1. Etiology and incidence
Pseudo condyloma vulvae is a benign papilloma, and its etiology is still unclear. Some scholars believe that it is caused by HPV infection.
Pseudo condyloma's HPV DNA test by Chen Lezhen showed that pseudo condyloma had nothing to do with HPV infection. Lin Hanliang et al. detected condyloma acuminatum and pseudo condyloma with naked eye morphology, histological features and human papillomavirus core-shell antigen (HPV-Ag), and used a broad-spectrum human papillomavirus DNA probe for nucleic acid in situ hybridization detection. The results showed that the detection rate of HPV DNA in condyloma acuminatum group was 90.9% (30/33), while that in pseudo condyloma group was only 2.6% (138). However, some data show that the infection rate of HPV in pseudo condyloma is 40.4%, which needs further study. In addition, some scholars believe that pseudo condyloma is caused by local long-term chronic inflammatory stimulation. Some scholars also think that candida infection may be related to the occurrence of this disease. Some scholars have observed that this disease will be aggravated during pregnancy and relieved after delivery, but they think it is related to the hormone level in the body. However, some scholars emphasize that this is an anatomical variation, a physiological abnormality like the pearl papules of male penis, and an atavism. The author observed 142 patients with vulvar pseudo condyloma, and found that there were 4 cases of HPV, 38 cases of fungi, 23 cases of trichomonas and 8 cases of Neisseria gonorrhoeae. The rest cases had no obvious infection, but there were many local secretions, poor hygiene and humidity. Therefore, the author thinks that infection and local conditions, such as increased vaginal discharge and other secretions, poor hygiene, local humidity and other specific and nonspecific chronic inflammatory stimuli to local tissues may be the important factors that cause pseudo condyloma.
Pseudo condyloma of vulva is common in clinic. The incidence of this disease was first reported in China in 1990. Subsequently, reports about this disease gradually increased. Zheng Minxin and others found 23 cases among women aged 13718-30, and the incidence rate was16.8%. Ye Zhaolong and others found 2 18 cases in 772 cases investigated, and the incidence rate was 28.24%. Lai Yonghun et al. found 249 cases in 51kloc-0/patients with sexually transmitted diseases and gynecological diseases, with an incidence rate of 48.73%. Hu Xiru investigated 500 women, of whom 4 1 case suffered from this disease, with an incidence rate of 8.2%. The author observed that vulva pseudo condyloma accounted for 31%in STD clinic.
2. Clinical manifestations and examination Hong Danhua observed pseudo condyloma with colposcope and divided its images into the following two types: ① Filamentous hyperplasia type: single filiform or small polypoid protrusions with symmetrical and dense distribution, with a diameter of about 1mm, and the protrusions with obvious proliferation can be as long as 4-5mm, but they have no branches, do not fuse with each other, and their surfaces are smooth and reddish. If the lesion is located in vaginal orifice and urethral orifice, fuzzy hairpin blood vessels can be seen, and the blood vessels disappear after being coated with acetic acid, and the lesion remains unchanged. ② Bubbly hyperplasia type: It is mostly seen in the inner surface of labia minora, and it is a symmetrical blister-like protuberance with the size of a needle tip. The surface is edema and bright, with a diameter of about 1mm, and the surface is covered with reddish epithelium. Sometimes fuzzy punctate blood vessels can be seen at the top of the protuberance. After applying acetic acid, the blood vessels disappear and the lesions do not change color. This type is mainly seen in patients with short course of disease. There was no obvious abnormality in cytological examination in pseudo condyloma, and HPV antigen and HPV DNA were mostly negative.
3. Histopathological examination of pseudo condyloma's histopathological features: under the light microscope, squamous epithelium is thickened, with slight papillomatosis, superficial cells of spinous cells are vacuolated, and their cells are evenly distributed in a network, with nuclear condensation, slight hyperkeratosis or dyskeratosis, vascular dilatation, congestion and edema in the dermis, and a small amount of inflammatory cells infiltration. Under the electron microscope, the epithelial cells of mucous membrane proliferate, the nucleus slightly swells and enlarges, there are glycogen particles in the cytoplasm of spinous cells, no hollow cells and no virus particles are found, the basal cells have no proliferation and mitotic phase, the capillaries in the stroma are dilated, and there are abundant lymphocytes and histiocytes.
4. Key points of differential diagnosis The main points of differential diagnosis between pseudo condyloma and condyloma acuminatum are the location of damage, the characteristics of damage, acetic acid test and pathological examination. Chen Lezhen and others analyzed the pathology and clinic of 32 1 abnormal negative biopsy tissue samples, and put forward the main points of clinical and pathological differential diagnosis between pseudo condyloma of vulva and condyloma acuminatum, as shown in Table11-0/,Table1-2.
Identification points: condyloma acuminatum in pseudo condyloma
The incubation period is 3-2 1 day for 2-3 months.
The development of lesions is self-limited and not self-limited
Symptoms are generally asymptomatic, some local itching, local itching and pain, and a few patients are asymptomatic.
The labia minora on both sides are mostly distributed symmetrically, with vulva, vagina, cervix and perianal region. It is common that two parts occur at the same time (13.4%), while vulva, vagina, cervix and perianal region occur at the same time (44.4%).
Locally, there are symmetrical caviar-like or pearl-like papules, some of which are polypoid, incompatible, and distributed in small groups. When touched, there are granular reddish or gray, moist papules and rashes, and some of them are polypoid, non-fused, and verrucous, often fused to form cauliflower, which is distributed in small groups, and when touched, there are granular vegetation.
Table 1 1-2 main points of histological differentiation between pseudo condyloma and condyloma acuminatum
Morphological changes of condyloma acuminatum in pseudo condyloma
Keratinized layer is rare, vulva, frenum and labia minora are rare.
Dyskeratosis is mild to moderate.
Dyskeratosis is rarely obvious.
The papillary structure is round, and the free section is more common with pointed nipples, and some nipples fuse into solid sheets.
The proliferation of spinous cell layer is not obvious.
Basal cell hyperplasia is not obvious, and there is atypical hyperplasia.
Epithelial thickness thickening is not obvious.
Cavity cells have no diagnostic cavity cells, and some cells have common intracellular edema and eccentric nuclei, with large nuclei and uneven nuclei edges.
The base of the epithelial foot is flat or undulate, blunt and round, often forming pseudoepithelioma-like hyperplasia.
Interstitial blood vessels are dilated, and interstitial loose expansion is obvious, which is close to the epidermis.
Lymphocyte infiltration is mild to moderate.
The author thinks that there are the following points to distinguish pseudo condyloma from condyloma acuminatum: ① Damage site: pseudo condyloma mainly occurs in the inner side of bilateral labia minora, and it occurs symmetrically; Condyloma acuminatum mainly occurs in vaginal orifice and other parts, but it can occur in many places and is asymmetric. ② Damage characteristics: pseudo condyloma lesions are caviar, papillary and villous, with smooth surface, clustered distribution and no fusion, and there is no increasing trend with time; Condyloma acuminatum is mostly cauliflower-like and papular, with uneven surface, single and multiple, which can be fused with each other. Friction damage is easy to bleed, and the damage gradually increases with time. ③ Acetic acid test: pseudo condyloma acetic acid test was negative; While condyloma acuminatum is positive. ④ Histopathology: pseudo condyloma has no diagnostic cavity cells, no obvious dyskeratosis, and no obvious proliferation of spinous cells and basal cells; Condyloma acuminatum has diagnostic hollow cells, obvious dyskeratosis, proliferation of spinous cells and basal cells. ⑤HPV detection: HPV detection of pathological tissues in pseudo condyloma is mostly negative, while condyloma acuminatum is mostly positive.
5. Generally speaking, there is no need to treat vulvar pseudo condyloma. It is important to find out some factors that may cause or aggravate pseudo condyloma, such as checking whether the patient has gonorrhea, nongonococcal urethritis, fungal or trichomonal vaginitis and other infections, and to treat related diseases. Poor local hygiene, humidity, friction and other stimuli can also aggravate the disease, so it is necessary to keep the local skin clean and dry and reduce the irritation to the local skin. For those who have a heavy mental burden and are afraid of the adverse consequences of this disease, cryotherapy, laser therapy or local rubbing drug therapy can be used to remove the diseased tissue. But some lesions may recur after removal.