Vaginal endometrial stromal sarcoma

　　Pathogenesis

　　The tumor tissue is grayish yellow and has a fishy texture. When locally invading the muscular wall, it can present as small nodular protuberances, with a rubbery texture and elasticity. Some parts of the muscular wall may thicken. There may be earthworm-like tumor thrombi in the blood vessels, which are elastic.

　　The cells of lowly malignant endometrial stromal sarcoma under microscopy are similar to normal proliferative phase endometrial stromal cells, and are full of thick-walled small blood vessels similar to those in the late secretory phase of spiral arteries. The cells are round, of uniform size, with little cytoplasm, deeply stained nuclei, and nuclear division figures.

　　Complications are common in cases with ulceration and infection.

　　1. Lowly malignant endometrial stromal sarcoma:The degree of malignancy is low, the prognosis is good, but the recurrence rate is high. Reoperation to remove the recurrent focus can still achieve good efficacy, and the tumor is moderately sensitive to radiation, and is effective for hormone therapy and chemotherapy. Patients with recurrence still have the possibility of long-term survival after comprehensive treatment.

　　2. Highly malignant endometrial stromal sarcoma:Easily bleeding and necrotic, and prone to recurrence, with a very poor prognosis.

　　Vaginal endometrial stromal sarcoma is mostly manifested as nodular protrusions on the vaginal wall, accompanied by vaginal bleeding, increased leukorrhea, and can also manifest as lower abdominal pain, vaginal and anal distension, difficulty in urination and defecation, tumor size of 3-10 cm, which can be polypoid, with clear boundaries, soft texture, no tenderness, mobile or fixed.

　　Uterine sarcoma is a rare malignant tumor of the female reproductive organs, accounting for 2%-4% of uterine malignant tumors and 1% of malignant tumors of the reproductive tract. It has a high degree of malignancy and is more common in women before and after menopause. This tumor originates from the mesoderm and can come from the muscle, connective tissue, blood vessels, endometrial stroma, or myoma of the uterus. The histological origin is mostly the uterine muscle layer, or the connective tissue within the muscle layer or the endometrial connective tissue. The incidence is about 20%-40%, most common in women aged 30-50, and sarcomas can occur in any part of the uterus, but the body of the uterus is much more common than the cervix, about 15:1. Uterine sarcoma accounts for 2-5% of uterine malignant tumors, and the common age is around 50 years, while cervical grape-like sarcoma is more common in young girls. Due to the lack of specific symptoms in the early stage, the diagnostic rate before surgery is only 30-39%.

　　Prognosis

　　The prognosis of vaginal endometrial stromal sarcoma is relatively good compared to other sarcomas, although the follow-up time varies from 6 months to 13 years in different reports, but there are no reports of death from the tumor. Only one case report shows that the tumor metastasized to the pelvis and lung 6 months after surgery. Chang et al. and Tao Shuyun et al. followed up for 1.5 years and 2 years respectively after surgery, and neither recurrence nor metastasis was observed. Peters et al. (1985) reported one case with tumor-free survival for 13 years after pelvic exenteration.

　　1. Examination of vaginal endometrial stromal sarcoma:Immunohistochemical examination, histopathological examination, colposcopy.

　　2、阴道镜检查：Vaginal colposcopy is a method of using colposcope under strong light source to magnify the epithelium of the cervix and vagina by 10-40 times for direct observation, in order to observe the microscopic changes that cannot be seen with the naked eye, and to perform localization biopsy at suspicious sites to improve the diagnostic rate of cervical diseases.

　　First, food therapy formula

　　1. Erxian Soup

　　Specific method: Cut 120g of fresh lotus root into slices, chop 120g of fresh Mao Gen into pieces, and boil them in water to make a decoction for tea.

　　Effect: Nourish yin, cool blood, remove stasis, and stop bleeding. Suitable for those with abundant menstrual flow and blood heat stasis.

　　2. Eliminate tumor eggs

　　Materials required: 2 eggs, 5 wall lizards of Chinese medicine, 9g of Ophiopogon, and 400g of water to boil together. Method: After the eggs are cooked, peel them and boil them again, discard the medicine and eat the eggs, and take 1 dose every night.

　　Effect: Dissipate nodules, relieve pain, dispel wind, and calm惊. Suitable for Qi stagnation and blood stasis type.

　　3. Silver ear and lotus root starch soup

　　Materials required: 25g of Silver ear, 10g of Lotus root starch, and appropriate amount of rock sugar. Specific method: Soak the Silver ear and then add appropriate amount of rock sugar to cook until soft, then add Lotus root starch and serve.

　　Effect: It has the effects of clearing heat, moistening dryness, and stopping bleeding. Suitable for those with abundant menstrual flow and bright red blood.

　　Second, what are the good foods for vaginal endometrial stromal sarcoma patients?

　　1. It is advisable to eat Ji Cai, Melon, Chinese water chestnut, Yiyi, Ficus carica, Sweet potato, Oyster, Chinese softshell turtle, Sea horse.

　　2. For hemorrhage, it is advisable to eat Fish scale, Sea cucumber, Squid, Black fungus, Mushroom, Dandan, Suanmei, Green bean.

　　3. For edema, it is advisable to eat Sturgeon, Shi Zhen, Chizao, Corn, Cyprinus carpio, Liza, Misgurnus anguillicaudatus, Clam, Pan fish, Duck meat, Lettuce, Coconut milk.

　　4. For lumbar pain, it is advisable to eat Lianzi, Walnut meat, Yiyi, chive, plum, chestnut, Yutou, Chinese softshell turtle, Jellyfish, Honey, Hemiscyllium, Squid.

　　5. For abundant leukorrhea, it is advisable to eat cuttlefish, sea asparagus, Whelk, Clam, Oyster, Turtle, Jellyfish, Yang pancreas, Sparrow, Cowpea, White fungus, Walnut, Lianzi, Euryale ferox.

　　6. Foods to prevent and treat the side effects of chemotherapy and radiotherapy: Tofu, pork liver, Qingyu, Jiyu, Black fungus, Mushroom, Dandan, Suanmei, Green bean, Lianzi, Ficus carica.

　　Third, what are the foods that are bad for vaginal endometrial stromal sarcoma patients?

　　1. Avoid smoking, alcohol, and spicy刺激性 food.

　　2. Avoid greasy, fried, moldy, and pickled foods.

　　3. Avoid warm foods such as lamb, chive, dog meat, pepper, ginger, cinnamon, etc.

　　4. Avoid foods that cause hair growth, such as rooster.

　　Traditional Chinese medicine treatment methods for vaginal endometrial stromal sarcoma

　　The treatment principle of this disease focuses on activating blood circulation, resolving stasis, softening hardness, and eliminating phlegm. The treatment of this disease mainly uses activating blood circulation and resolving stasis to eliminate phlegm. Observing the physical condition, for those with solid constitution, it is advisable to eliminate evil first, and then support the healthy qi; for those with weak physique, it is advisable to support the healthy qi and eliminate evil, taking both the root and the branch into consideration.

　　First, select the prescription based on differentiation

　　1. Treatment method for blood stasis and phlegm congestion:

　　2. Treatment method for damp-toxin congestion: Eliminate phlegm and activate blood circulation. Prescription: Modified Guizhi茯苓Bulbus. 15g of Guizhi, 20g of Fuling, 15g of Danpi, 15g of Chishao, 15g of Taoren, 30g of Biejia, 30g of Guafu, 30g of牡蛎Muhuaishu, 20g of Xianhecao, 15g of Shancigu. Add 15g of Huairuishi and 10g of Sanqi if there is a large amount of bleeding; add 15g of Zhiqu, 15g of Houpu if there is abdominal distension.Clear heat and drain dampness, resolve blood stasis and stop bleeding. Prescription: Modified Huanglian Decoction. 15g of Coptis, 15g of Scutellaria, 15g of Phellodendron, 15g of Gardenia, 20g of Poria, 20g of Dandelion, 50g of Coix Seed, 20g of Bupleurum, 15g of Solanum nigrum, 10g of Panax notoginseng. For abdominal distension like a drum, add 15g of Pericarpium perillae, 15g of Magnolia officinalis, 15g of Areca catechu; for severe pain, add 20g of Corydalis yanhusuo, 20g of Myrrha.

　　Treatment method for deficiency of both Qi and blood:Second, special prescription

　　1. 60g of purple root powder, add 500ml of distilled water, soak for three minutes, then boil and filter in a sand pot, 100ml each day, divided into four servings. Suitable for uterine cancer.

　　2. 15g of Yuanhu, 15g of Wulingzhi, fried into charcoal with vinegar, take all at once, with hot water, can take three doses in a row, suitable for abdominal pain and vaginal bleeding in uterine cancer.

　　1. 60g of purple root powder, add 500ml of distilled water, soak for three minutes, then boil and filter in a sand pot, 100ml each day, divided into four servings. Suitable for uterine cancer.

　　Three. Patent Medicines

　　1. Yunnan Baiyao:It has the effects of resolving blood stasis, stopping bleeding, and reducing swelling and healing wounds. Suitable for uterine sarcoma with a large amount of vaginal bleeding. Take 0.5g three times a day, orally.

　　2. Ginseng and Spleen Pill:It has the effects of nourishing the heart and spleen, invigorating Qi and replenishing blood. Suitable for uterine sarcoma with deficiency of both Qi and blood and vaginal bleeding. Take 1-2 pills three times a day.

　　3. Xi Huang Pill:It has the effects of clearing heat and detoxifying, resolving blood stasis and alleviating pain. Suitable for patients with uterine sarcoma with internal accumulation of phlegm and blood stasis and severe pain, 5g each time, three times a day, orally. The Western medical treatment for vaginal endometrial stromal sarcoma mainly involves surgery, most often with partial vaginal resection combined with total hysterectomy and bilateral salpingectomy. Chang et al. advocate adjuvant radiotherapy after surgery, while Tao Shuyun et al. believe that radiotherapy is not necessary after surgery for patients with low malignancy, and chemotherapy can improve the efficacy, mainly with doxorubicin, supplemented by cyclophosphamide, cisplatin, vincristine, and others, and pelvic artery perfusion chemotherapy can be adopted. For recurrent patients, such as those with positive estrogen and progesterone receptors, gestagen therapy can be used.