Vulvar lymphangioma

　　One, Etiology

　　Vulvar lymphangioma is caused by the expansion and benign hyperplasia of lymphatic vessels.

　　Two, Pathogenesis

　　Vulvar lymphangioma (lymphangioma) is an abnormality or developmental disorder of lymphatic vessels, a benign hyperplasia of lymphatic vessels. The tumor is single or multiple,呈grayish red or grayish white cystic nodules of varying sizes, generally a few millimeters to a few centimeters in diameter, occasionally expanding to most of the vulva, even the vagina. The surface of the tumor may present blisters, which break and exude lymph fluid. Under the microscope, cysticly expanded lymphatic vessels can be seen in the dermis or subcutaneous tissue, lined by endothelial cells. The cyst cavity is filled with lymph and lymphocytes, and sometimes the lymphangioma can also be associated with vascular tumor components. Although it can be divided into three types clinically, they often coexist.

　　1. Simple lymphangioma is a common type of lymphangioma in the vulva. It is soft, compressible, nodular or diffuse. The cystic nodules are pale red or grayish white, single or multiple, with numerous flocks of yellowish vesicles on the surface of the tumor. Occasionally, the vesicles rupture and lymph leaks out.

　　Pathologically, a group of cavities of different sizes lined with flat endothelial cells can be seen, filled with eosinophilic lymph and lymphocytes. Under the microscope, irregularly expanded lymphatic channels can be observed.

　　2. cavernous lymphangioma is soft and compressible, the involved labia presents with diffuse thickening, unclear boundaries, and can extend downward to the perineum, or upward to the vagina. The covering epithelium of the tumor is quite normal.

　　Pathologically, cystic expansion of lymphatic vessels can be seen in the dermis and subcutaneous tissue, with the inner wall lined by endothelial cells, the cavity being empty or filled with lymph and lymphocytes. The lesion can also extend to the muscular layer, with the connective tissue surrounding the lymphatic vessels proliferating and thickening.

　　Cystic lymphangioma is very rare, consisting of lymphatic vessels with uneven wall thickness and size, expanding into cystic shapes. The cyst wall is thin, the contents are clear, pale yellow in color, with a diameter of 10cm or more.

　　Pathologically, the vessel wall may sometimes have smooth muscle and abundant connective tissue stroma. They are often located in the deep dermis and can extend to the underlying muscles or other tissues, and are often accompanied by deep blisters.

　　1. Vulvar edema Vulvar edema can occur in patients with venous return obstruction, or accompanied by hypoalbuminemia and water and sodium retention. Vulvar edema can be divided into two types: primary and secondary edema. The former is caused by congenital maldevelopment of lymphatic vessels, and the latter is due to systemic diseases such as malignant tumors metastasizing to lymph nodes or filariasis blocking lymphatic vessels. Circulatory disorders can occur due to lymphangitis caused by lymph node dissection in the inguinal or pelvic region, obstruction of lymphatic return, and inflammation. Clinical manifestations include the local epidermis gradually becoming shiny at first, and a depression when pressed. Over time, the area gradually increases, and can spread from the labia majora and labia minora to the mons pubis and perineum. Blisters may appear on the epidermis, and when they rupture, yellow fluid is discharged. Vulvar edema should be treated according to the cause, and surgical treatment may be necessary if necessary.

　　2. Vulvar varicose veins Vulvar varicose veins can be seen under the skin in normal conditions, but if the person has been standing for a long time or in the later stages of pregnancy, the veins may become prominent like worms. This is mainly due to circulatory disorders and long-term expansion of blood vessels. Generally, there are no obvious symptoms, but there may be a feeling of discomfort in the vulva after prolonged standing. If infection and inflammation occur, blood flow is slow, and thrombosis can form. Detached thrombus can cause thrombophlebitis. At this time, the vulva may be painful, swollen, and hard, with fever and increased heart rate. Vulvar varicose veins are rarely infected, and occasionally rupture, which is difficult to heal. Generally, no special treatment is required, but appropriate rest, elevation of the lower limbs, and the use of elastic bandages should be considered to prevent rupture, bleeding, and infection.

　　3. Vulvar elephantiasis can be caused by tuberculosis, filariasis, and syphilis, leading to long-term chronic proliferative inflammation of the vulva, affecting venous and lymphatic flow, resulting in thickening of one or both labia majora, with a tough texture like elephant skin. The onset time is variable, with rough skin surface, hyperpigmentation, hardness, and sometimes white lesions. Treatment should be targeted at the cause. If the local enlargement has been present for a long time, material can be taken from the ulcer or fissure for pathological examination while anti-inflammatory treatment is administered. Mild cases can be treated with laser irradiation to reduce swelling, while severe cases may require surgical treatment.

　　It is more common in the large labia, and sometimes involves the entire vulva. This type of lymphangioma is more common in children. During examination, it can be seen that the vulvar skin has single or multiple superficial red or grayish white cystic nodules or warty objects of varying sizes. The tumor surface may present vesicles, and when pressed, the mass breaks and lymph fluid is discharged. It may be accompanied by diffuse thickening and protrusion of the skin. Lymphangiomas generally do not regress spontaneously and usually continue to grow and expand. Lymphangiomas can grow very large, causing deformities, and even death.

　　1. Simple Lymphangioma

　　Common external vulvar lymphangioma, manifested as clusters of needle-to-pea-sized vesicles, semi-transparent or milky white, often arranged in linear patterns resembling herpes zoster, with soft texture, which can occur singly or multiply. When the mass is small, there may be no symptoms at all. When it grows larger or ruptures, a feeling of坠 will appear, and lymph fluid may exude from the mass.

　　2, Vulvar cavernous lymphangioma

　　It grows diffusely, soft in texture, slightly elevated on the surface, with unclear boundaries, and extends backward to the perineum. Generally, there are no symptoms, occasionally accompanied by itching or sensation of ants crawling, with a hardness like a lipoma, a fluctuating sensation, resembling a海绵状, sometimes a subcutaneous tissue mass or diffuse swelling, unless accompanied by hemangioma, generally no change in surface color.

　　3. Cystic Lymphangioma

　　It is usually a multicystic cystic mass, soft in texture, a tense subcutaneous mass, most common in the neck, occasionally occurring in the armpit, inguinal area, and retroperitoneal area.

　　First, prevention

　　1, Regular physical examination:Pay attention to regular physical examinations and self-examinations, seek medical treatment in time after finding a mass, in order to achieve early detection, early diagnosis, and early treatment.

　　2, Do a good follow-up:Prevent the disease from worsening.

　　3, Pay attention to personal hygiene:Especially the hygiene of the genital area during menstruation and puerperium.

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

　　Second, before treatment

　　It is necessary to have a detailed understanding of the symptoms of the disease and the relevant taboos.

　　Third, prognosis

　　Cavernous lymphangioma is prone to recurrence.

　　The diagnosis of vulvar lymphangioma, in addition to relying on clinical manifestations, also requires corresponding auxiliary examinations, which are indispensable. The examination methods are as follows:

     1, Secretion examination, tumor marker examination.

　　2, Histopathological examination.

　　First, the dietetic recipe for vulvar lymphangioma

　　1, Seaweed and purple grass oyster meat soup: 50 grams of seaweed, 10 grams of purple grass, 250 grams of oyster meat. Soak the seaweed in water, wash and cut into thin strips, cook in water until soft, then add the purple grass and oyster meat and cook together. Season with salt and oil to taste and serve.

　　2, Chinese yam and Chinese wolfberry stewed oyster meat: 30 grams of Chinese yam, 20 grams of Chinese wolfberry, 100 grams of oyster meat. Wash the Chinese yam, slice, wash the Chinese wolfberry and pick out impurities, clean the oyster meat, and put them all in a pot with an appropriate amount of water. Add ginger slices, oil, and an appropriate amount of salt, boil and then simmer over low heat for 30 minutes. It can be eaten after cooking.

　　3, Seaweed and Mushroom Soup: 30 grams of dried mushroom, 50 grams of seaweed. Soak the seaweed in water to remove the saltiness, cut into strips. Clean the mushroom, soak in warm water to open, cut into pieces, and then put them together in a pot with an appropriate amount of water to make soup. After boiling, add oil, top-grade fish sauce, a small amount of garlic, and scallion, and cook for a while before serving.

　　4, Seaweed Shredded Celery: 100 grams of seaweed, 300 grams of mung bean sprouts, 100 grams of tofu. Soak the seaweed clean to remove the saltiness, cut into thin strips, pinch off the bud and root of the mung bean sprouts, and cut the tofu into thin strips. Place the wok on a high heat, add an appropriate amount of peanut oil, heat the oil, and add the seaweed, tofu, and mung bean sprouts to the wok; add a small amount of water, stir-fry until cooked, add a small amount of vinegar, sugar, monosodium glutamate, and top-grade fish sauce, stir-fry for a moment, and then remove from heat to serve.

　　Two, what foods are good for the body with vulvar lymphangioma

　　2. Eat more foods with anti-vulvar tumor and leukoplakia effects, such as sesame, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, blacksnake, pork pancreas, chrysanthemum, black plum, peach, lychee, Shepherd's purse, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, turtle.

　　1. Control the intake of calories and salt, reduce the intake level of fat and cholesterol, control weight, prevent or correct obesity, diuretic and natriuresis, regulate blood volume, protect heart, brain, and kidney vascular function. Adopt a diet low in fat and cholesterol, low in sodium, high in vitamins, moderate in protein and calories.

　　Three, it is best not to eat those foods for vulvar lymphangioma

　　Avoid stimulant drinks such as coffee.

　　Avoid spicy and刺激性 foods such as scallions, garlic, ginger, cinnamon, etc.

　　Avoid smoking and alcohol.

　　Avoid greasy, fried, moldy, and preserved foods.

　　Avoid 发物 such as rooster, goose, etc.

　　When itching is severe, avoid seafood and刺激性, allergenic foods.

　　Surgical Treatment:

　　The principle of treatment is surgery. Symptomatic or larger lymphomas can be surgically removed, but it is often not easy to completely remove them, and the lymphangioma should be as completely removed as possible during surgery.

　　1. Simple Lymphangioma

　　For those with small tumors and no自觉 symptoms, treatment is not required. If the tumor is large or the skin is ulcerated, surgical resection should be performed, but it is not easy to completely cure. For certain localized lesions, sclerosing agents can be used for treatment. Simple ones can also be treated with electro-drying, freezing, or laser therapy.

　　2. Spongy Lymphangioma

　　Spongy ones are often not completely removed and tend to recur, requiring radical surgery. Due to its diffuse growth, soft texture, compressibility, and wide range, it can extend from the vulva into the vagina upwards and downwards to the perineum, so the surgery is more difficult, not easy to completely remove, and can also be treated with sclerosing agents after surgery. Radiotherapy is not sensitive to spongy ones.

　　3. Cystic Lymphangioma

　　For cystic lymphangiomas and small lymphomas, liquid nitrogen freezing, electrocoagulation, or laser, radioactive nuclide therapy can be performed.