This article is transferred from the WeChat public account: Dr. Xiaoye Wu Xin from the Red House, 19 years old, a well-known university student, recently in the bath inadvertently touched something coming out of the vagina, such as the size of a pigeon egg, although it is not painful or itchy, but also She was terrified! In a hurry, she hurriedly searched the Internet for the reason, but did not find a satisfactory answer. When Xiaoye was nervous and anxious, she saw Professor Wu Xin’s expert clinic on the Red House patient service platform. The next day, she came to Professor Wu’s outpatient clinic. Professor Wu had a detailed consultation and physical examination. During the gynecological inspection, she found a vague mass in the vagina. The color was the same as that of normal mucosa, protruding from the margin of the hymen, and it was yellow with light clamp Clear liquid oozes. Due to the asexual life of the lobules, an anal examination was performed, and a cystic mass in the vagina was touched through the anal examination, with a size of about 7.5*7.5cm. Red House Hospital B-ultrasound tips: The vagina is mainly mixed with cysts under the cervix, the size is about 76*76*61mm, and the blood supply is abundant. The tumor markers CA153, CA199, CEA, AFP, CA125, SCC, and HE4 were all normal and were admitted to the hospital for further evaluation. Admission examination After admission, the relevant examinations were perfected, and surgical contraindications were excluded. On 2018-02-11, vaginal intravaginal mass resection was performed under general anesthesia. During the operation, a cervix with a diameter of about 8*7*6cm3 was seen, the composition was leaf-like, partly cystic, solid, and jelly-like. The probe pedicle is about 0.8cm wide from the 2 o’clock position of the internal cervical os. The ultrasonic knife slides to the pedicle of the tumor, and coagulates in stages to remove the tumor. Intraoperative freezing: (intravaginal mass) microscopically, the mass is composed of mesenchymal components and glands. Postoperative pathological report: (intravaginal mass) cervical embryonic rhabdomyosarcoma. Immunohistochemistry: MyoD1 (nuclear) (+), Myogenin (focal +), P53 (scattered +), Ki-67 (70% +), Myosin (individual cells +), SMA (-), Desmin (+) , Caldesmon (-), CD10 (+), EMA (-), CCND1 (+). After the multidisciplinary consultation and pathology results came out, Xiaoye was undoubtedly a fatal blow. She was still so young and her life had just begun. She couldn’t face everything in front of her, and desperately desperate, she found Professor Wu Xin again. Professor Wu told her that the main surgical method in this case in the world is total uterus plus bilateral appendectomy, extensive hysterectomy plus pelvic lymph node dissection when the lesion is close to the cervix, and postoperative adjuvant chemotherapy or radiotherapy. Considering that Xiaoye was 19 years old and had a strong requirement to preserve fertility, Professor Wu organized a multidisciplinary consultation for her. After discussion in the pathology department, it was concluded that the interstitium under the germinal layer was loose, with short spindle-shaped tumor cells scattered, and there was no obvious abnormality. Only part of the tumor cells showed significant atypia, and some had large single nucleoli. It is inferred that tumor cells with active proliferation are clustered in small areas. The imaging department performed a comprehensive PET-CT assessment, and the results were not abnormal. Considering that the patient is 19 years old and has a strong need to preserve fertility, combined with existing literature, combined with the patient’s pathology, the degree of cell malignancy is not high. It was decided to perform hysteroscopic root pedicle resection + sentinel lymph node biopsy, and it has been determined whether the patient has residual disease and the possibility of metastasis. Surgical treatment March 19, 2018 was an unforgettable day for Xiaoye. She entered the operating room again. This time she was no longer alone and afraid because she believed that Professor Wu could help her realize her wish! After general anesthesia, Professor Wu performed hysteroscopy + partial cervical canal resection + laparoscopic sentinel lymph node biopsy + partial omentum resection + multiple peritoneal biopsy. Under hysteroscopy: only the rough surface is seen at 2 o’clock of the cervical canal, and the endometrium of the uterine wall is uniform. Resection of the inner wall of the neck canal at 1 to 3 points at the level of the internal cervix with a resection microscope. Under laparoscopic surgery, the sentinel lymph node was removed for biopsy under the guidance of indocyanine green. Pathological results: Intraoperative frozen pathology: (bilateral sentinel lymph nodes) there was no tumor metastasis. 2018-3-22 pathological results report: 1. (cervical canal tissue) neck canal tissue with heat damage, no tumors. 2. (Bilateral sentinel lymph node) 4 lymph nodes, no tumor metastasis was found. 3. (Part of the greater omentum) fibrous fatty tissue, no lesions were seen. 4. (Abdominal cavity peritoneum) collagen fiber connective tissue, no lesions were seen. 5. (Pelvic peritoneum) collagen fibrous fatty tissue, no lesions were seen. 6. (Cutting from the uterine cavity) The endometrium shows secretory changes. pathology
Vaginitis refers to a series of inflammation of the reproductive system caused by bacteria, Neisseria gonorrhoeae, Treponema pallidum, Mycoplasma, Chlamydia, or due to the decline of ovarian function and the reduction of estrogen levels. If it is not due to ovarian function, vaginitis can usually be cured under the guidance of a doctor, and some parts have not been significantly improved after a long period of local or even systemic treatment, resulting in a long-term cure, even if the course of treatment is short, Relapse after time. The reasons may be: 1. Irregular treatment medication, insufficient treatment duration, insufficient dose, failure to regularly review, stop medication without confirmation of the disease, cannot completely kill the pathogen, the remaining pathogen can continue to reproduce locally, so that the symptoms cannot be alleviated Repeated episodes cannot be cured. 2. Inflammation is caused by mixed infections. The use of drugs directed against one pathogen alone cannot kill the pathogens of mixed infections, which may lead to serious disorders of the vaginal flora and the emergence of drug-resistant strains, which makes treatment difficult. 3. Some vaginitis can be infected through sexual intercourse, direct or indirect contact. Such as trichomonas vaginitis, fungal vaginitis, if the man has an infection, it can be transmitted to the woman through sexual intercourse, so during treatment, his spouse or sexual partner also need to be treated simultaneously. 4. Patients who have been treated with broad-spectrum antibiotics or hormones for a long period of time are likely to cause a decrease in body resistance and dysbacteriosis, making it difficult to cure vaginitis. 5. During treatment, the vagina should be kept clean, the vulva should be washed frequently, and the underwear should be changed frequently to avoid sexual intercourse. Underpants and towels should be boiled and sterilized and exposed to sunlight. 6. There are other diseases. For the long-term treatment of fungal vaginitis, we should be alert to the possibility of diabetes, because the blood sugar is high, and the level of sugar in the vagina also increases. After the action of lactic acid bacteria, the acidity in the vagina is large, suitable for fungal growth. If diabetes is not controlled, fungal vaginitis is difficult to control. Therefore, for vaginitis that cannot be cured for a long time, we must consider various aspects and remove various unfavorable factors to achieve the best treatment effect.
“Why do senile menopausal men who have no sexual life still suffer from vaginitis?” Many people think that vaginitis is the only way for women with sexual life to “stroke”, and women of other ages should not There will be this trouble again, this is a misunderstanding of vaginitis. Even elderly people who have no sex life should also prevent vaginitis. This is because after the menopause, due to ovarian function decline, estrogen secretion decline, and vaginal wall atrophy, the mucous membrane in the vagina becomes thinner and thinner until it disappears, and the glycogen and acidity in the vagina will increase, allowing the bacteria to take advantage of the inflammation. Atrophic vaginitis is more common in the elderly. Vaginitis in the elderly is more common in atrophic vaginitis (ie, senile vaginitis). This type of vaginitis is mainly caused by the lack of nutrition in the vagina caused by low estrogen levels. The relationship between love and cleanliness is not too big. There are also a small number of elderly people who have vaginitis like young women, which can be caused by infections with pathogens such as bacteria and fungi. Elderly women “provoke” vaginitis, which can also be manifested as burning discomfort in the vulva, itching, increased vaginal secretions, odor, pain during sex, etc. According to the color and characteristics of vaginal secretions, we can also identify different types of vaginitis. For example, the secretions in atrophic vaginitis are yellow. The gynecological examination shows that the vaginal mucosa is pale and the folds disappear, and the secretions in bacterial vaginitis Mostly white, the secretions of fungal vaginitis are mostly viscous and tofu-like. When trichomonas vaginitis, the secretions are gray foam… It is recommended to check blood sugar after vaginitis is detected. When you are not panicking or embarrassed, you should go to the hospital in time. After excluding cervical cancer, endometrial cancer and other common malignant tumors with early performance very similar to senile vaginitis, as well as benign tumors such as polyps and neoplasms, then check the vaginal secretions to confirm whether you have a vagina Inflammation and what type of vaginitis is suffering, and then targeted medication. It should be reminded that if older women detect candidal vaginitis, it is best to check blood sugar. Because diabetic patients can cause increased glycogen content in vaginal epithelial cells due to disturbance of glucose metabolism in the body, under the action of vaginal lactobacillus, the acidity of the intravaginal environment is increased to form an environment conducive to the growth of mold. Furthermore, due to local Long-term stimulation by high-glycemic urine, coupled with more creases in the vulva area of women, is easy to hide dirt and dirt, which can also easily lead to the occurrence of candidal vaginitis or vaginitis. How to prevent vaginitis in the elderly 1. Pay attention to personal hygiene: choose loose, comfortable and cotton underwear, change the underwear frequently, and wash it separately from other clothes, and put the washed underwear in the sun to dry. When going out to play, it is best to live in a hotel with relatively strict disinfection. Try to use your own bath towels. It is not advisable to wash the vagina with lotion. In order to avoid artificially changing the acid-base environment and natural flora balance in the vagina, the self-purification effect of the vagina itself is weakened. 2. Appropriate sex life: Appropriate sex life stimulation can increase the blood circulation of the reproductive organs and maintain the vitality of the skin in the vagina, so as to calmly prevent the occurrence of senile vaginitis. Elderly people with dry vagina can use some vaginal lubricants during sex. However, during vaginitis, it is best not to have sex.
Some women in sexual life do not want to use condoms, often use lavage to prevent condyloma acuminatum, is this practice scientific? In fact, lavage of the vagina is not good. Regular lavage will cause the natural healthy secretions and bacteria in the vagina to be cleared, destroying the acidic environment in the vagina, and susceptible to infection. At the same time, the bacteria may be washed into the uterine cavity, causing ascending infections, such as appendicitis and pelvic inflammatory disease. And frequent lavage will cause vaginal dryness and itching, and it is easy to cause damage to the vaginal mucosa during intercourse. This makes it very easy for HPV and other viruses to enter the human body through the injury gap of the vaginal mucosa, causing condyloma acuminatum infection. Rinse gently with warm water and do not use hot water to clean it at any time, because hot water will cause local irritation and damage, and it is not suitable to use cold water. This is not only because cleaning the cold water will feel uncomfortable, but it is not easy to secrete locally. Washing things; female sex organs have a natural defense function. This natural defense mechanism mainly refers to the large amount of lactobacilli that reside in the female vagina. They can make the glycogen in the vaginal epithelial cells into lactic acid, so as to keep the vagina. The acidic environment prevents other pathogenic bacteria from growing. For whatever reason, the acidic environment in the vagina is destroyed, and various pathogenic bacteria will take advantage of it. At this time, various gynecological infections are difficult to avoid.