Contents 1 Pinyin 2 English reference 3 Disease code 4 Disease classification 5 Disease overview 6 Disease description 7 Symptoms and signs 8 Cause of disease 9 Pathophysiology 10 Diagnostic examination 11 Differential diagnosis 12 Treatment plan 13 Complications 14 Prognosis and prevention 15 Epidemiology 16 Special reminder: 1 Chinese patent medicines for treating *** adenosis 2 *** Drugs related to adenosis 1 Pinyin
yīn dào xiàn bìng 2 English reference
vaginal adenosis 3 Disease Code
ICD:D28.1 4 Disease Classification
Obstetrics and Gynecology 5 Disease Overview
*** Adenosis (adenosis?vaginae) It refers to the presence of glandular tissue or hyperplasia of glandular tissue structure on the vaginal wall or cervical vaginal surface or in the epidermal submucosal connective tissue. Adenosis can occur in middle-aged and elderly women and women after puberty and puberty. The age of onset is mostly in women under 30 years old.
Symptoms: Most patients have no obvious conscious symptoms. The lesions are extensive or involve the mucosal surface, and symptoms of increased leucorrhea, thin mucus-like or bloody leucorrhea are often present, and may also manifest as post-ejaculation bleeding, vaginal pain and vaginal burning sensation. 6 Disease Description
***Adenosis (adenosis?vaginae) refers to the presence of glandular tissue or hyperplasia of glandular tissue structures on the surface of the vaginal wall or cervical vaginal surface or in the epidermal submucosal connective tissue. . Normal vaginal walls and cervical squamous epithelial coverings generally do not have glandular tissue. The presence of glandular tissue on the vaginal wall is considered to be the remnants of the paramesonephric ducts during the embryonic period. The focal glandular epithelium can transform into normal squamous epithelium or undergo malignant transformation. 7 Symptoms and Signs
1. Symptoms? Most patients have no obvious conscious symptoms. The lesions are extensive or involve the mucosal surface, and symptoms of increased leucorrhea, thin mucus-like or bloody leucorrhea are often present, and may also manifest as post-ejaculation bleeding, vaginal pain and vaginal burning sensation.
2. Gynecological examination? ***Adenosis lesions are mostly located in the fornix of *** and the upper and middle posterior walls of ***. Speculum examination showed that *** mucosa was eroded, red granular, red spot-like, superficial ulcer-like, and could bleed when touched. Some may present polyp-like protrusions, some may present single or multiple cyst-like protrusions on the vaginal wall, and some may show vaginal mucosa folded into a ring around the external cervix. *** Sometimes palpable *** Submucosal nodular or sand-like lesions, generally 0.5 to 5 cm in diameter. If the lesion is in the cervix, cervical transverse ridges or folds, cervical dysplasia, cervical comb-like protrusions or cervical ectropion can be found. 8 Causes of the disease
*** The exact cause of adenosis is unknown. *** The glandular tissue appearing on the wall is the remnants of the paramesonephric ducts during the embryonic period. It has not been transformed into columnar epithelium that has not transformed into squamous epithelium. Under certain factors Different types of adenopathies develop under the influence. This change may be caused by the following reasons.
1. Influence of drugs? Most believe that the occurrence of adenosis is closely related to the mother's taking of the non-steroidal synthetic estrogen diethylstibestrol (DES) or similar synthetic estrogens during pregnancy. The genotoxicity of DES may be related to one of its quinone metabolites, which can pass through the placenta and cause a series of developmental abnormalities in the fetus. Pregnant women taking DES can cause the mesodermal tissue in the developing paramesonephric ducts to grow into the normal cervix. Below the external opening, the junction of squamous epithelium and columnar epithelium moves downward. In addition, it may also interfere with the normal transformation process of urogenital sinus epithelium and paramesonephric duct epithelium during fetal development, causing some glandular residues to fail to transform into squamous epithelium in time. Later, during female infancy or adolescence, certain factors such as inflammation, hormones, injury, etc. will cause residual gland hyperplasia to form adenosis or even tumors. The occurrence of adenosis is positively related to the time and dose of early embryonic exposure to DES?. The earlier, longer the exposure time, and the greater the dose, the higher the incidence of adenosis. About 1/3 of the offspring of mothers who took DES before 18 weeks of gestation will develop adenosis. If DES is taken before 8 weeks of gestation, the incidence of adenosis in their female offspring will be as high as 1/3. 70% took the medicine after 18 weeks, but none of them got sick. Such cases are mostly discovered in adolescence. However, Kaufman's follow-up study found that there was no effect on the third-generation female offspring and their mothers who were exposed to DES during embryonic period.
Chemotherapy drugs may play a certain role in promoting the occurrence of adenosis. Goodman (1991) reported a case of adenosis occurring 8 months after the application of 5Fu to treat genital warts, and 40 months later. It developed into clear cell carcinoma of the vagina. In 1993, Bornstein reported a case of adenosis lesions appearing in the fornix of the penis 1 year after the application of 5Fu to treat genital warts.
2. *** Environmental impact Before the death of DES in 1938, Von Pruesohe found 4 cases of *** glandular tissue in the wall in 34 female autopsies. Domestic scholars reported 37 cases of *** adenosis, none of which had a history of DES exposure. Therefore, it is believed that patients without a history of DES? exposure may also develop adenopathy, and DES? exposure is not the only cause. Patients with no history of DES? exposure mostly acquire it after puberty. Therefore, it is also called acquired vaginal adenosis (acquiredVaginal? Adenosis). *** After normal epithelium is destroyed by certain physical and chemical factors such as drugs, laser, birth trauma, etc., or *** the normal acidic environment is changed, the internal pH of *** is increased, making *** epithelium resemble columnar epithelial metaplasia. Similarly, the squamous epithelium of the adenocarcinoma is replaced by columnar epithelium and further forms a glandular structure, finally developing into adenosis. 9 Pathophysiology
Most of the *** adenosis is located in the upper 1/3 of the ***. It is more common on the anterior wall of the ***. Some cases can spread to the middle 1/3 of the ***, and a few can spread. To the lower 1/3 of the penis, even the hymen. *** Gross examination of adenosis can be divided into 4 types.
1. Occult type (occult)? *** There are no abnormalities on the outer surface of the mucosa, but *** glandular tissue exists under the mucosal epidermis, which is often found in tissue biopsy or autopsy.
2. Cycstic type (cycstic) *** The intima contains one or more cystic structures of different sizes. The cysts contain mucus and the cyst wall is lined with cervical glandular epithelium. Sometimes a low and simple *** can be formed.
3. Adenomatous? The glandular tissue proliferates excessively, growing outward and protruding into the vagina to form a vaginal mass, sometimes in the shape of a polyp.
4. Spot type (effluent)? *** Hyperplasia of internal gland tissue. The glandular cavity is connected with the vagina, so that the squamous epithelium of the vagina is replaced by columnar epithelium. When examined, the lesions appear red spots, granular, mottled or erosive, and are not stained by iodine.
Under the microscope, glandular epithelium can show three types of shapes:
(1) Similar to endocervical glandular epithelium, the glandular epithelium is tall columnar. The cells contain mucus, which is the most common type.
(2) Similar to endometrial epithelium, but without endometrial stroma.
(3) Similar to fallopian tube epithelial cells, this type is rare.
*** Glandular cells of adenosis often secrete mucus and react positively to mucus carmine or PAS?. When the vaginal pH value is low, varying degrees of squamous metaplasia can occur in glandular epithelial cells, and nail-like squamous epithelium can appear. Mucus droplets can sometimes be seen in the latter, which can be used as the basis for breast adenosis. . The surface squamous epithelium involved by the disease is mainly composed of basal cells and spiny cells that lack glycogen. 10 Diagnostic examination
Diagnosis: The pathological diagnostic criteria are *** glands under the mucosa similar to cervical mucosa, endometrium or fallopian tube mucosa, or *** normal stratified squamous epithelium replaced by glandular epithelium , that is, it can be diagnosed as adenopathy. The patient's mother can be asked in detail whether she has a history of taking DES during pregnancy, especially before 8 weeks of pregnancy. People with such a history should be highly vigilant and should be followed up even if they are asymptomatic.
Laboratory examination:
1. Biopsy? Multi-point biopsy of the lesion under direct vision or a microscope is the method for diagnosing adenosis.
2. *** Microscopic examination and biopsy? Usually *** Under the microscope, there are columnar epithelial changes similar to the cervical transition zone in the lesions. Typical grape-like tissue can be seen after applying acetic acid, and squamous tissue can be seen in the transformation zone. Cylindrical epithelial metaplasia, columnar epithelial islands, gland openings and small glandular cysts, and sometimes white epithelium, white spots, punctate blood vessels, mosaics and other microscopic images can be seen. In 90% of adenopathies caused by DES?, the above different images can be seen on microscopic examination. Vascular signs usually require careful observation under a green filter, but usually there is no obvious change in shape. Acetic acid and iodine often do not stain the lesion area. The use of endoscopic examination to diagnose adenopathy has high reliability.
Cytological examination: Scrape directly on the surface of the suspicious lesion, or scrape the mucosa from the *** fornix and upper and middle segments for cytological examination. If mucinous epithelial cells or squamation are found, cells, suggesting the possibility of *** adenosis. However, because most lesions are located under the mucosa, scraping cytology results are mostly negative, and they are easily affected by inflammation of the vagina, so their significance in diagnosing adenopathy is limited.
However, for follow-up, epithelial atypical hyperplasia and early detection of malignant transformation can be regarded as a simple and economical means.
Other auxiliary inspections: no special performance. 11 Differential diagnosis
1. Endometriosis
2. Mesonephric duct cyst
(1) *** Mesonephric duct cyst
p>(2) Inclusion cyst
3. *** Botryoid sarcoma
4. *** Clear cell carcinoma
5. * ** Treatment plan for squamous cell carcinoma 12
1. *** Inflammation? *** Inflammatory lesions can induce symptoms of latent *** adenosis, so the causes of *** various inflammations should be actively treated treat.
2. Increase *** acidity? *** Highly acidified environment (pH? 1.8~2.4) can promote glandular epithelial squamation. Use local sitz bath and rinse***, such as 0.5% acetic acid rinse ***, 8~10g of boric acid powder? Sitz bath, etc.
3. Physical and chemical treatment? For superficial and small lesions, laser, freezing, electrocautery and other treatments can be used. The depth is generally 3 to 5mm to cause the lesions to become necrotic, vaporize and fall off. You can also apply 10% to 20% silver nitrate or potassium dichromate solution locally, 2 times a week for 3 months to make the lesions necrotic and fall off.
4. Surgical treatment? For a single localized submucosal lesion, surgery can be used to completely remove the lesion. For those who are found to have severe atypical hyperplasia or malignant transformation, the treatment principles are the same as those for breast cancer, and tumor resection or total breast resection is performed, followed by vaginal cystoplasty. 13 Complications
Sometimes accompanied by cervical adenosis, cervical dysplasia occurs, and deformities such as transverse ridges, folds, or cockscomb-like protrusions appear on the cervix. 14 Prognosis and Prevention
Prognosis:
1. Persistence or squamation? Some *** adenosis can be asymptomatic and persist. In 1989, Fu et al. followed up and observed Of the 953 cases of *** adenosis, 5% persisted during the 6-year follow-up. Some follow-up biopsies have found that the columnar epithelium covering the surface can transform into squamous epithelium.
2. *** Excessive microglandular hyperplasia? It is mostly caused by patients with *** adenosis taking progesterone drugs. *** There is hyperplasia of many tiny glands in adenosis. *** Flat particles or scattered polyp-like masses or small cauliflower-like nodules appear on the wall surface, which usually disappear on their own after stopping the drug.
3. Atypical adenosis? It is a precancerous lesion. Under the microscope, the glands are irregular and neatly arranged. The epithelium is mostly endometrium type, with single-layer or pseudo-stratified columnar cells and large nuclei. , different shapes, deeply stained nuclei, visible nucleoli, rare mitoses, DNA polyploidy or euploidy. Approximately 75%*** of clear cell carcinomas may be associated with atypical adenosis.
4. Malignant transformation? *** Adenosis can develop into atypical hyperplasia and cancer, mostly adenocarcinoma. Squamous cell carcinoma or clear cell carcinoma are rare, and clear cell carcinoma occurs in about 0.1%.
Prevention: Avoid the abuse of estrogen during pregnancy to reduce and prevent the occurrence of adenopathy. Women who have been affected by DES in utero should undergo regular gynecological examinations and strengthen follow-up. Patients with a history of local treatment of ***, especially those treated with fluorouracil and laser, should be followed up regularly.
Follow-up: For those with small lesions, asymptomatic, and benign biopsies, follow-up observation can be carried out. Regular follow-up examinations should be performed once every six months to one year. The examination should include routine leucorrhea examination, original After scraping cytology and microscopy of the lesion area, if suspicious or original lesions are found to have expanded range or changed properties, another biopsy should be performed to confirm the diagnosis, excluding malignant transformation. 15 Epidemiology
***Adenosis can occur in middle-aged and elderly women and post-adolescent women. The age of onset is mostly in women under 30 years old. In the past, this disease was considered rare, but in recent years, the number of cases reported in the literature has increased. 16 Special Tips
Avoid the abuse of estrogen during pregnancy to reduce and prevent the occurrence of adenopathy. Women who have been affected by DES in utero should undergo regular gynecological examinations and strengthen follow-up. Patients with a history of local treatment of ***, especially those treated with fluorouracil and laser, should be followed up regularly. Shenling Baizhu Powder: ① Transparent sticky leucorrhea, which is more common in cervicitis, ovarian dysfunction, adenosis or well-differentiated adenocarcinoma of the cervix. ②Thin gray-yellow or yellow-white foamy band... Yinqiao Powder
Sachi virus B3, poliovirus type Ⅰ, vesicular stomatitis virus, adenovirus and other infections have direct killing effect.
Licorice also has an effect on some of the above-mentioned bacteria... Sini Powder
The antiviral efficacy of herpes virus type Ⅰ, chickenpox-zoster virus, vesicular stomatitis virus, adenovirus type Ⅲ, and vaccinia virus is certain; licorice polysaccharide has a certain antiviral effect It can inhibit water... Zhimi Fuling Pills
It has a significant inhibitory effect on Staphylococcus, Streptococcus, and Streptococcus pneumoniae, and it also has a killing effect on *** Trichomonas. The 60% alcohol extract of ginger has The above bacteria and... Chuanxiong tea powder
Type I herpes simplex virus and vaccinia virus; glycyrrhizic acid has strong resistance to coxsackie virus, adenovirus, and syncytial virus; glycyrrhizic acid monoamine can inactivate HIV, licorice... More Chinese patent medicines for the treatment of *** adenosis
*** Adenosis-related drugs combined with estrogen tablets
Diethylstilbestrol (DES) for treatment Studies of women have shown that their girls are more likely to develop adenosis, cervical squamous cell dysplasia, and later clear cell carcinoma of the vagina... Diethylstilbestrol Injection
Contraindications (1) It is contraindicated for pregnant women (it may cause an increase in the incidence of adenosis and adenocarcinoma in second-generation women, abnormalities in the male reproductive tract and vaginal abnormalities... Diethylstilbestrol Tablets
Contraindications (1) It is contraindicated for pregnant women (it may cause an increase in the incidence of adenosis and adenocarcinoma in second-generation women, abnormalities in the male reproductive tract and vaginal abnormalities... Diethylstilbestrol Tablets
Contraindications 1. Contraindicated in pregnant women (it may cause an increase in the incidence of adenosis and adenocarcinoma in second-generation women, abnormalities in the male reproductive tract and anomalies in the vagina... Danazol Capsules