classification
Tumor
Primary vaginal squamous cell carcinoma:
In the early stage, there are no obvious symptoms, and then about 60% of patients have retrospective history with painless bleeding, and 20% have increased leucorrhea, with or without blood stains.
When nodule necrosis forms ulcers, watery or bloody secretions, irregular vaginal bleeding, bleeding during intercourse, or postmenopausal bleeding occur. Such as co-infection, foul-smelling discharge. In advanced patients, when the tumor invades the nerves or pelvis, pain in the lower abdomen, waist and legs may occur; such as erosion of the bladder, there may be frequent urination, painful urination, dysuria and hematuria. When cancer compresses or invades the rectum, anal swelling, painful defecation and constipation may occur. Sometimes the cancer thickens and hardens along the vaginal wall, narrowing the vaginal cavity. As the tumor continues to develop, vesicovaginal fistula or rectovaginal fistula will eventually form.
Speculum examination or palpation shows that the vaginal wall has nodules, cauliflower-like, ulcers or local hardening. In advanced patients, cancer fills the vaginal cavity, and a large amount of foul-smelling secretions are discharged. In addition, cancer tumors that occur in the lower third of the vagina are often accompanied by inguinal lymph node metastasis. During the examination, the swollen lymph nodes may be felt, which are hard, or even fused and fixed or ulcerated.
Vaginal clear cell adenocarcinoma:
Vaginal clear cell adenocarcinoma is rare, accounting for about 5-10% of primary vaginal cancers, and often occurs in young women and girls. According to statistics from foreign literature, the youngest age of onset is 7 years old, the oldest is 28 years old, and the average age is 17 years old. The clinical manifestations have no special symptoms, and most patients have irregular vaginal bleeding, discharge and pain during intercourse, which are indistinguishable from general cervical adenocarcinoma. A few patients are asymptomatic.
The lesions are more common in the upper 1/3 of the anterior wall of the vagina, and occasionally in the lower 1/3 or the posterior wall. Most of them are polypoid, or nodular or papillary. They are brittle and easy to bleed. Sometimes the tumor is necrotic and not formed. Regular ulcers. The lymphatic metastasis rate of clear cell adenocarcinoma is relatively high. In the case of recurrence, in addition to the invasion of the pelvis and adjacent organs, metastasis to the lung and supraclavicular lymph nodes accounts for about 35%.
polyp:
Vaginal sarcoma is rare. Including leiomyosarcoma, fibrosarcoma and botryoid sarcoma. It can occur in both young girls and adults. However, 80% of infant vaginal sarcoma are botryoid sarcoma. Clinical manifestations: asymptomatic in the early stage. After the tumor develops, there are more vaginal discharges and a foul smell. At the same time, irregular vaginal bleeding and sexual communication occur. In severe cases, there will be pain and vaginal obstruction and falling. Vaginal examination showed nodular masses or infiltrative lumps, surface ulcers, and hard and narrow vaginal walls. Late-stage patients may have metastases to distant organs such as the lungs and liver, often complicated by uremia and cachexia. A biopsy of the primary lesion in the vagina must be done to confirm the diagnosis.
Malignant melanoma of the vagina:
Primary melanoma of the vagina is very rare and is a highly malignant tumor. It grows fast, easy to spread blood, and early metastasis. It occurs in elderly women with an average age of onset of 62 years. Clinical manifestations: The main symptoms are irregular vaginal bleeding (65%) and increased vaginal discharge (30%). If the tumor necrosis and discharge melanoma-like tissue, it may be mistaken for old black blood clots. After the tumor develops, pain, difficulty urinating, and swelling of the lower abdomen may occur. On examination, it can be seen that there are blue-black or brown-black bumps on the vaginal wall, which are nipple or nodular, irregular in shape and uneven on the surface, sometimes forming ulcers. The tumor grows rapidly, spreads directly outwards and can protrude from the vaginal opening, spread upward to the cervix and main ligament, and erode the vagina, rectum and bladder inward. In advanced patients, it spreads through blood, and metastases to distant organs such as liver, lung, and brain may occur.
Vaginal metastatic tumors:
Vaginal metastatic tumors are more common than primary tumors. Most are metastasized from cancer of the cervix, uterus and vulva; a few are from ovarian, bladder, urethra and rectal cancer, etc.; it is rare for cancers of the kidney and breast to metastasize to the vagina. Its transfer methods include 1. Direct spread and spread. Common ones are cancer of the vulva, cervix, bladder, urethra and rectum; 2. Lymphatic penetration. Such as endometrium, cervix, bladder, rectum and anus cancer, etc.; 3. Dissemination of bloody tumor thrombi. More common in uterine body, kidney, ovarian tumors and malignant trophoblastic tumors; 4. Direct implantation. Such as malignant tumors of the endometrium and cervix.
The appearance and surface form of vaginal metastatic tumors can vary depending on the location, nature, and way of metastasis of the primary tumor. Generally, it is nodular mass, or presents multiple superficial or deep ulcers of varying sizes; when trophoblast cells transfer, they often appear as single or multiple purple-blue nodules, often with ulceration and bleeding on the surface.
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