Vaginal granulocytic sarcoma

　　1. Etiology

　　The pathogenic factors of granulocytic sarcoma of the vagina are not yet clear.

　　2. Pathogenesis

　　Granulocytic sarcoma of the vagina presents as diffuse homogeneous infiltration, mainly composed of numerous immature bone marrow cells and a small number of bone marrow megakaryocytes. The presence of eosinophilic blast cells has a strong indicative value for the diagnosis of this tumor. Electron microscopy shows that Giemsa staining can have neutrophilic granules in the cytoplasm. Histological and immunohistochemical examination shows positive results for myeloperoxidase, chloroacetate esterase, and lysozyme, and bone marrow mononuclear cells, anti-body, CD68, CD43 are all positive.

　　Some patients may have concurrent infectious sepsis. Sepsis: It varies with the type, quantity, virulence of the pathogenic bacteria, as well as the age and resistance of the child. The mild form may only have general infection symptoms, while the severe form can lead to infectious shock, DIC, multiple organ failure, and other complications. The total white blood cell count in blood pictures is usually significantly increased, reaching 10-30×10^9/L, with an increased percentage of neutrophils, usually above 80%, and there may be marked nuclear left shift and intracellular toxic granules. In a few cases of Gram-negative sepsis and reduced immune function, the total white blood cell count may be normal or slightly reduced. 2. Nitroblue tetrazolium (NBT) test This test is positive only in bacterial infections, and can be as high as over 20% (normal below 8%), which helps in distinguishing between viral infections, non-infectious diseases, and bacterial infections.

　　1. The main manifestations of granulocytic sarcoma of the vagina are vaginal bleeding or spotting after menopause, vaginal discharge, and may be accompanied by lower abdominal pain. The vaginal mass is hard and localized to the subcutaneous tissue or infiltrates the surrounding pelvic tissues.

　　2. Because granulocytic sarcoma of the vagina is rare, especially when peripheral blood and bone marrow examination are normal, diagnosis is often difficult, and an electron microscope may be needed for confirmation when necessary.

　　3. Granulocytic sarcoma of the vagina can be seen in recurrent acute myeloid leukemia and can occur simultaneously with breast granulocytic sarcoma. There are also reports of granulocytic sarcoma of the vagina being diagnosed, and then bone marrow biopsy revealing acute myeloid leukemia.

　　1. Actively treat diseases such as vaginal leukoplakia, chronic inflammation, and ulcers.

　　2. For any irregular vaginal bleeding or abnormal leukorrhea, an early and clear diagnosis should be made, and active treatment should be carried out.

　　After the treatment of vaginal granulocytic sarcoma, it is necessary to have a follow-up examination once every 3 to 6 months, and cellological examination should be performed. If vaginal bleeding or abnormal leukorrhea occurs again, seek medical attention in time.

　　1. The main examinations for vaginal granulocytic sarcoma include:Blood routine examination, tumor marker examination, histochemistry and immunohistochemistry examination.

　　2. Colposcopy examination:The main manifestations of vaginal granulocytic sarcoma are vaginal bleeding or spotting after menopause, vaginal discharge, and may have lower abdominal pain. The vaginal mass is hard, localized under the skin or infiltrating around the pelvic tissue.

　　1. Diet should be light and nutritious. Eat more vegetables (such as cabbage and cauliflower), radishes, sour plums, soybeans, beef, mushrooms, asparagus, Yiyiren, etc., which contain anticancer substances. Fruits, milk, turtle and other foods are rich in a variety of amino acids, vitamins, proteins and easily digestible tonifying foods.

　　2. Patients with tumors have high energy consumption, so their diet should increase 20% more protein than normal people.

　　3. Eat less greasy and heavy foods; eat less dog meat, mutton and other warm-tonifying foods; eat less shell-free seafood, bamboo shoots, taros and other easily allergic 'invigorating' foods; eat less drinks and snacks containing chemicals, preservatives, and additives. Avoid over-acid, spicy, salty, tobacco and alcohol and other stimulating substances.

　　Traditional Chinese medicine therapy is based on the principle of activating blood circulation to resolve stasis, attacking hard masses, detoxifying and removing dampness, but the specific application needs to be based on the main symptom of the syndrome. Generally, at the initial stage of the disease, for those with strong healthy body and real evil, surgical resection should be the main treatment, combined with traditional Chinese medicine to break stasis and dissipate masses. At the middle and advanced stages, according to the condition, it may focus on attack or supplement, or both attack and supplement, and grasp the appropriate amount, 'decrease by half and stop'. At the same time, attention should be paid to the application of radiotherapy, chemotherapy and other methods of treatment.

　　1. Differential diagnosis and selection of formula

　　1. Liver meridian damp-heat

　　Treatment method: Clear heat and promote diuresis.

　　Herbal formula: Modified Longdan Xiegan Decoction, Longdan 30g, Chaihu 15g, Zhizi 15g, Huangqin 15g, Shengdi 15g, Gancao 10g, Zexie 15g, Mutong 10g, Cheqianzi 10g, Danggui 15g. Banjialian 15g, Baisao 15g, Fuling 10g, Yimizi 10g. Add Sanlie for dark tongue; add Chishao and Yinchen for bitter mouth and restlessness.

　　2. Qi stasis and blood stasis

　　Treatment method: Regulate Qi and activate blood, resolve blood stasis and dissipate accumulation.

　　Herbal formula: Modified Guizhi茯苓 Decoction. 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, Tufuling, Shenglongmu each 15g, for severe pain, add Ru xiang and Mo xiang.

　　3. Damp-heat and toxic retention

　　Treatment method: clearing heat and dampness, detoxifying and resolving nodules.

　　Prescription: Wuwei Xiaoyao Decoction with modification. 20g of Flos Lonicerae, 15g of Forsythia, 15g of Viola yedoensis, 15g of Dendranthema indicum, 10g of Semiaquilegia adoxa, 10g of Smilax glabra, 15g of Herba Epimedii, 15g of Herba Epimedii, 15g of Angelica sinensis, 15g of Ligusticum chuanxiong, 10g of Borneol, 10g of Myrrha, 15g of Herba Houttuyniae, 15g of Herba Houttuyniae.

　　4. Yang deficiency of liver and kidney

　　Treatment method: tonifying the kidney and detoxifying and resolving swelling.

　　Prescription: Zhibai Dihuang Wan with modification, 20g of Anemarrhena, 20g of Phellodendri, 25g of Rehmannia, 15g of Poria, 25g of Cornus officinalis, 50g of Dioscorea, 15g of Alisma orientale, 20g of Moutan Cortex, 15g of Herba Eupatorii, 10g of Herba Epimedii, 10g of Liquorice, 10g of Herba Epimedii, 20g of Herba Epimedii, 15g of Herba Epimedii, 15g of Angelica sinensis, 15g of Ligusticum chuanxiong, 10g of Borneol, 10g of Myrrha, 15g of Herba Houttuyniae, 15g of Herba Houttuyniae.

　　Second, special formulas and prescriptions

　　1. External washing formula

　　(1) Sanpin formula: 45g of arsenic trioxide, 60g of alunite, 7.2g of realgar, 3.6g of myrrha. Grind into fine powder and mix to make three coins-sized (2mm thick, 0.2g heavy) Sanpin cakes, ultraviolet disinfected and reserved. The patient lies on the gynecological examination bed, the vagina is disinfected, and a vaseline oil gauze strip is used to protect the unbroken parts of the vagina and fornix. Apply the Sanpin cake on the tumor, after 5-7 days, there is necrotic tissue shedding, wait for the absorption of the Sanpin cake, and change the traditional Chinese medicine 'Shuangzi powder' (Radix Scutellariae, Viola yedoensis, Herba Eupatorii, Phellodendri, Herba Polygoni multiflori, each 30g, a little Borneol, ground into powder and high-pressure disinfected) before the tissue falls off. The medicine should be taken 5-7 days after the menstrual period to 5 days before the menstrual period; this method disinfects, anti-cancer, resolves swelling, and removes blood stasis. It is contraindicated in patients with severe liver and kidney dysfunction. 2. Huangwu powder No. 1: 64% Phellodendri, 13% Zhenfu, 7% Centipede, 3% Borneol, 0.7% Musk, 12.3% Realgar. Grind separately into powder and pass through a 100-mesh sieve, mix and reserve. Use a sterile tail thread cotton ball, dip about 1g of medicine powder with a long-handled forceps and send it into the vaginal lesion; mild cases once a week, severe cases 2-3 times a week. Avoid sexual life during treatment.

　　2. Internal treatment formula

　　(1) Anticancer tablet: 5 catties of Strychnos nux-vomica, Trichosanthes kirilowii, and Fritillaria thunbergii, 1 catty of Liquorice, the Strychnos nux-vomica peeled, fried in sesame oil until crisp, mixed with the other three herbs into a fine powder, added with starch to make tablets, each tablet weighing 0.3g, taken 3 times a day; initially, 3 tablets per time, without adverse reactions, increase to 5 tablets per time, without course division, continue taking the medicine. Most patients have increased physical strength and appetite; excessive or prolonged medication may cause symptoms such as tightness in the hands and feet, which disappear after stopping the medicine. This formula detoxifies, resolves swelling, and removes blood stasis.

　　(2) Pinellia ternata formula: Pinellia ternata in appropriate amount, made into oral tablets; taken orally, 3 times a day, with a total dosage of about 60g of crude drug, which has a significant effect of clearing heat, detoxifying and anti-cancer.

　　3. Formulas for preventing and treating the toxic and side effects of radiotherapy and chemotherapy

　　Chemotherapy and radiotherapy for malignant tumors often lead to a series of toxic and side effects; such as local pain, adhesion, tissue necrosis, decreased blood cells and platelets in the whole body, disordered digestive function, liver and kidney dysfunction, nervous system damage, etc. The application of traditional Chinese medicine formulas has a good effect in preventing and treating these toxic and side effects. The following formulas can be selected for use.

　　(1) Shenqi Fandu decoction: Astragalus membranaceus, Astragalus mongholicus each 30g. Schisandra chinensis, Psoralea corylifolia, fried Astragalus membranaceus each 15g, Ophiopogon japonicus 20g, Angelica sinensis, Poria cocos, Citrus reticulata, Paeonia lactiflora each 12g, decocted, 1 dose per day, taken 2-3 times, starting 3 days before chemotherapy. This product has the function of invigorating the body and anti-cancer, nourishing Yin and blood, promoting Qi and drying dampness, invigorating the spleen and stomach to stop vomiting, and removing blood stasis and dispersing nodules, which can prevent the toxic and side effects of chemotherapy and make the chemotherapy proceed smoothly.

　　(2) Nourishing blood and raising white drink: Astragalus membranaceus, Astragalus mongholicus, Angelica sinensis, Rehmannia glutinosa, Schisandra chinensis, Spatholobus suberectus, Smilax glabra each 15g, Bupleurum chinense, Psoralea corylifolia each 10g, Carcassus, Licorice each 6g, Carcassus, Carcassus each 9g, add Rehmannia glutinosa and Osteoxysmus gigas each 15g for Yin deficiency; add Morinda officinalis and Curculigo orchioides each 12g for Yang deficiency; add Ziziphus jujuba and Cuscuta chinensis each 12g for insufficient heart blood; add Phellodendron amurense and Alisma orientale each 10g for damp-heat. This formula has the effect of invigorating Qi and spleen, balancing Yin and Yang, promoting blood circulation and detoxifying, and is used for leukopenia caused by chemotherapy.

　　Third, other therapies

　　1. Rubbing method:

Apply Yizhu oil ointment, apply this ointment to the irradiated area after radiotherapy and let it dry, instruct the patient to wear loose underwear to prevent it from sticking to the skin; suitable for skin burns caused by radiotherapy.

　　2. Chinese medicine injection method:

　　(1) Shechuangye injection, 4ml each time, once a day, intramuscular injection, 30 days as a course, with the effect of clearing heat and dampness, detoxifying and reducing swelling.

　　(2) Add 10% Brucea javanica oil to the disinfected vagina and use a 5ml syringe with a needle. Inject at the tumor site according to the lesion, twice a week, 5-10% Brucea javanica oil 4-8ml each time, after injection, stop medication according to the situation of lesion shedding, necrosis, and regeneration; it has the effect of removing corrupt tissues and promoting new growth. Chinese medicine search Breakline western medical treatment for vaginal granulocytic sarcoma

　　3. Chemotherapy (Radiotherapy):

　　Patients with vaginal granulocytic sarcoma can be treated with chemotherapy and (or) radiotherapy. Chemotherapy commonly uses DA (daunorubicin and cytarabine) or TAD (thioguanine, cytarabine, and daunorubicin).