eat some cancer-preventing foods and alkaline foods with high alkaline content, and maintain a good mental state.

　　2. Maintain a good attitude towards stress, combine work and rest, and avoid overexertion.

　　3. Pay attention to the hygiene of the vulva, avoid long-term stimulation of secretions. If vulvar itching occurs, treatment should be sought actively, and it is noted not to use strong irritant drugs to clean the vulva.

　　4. Strengthen physical exercise, enhance physical fitness, and exercise more often in the sun. Excessive sweating can expel acidic substances from the body through sweat, preventing the formation of an acidic constitution.

　　5. If nodules, ulcers, and white lesions on the vulva are found, medical attention should be sought promptly.

　　Secondly, Western medical treatment methods for vulvar fibrosarcoma

　　1. Surgical treatment

　　Well-differentiated cases can be treated with extensive local resection of the tumor, which is suitable for grade I fibrosarcoma and can be applied to selected cases of grade II-IV fibrosarcoma. Poorly differentiated cases often require radical vulvectomy combined with inguinal lymph node dissection. The extent of resection of the primary tumor must be sufficient; otherwise, local recurrence is common. If inguinal lymph nodes are positive, pelvic lymph node dissection should be performed. Excisional surgery or conservative surgery is used, and about 80% of local recurrences occur.

　　2. Anticancer chemotherapy

　　Fibrosarcoma is insensitive to radiotherapy, and radiotherapy is only used as palliative treatment for those who cannot undergo surgery. Preoperative chemotherapy has no significant effect and is not commonly used. Periodic combined chemotherapy can be performed after surgery.

　　(1) VAC regimen: vincristine (vincristine) 1.5mg/m2, intravenous injection, days 1, 8; actinomycin or actinomycin D (regeneratin) 400-600g, intravenous injection, days 1-4; cyclophosphamide (cyclophosphamide) 300mg/m2, intravenous injection, days 1, 4, 8. Repeated every 3-4 weeks, but depending on the recovery of bone marrow function.

　　(2) ADIC regimen: doxorubicin (adriamycin) 60mg, intravenous infusion, day 1; dacarbazine (thiotepa) (DTIC) 250mg, intravenous infusion, days 1-5. Effective rate 42% (Beretta, 1983).

　　(3) CYVADIC regimen: cyclophosphamide 500mg, intravenous infusion, day 2; vincristine 1.5mg, intravenous injection, days 1, 8; dacarbazine (thiotepa) 250mg, intravenous infusion, day 2. Treatment interval 4 weeks. Effective rate 47%.

　　(4) IVA regimen: ifosfamide (ifosfamide) 3mg/m2, intravenous infusion, days 1-2. mesna 600mg/m2, intravenous injection, days 1-2 (0.48h/d). Vincristine 1.5mg/m2 (maximum dose 2mg), intravenous infusion, day 1. Actinomycin D 1.5mg/m2 (maximum dose 2mg), intravenous infusion, day 1.

　　3. Radiotherapy

　　Adjuvant radiotherapy is beneficial, which can reduce the local recurrence rate after surgery, and can also achieve short-term cure when combined with chemotherapy.

　　4. Freezing Treatment

　　Freezing treatment can be used if it is not suitable to excise multiple lesions.

　　5. Laser Treatment

　　A colposcopy should be performed before treatment to clearly define the edges of the disease. The depth of treatment is determined according to the size of the lesion and the VIN grade. Generally, the depth of laser treatment in hairless areas is 1mm. In areas with hair, the treatment depth should be less than 2mm.

　　3. Prognosis

　　The prognosis of fibrosarcoma depends on its histological grade and age. The survival rate for grades Ⅰ~Ⅱ is 60%, and for grades Ⅲ and Ⅳ is about 30%. The prognosis of children under 10 years of age is significantly better, with less metastasis, generally less than 10%.