Gallbladder Leiomyosarcoma
Introduction
Introduction to gallbladder leiomyosarcoma Gastrointestinal smooth muscle tumor is a malignant tumor mainly originating from smooth muscle tissue, which occurs in the stomach (about 33%), small intestine (37%), colon (27%), rare in gallbladder, accounting for about all leiomyosarcoma. %. The main metastatic route of this disease is direct infiltration, transfusion of the blood or lymphatic metastasis, and intra-abdominal implantable metastasis. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: jaundice ascites
Cause
Causes of gallbladder leiomyosarcoma
(1) Causes of the disease
Most think that it is related to gallstones, and its combined rate with gallstones is 52%-82.2%, but the exact relationship is not clear.
(two) pathogenesis
Gallbladder leiomyosarcoma occurs mostly in the body and bottom of the gallbladder. The tumor is generally larger. It has been reported to be 10cm × 9cm × 8cm. It is often invasive growth, hard texture, obvious adhesion to the surrounding area, signs of infiltration and metastasis, pathological examination. It is found that the gallbladder wall is thickened, and a few can be accompanied by acute inflammatory changes. There may be stones of different sizes. The surface of the mass is uneven, dark brown, the cut surface is gray, tender, and may have focal hemorrhage, necrosis, and some gallbladder walls are seen under the microscope. The complex epithelium is intact, and there may be inflammatory cell infiltration. The tumor cells are fusiform, elliptical or polygonal, and the shape is obvious. The mitotic figures are more common, deep staining, multinuclear or megakaryoblast cells are visible, and immunohistochemistry -actin(+), Vimentin ( ±), RF silver-stained reticular fibers are richer around a single tumor cell, and VG-stained tumor tissue is yellow.
Prevention
Prevention of gallbladder leiomyosarcoma
prevention:
1. Maintain a happy state of mind, develop good eating habits, fast food, eat less thick food, do not drink hard alcohol.
2. Active treatment of cancerous lesions, in addition to the early cause of cancer may cause cancer, such as active treatment of cholecystitis, as early as possible for cholecystectomy for symptomatic gallstones or larger stones.
Complication
Gallbladder leiomyosarcoma complications Complications
In advanced patients, obstructive jaundice and ascites may occur.
Symptom
Symptoms of gallbladder leiomyosarcoma Common symptoms Gallstones, abdominal distension, jaundice, fatigue, ascites, dull pain, nausea, gallbladder wall thinning
More common in women, the age of good hair is 50 to 60 years old, early without clinical symptoms, late patients have fatigue, anorexia, bloating, nausea, vomiting, weight loss, symptoms are significantly different from the past (if the patient has cholecystitis, gallstones in the past) Dull pain in the right upper abdomen, radiation to the back, right lower abdomen and right lower back and back, such as obstructive jaundice, suggesting that there is infiltration of the common bile duct or lymph node enlargement around the extrahepatic bile duct, physical examination may touch the mass in the right upper abdomen, sometimes appears Ascites, patients are mostly accompanied by stones.
Examine
Examination of gallbladder leiomyosarcoma
Tumor markers such as CEA, CA-50, CA19-9, combined with clinical manifestations, have certain value in determining the benign and malignant tumors.
1. Abdominal X-ray film may find a gallbladder mass.
2. Gallbladder angiography is not developed, such as gallbladder development is good but there is filling defect, it strongly suggests gallbladder tumor.
3. PTC can show bile duct stenosis, index or not filling.
4. ERCP shows that the gallbladder is not filled and the bile duct is compressed and obstructed.
Diagnosis
Diagnosis and differential diagnosis of gallbladder leiomyosarcoma
Diagnostic criteria
The early diagnosis of this disease is not easy, often misdiagnosed as cholecystitis, gallstones, occasionally for other reasons for cholecystectomy was found.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
Differential diagnosis
1. The five indicators of gallbladder cancer support for gallbladder cancer are:
(1) Single lesion with irregular shape.
(2) The diameter of the lesion is greater than 10 mm.
(3) Guangji.
(4) A lesion with an increasing tendency.
(5) diffuse irregular thickening of the gallbladder wall.
2. Single-crystal cholesterol crystal, inflammatory granulation tissue, polyp and adenoma early exogenous gallbladder cancer, when the lesion is limited, it is often necessary to identify it. Cholesterol crystals adhere to the surface of the mucosa, and the echo is more uniform, mostly granular. Inflammatory granulation tissue often has a somogram of chronic cholecystitis. The lesion protrudes from the mucosa toward the gallbladder cavity, the contour is smooth, the mucosa and gallbladder wall are not damaged, the polyp is papillary, uniform medium echo, pedicle and mucosal line Connected, gallbladder cancer is a low-medium echo, the distribution is not uniform, the shape is irregular, the mucosa and wall layer are destroyed, and interrupted.
