Department of Obstetrics and Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany.
Gynecol Oncol. 2011 Aug;122(2):313-8. doi: 10.1016/j.ygyno.2011.04.040. Epub 2011 May 31.
We have suggested to base cancer surgery on ontogenetic anatomy and the compartment theory of tumor permeation in order to improve local tumor control and to lower treatment-related morbidity. Following the validation of this concept for the uterine cervix, proximal vagina and vulva, this study explores its applicability for the distal vagina.
Serial transverse sections of female embryos and fetuses aged 8-17 weeks were assessed for the morphological changes in the region defined by the deep urogenital sinus-vaginal plate complex. Histopathological pattern analysis of local tumor spread was performed with carcinomas of the lower genital tract involving the distal vagina to test the compartment theory.
Ontogenetically, the female urethra, urethrovaginal septum, distal vagina and rectovaginal septum represent a morphogenetic unit derived from the deep urogenital sinus-vaginal plate complex. Herein, the posterior urethra, the urethrovaginal septum and the distal vagina form a distinct subcompartment differentiated from the dorsal wall of the urogenital sinus. From 150 consecutive patients with distal vaginectomy as part of their surgical treatment 26 carcinomas of the lower genital tract had infiltrated the distal vagina. All 22 tumors involving the ventral wall invaded the urethra/periurethral tissue. Of the five carcinomas involving the dorsal wall none invaded the rectum/mesorectum.
The pattern of local tumor permeation of lower genital tract cancer in the distal vagina can be consistently explained with ontogenetic anatomy and the compartment theory.
我们提出将癌症手术基于个体发生解剖学和肿瘤渗透的隔室理论，以提高局部肿瘤控制并降低治疗相关的发病率。在子宫颈、近端阴道和外阴验证了这一概念后，本研究探讨了其在阴道远端的适用性。
评估了 8-17 周龄女性胚胎和胎儿的连续横切面，以了解深泌尿生殖窦-阴道板复合体界定区域的形态变化。对涉及阴道远端的下生殖道癌进行局部肿瘤扩散的组织病理学模式分析，以检验隔室理论。
从个体发生的角度来看，女性尿道、尿道阴道隔、阴道远端和直肠阴道隔代表了一个源自深泌尿生殖窦-阴道板复合体的形态发生单位。在这里，后尿道、尿道阴道隔和阴道远端形成了一个与泌尿生殖窦背壁明显不同的子隔室。在作为其治疗一部分接受阴道远端切除术的 26 例下生殖道癌患者中，有 22 例肿瘤浸润了阴道远端。所有累及前壁的肿瘤均侵犯了尿道/尿道周围组织。累及后壁的 5 例肿瘤无一例侵犯直肠/直肠系膜。
下生殖道癌在阴道远端的局部肿瘤渗透模式可以通过个体发生解剖学和隔室理论得到一致解释。
