Vaginal vascular sarcoma

　　I. Etiology

　　1. Viral infection:Gessi et al. (2002) used PCR, in situ hybridization, and direct observation under an electron microscope to discover the presence of human herpesvirus-8 (HHV-8) in vaginal vascular sarcoma, and believe that HHV-8 infection is related to the occurrence of vascular sarcoma.

　　2. Chronic stimulation:Both patients with vaginal epithelioid vascular sarcoma have a history of vaginal pessary placement for several years.

　　3. Radiotherapy:A total of 4 patients were treated with pelvic radiotherapy for endometrial cancer, cervical adenocarcinoma, cervical squamous cell carcinoma, and cervical squamous cell carcinoma, respectively. Vascular sarcoma appeared at the site of radiotherapy 9, 14, 20, and 21 years later. Morimura et al. (2001) believe that to diagnose vascular sarcoma caused by radiotherapy, it is necessary to exclude chronic lymphedema, and it must occur several years later at the original site of radiotherapy.

　　Second, pathogenesis

　　The tumor presents as a blood blister-like or indistinct plaque. The section is purple-red, microcystic or spongy, with unclear boundaries, while the range of infiltration seen under the microscope is far beyond what can be seen with the naked eye.

　　Microscopy shows明显 expanded vascular tumor-like cavities, irregular in size and shape, interlocking to form a complex sinusoidal network, with red blood cells visible in the cavities. Tumor cells proliferate within the basement membrane, can adhere to the inner wall of the blood vessels, and form nodular protuberances protruding into the lumen. Tumor cells are mostly fusiform, undifferentiated ones are polygonal, resembling endothelial cells or epithelial cells, with obvious nuclear atypia and frequent nuclear division. Under the electron microscope, endothelial differentiation can be seen, such as partial coverage of the basement membrane, tight junctions between cells, pinocytotic vesicles, and occasionally microfilaments, Weibel-Palade bodies, tubular structures, and so on.

　　Immunohistochemical vascular endothelial markers FⅧ factor, CD31, CD34 are mostly positive, and some low molecular weight keratins in epithelioid angiosarcoma can also be positive.

　　Ulceration, ulceration, and infection. Ulcers are localized defects and ulcers on the surface of the skin or mucous membrane tissue, which are often covered with pus, necrotic tissue, or scabs. Scars remain after healing, which may be caused by infection, trauma, nodules, or the ulceration of tumors. The size, shape, depth, and development process are also inconsistent. They often accompany chronic infection and may not heal for a long time.

　　Vaginal angiosarcoma is mainly manifested as vaginal bleeding, which may be accompanied by difficulty in urination. The mass is located at the vaginal stump, the upper wall of the vagina, and the vaginal fornix, etc., and is irregular and hard, with sizes ranging from 2 to 8 cm. The surface may have ulcers and can also infiltrate the vaginal wall.

　　1. Sexual life is conducive to the discovery of malignant tumors

　　In traditional Chinese concepts, many people believe that older people no longer need sexual life. Experts believe that sexual life is beneficial to the physical and mental health of perimenopausal women. Sexual life not only allows women to have a youthful mindset, enhances the couple's feelings, but also provides a benign stimulation to the female vagina physically, and is also easy to detect some malignant tumors, such as vaginal angiosarcoma, cervical cancer, and so on. For example, a woman's vaginal angiosarcoma had grown into a 'fleshy mass' before she sought medical attention, and the doctor learned that her sexual life had stopped for many years. Experts point out that if there is contact bleeding during sexual life, it may be a small cancerous focus. If this woman had sexual life regularly, she would not have developed a cancerous mass as large as a 'fleshy mass' before being discovered.

　　2. Prognosis

　　The prognosis of vaginal angiosarcoma is poor, with an average survival period of 14 months.

　　Tumor marker examination, secretion examination, histopathological examination. Colposcopy.

　　Vaginal angiosarcoma can be diagnosed according to clinical manifestations, symptoms, and related laboratory examinations. The diagnosis mainly relies on pathological tissue examination.

　　During chemotherapy, it is easy to cause dry mouth and throat, burning pain behind the sternum, etc., it is advisable to choose nutritious, soft and moist food that is easy to swallow, such as sugarcane juice, milk, egg custard, lotus root powder, watermelon, etc. Eat less and more often, let the patient eat as they wish, pay attention to the color, smell, taste, and shape of food. More sweet and sour, less bitter and spicy. Patients undergoing radiotherapy and chemotherapy have a weak sense of sweetness and sourness, and are more sensitive to bitterness, so appropriate sweet and sour foods should be enhanced. Daily diet should be light and tasteless, and 'more sweet and sour' means eating more sweet and sour foods appropriately, not eating too sweet and sour things, especially not giving patients too sweet food. In addition, when cooking, try to adjust the amount of salt according to the patient's sense of saltiness and blandness.

　　Dialectical prescription selection

　　1. Treatment for damp-heat in the liver meridian:Clear heat and promote diuresis. Prescription: Modified Longdan Xiegan Decoction, Longdan 30g, Chaihu 15g, Zhizi 15g, Huangqin 15g, Shengdi 15g, Gancao 10g, Zexie 15g, Mutong 10g, Cheqianzi 10g, Danggui 15g. Shuanghuānlián 15g, Bajicao 15g, Fuling 10g, Yimi 10g. Add Sanlie for dark tongue; add Chishao and Yinchen for bitter taste and restlessness.

　　2. Treatment for Qi stagnation and blood stasis:Regulate Qi and activate blood circulation, resolve blood stasis and disperse accumulation. Prescription: Modified Guizhi Fu Ling Wan. Guizhi 30g, Fuling 10g, Chishao 15g, Taoren 15g, Danpi 15g, Danggui 20g, Chuanxiong 15g, Yizhu 20g, Jixueteng 15g, Sanlie, Yuanhu, Chuanlianzi, Houpu, Qianchi, Longkui each 10g, Huangqi, Jixueteng, Tiefu, Shenglongmu each 15g, for severe pain, add Mosaic and Moshu.

　　3. Treatment for damp-heat and toxic retention:Clear heat and promote diuresis, detoxify and disperse nodules. Prescription: Modified Five Flavors Detoxification Drink. Double flower 20g, Forsythia 15g, purple bellflower 15g, wild chrysanthemum 15g, Tiankui 10g, Tiefu 10g, Huai麦 15g, Shuanghuānlián 15g, Danggui 15g, Chuanxiong 15g, Mosaic 10g, Moshu 10g, Baihuasheche 15g, Yuxingcao 15g.