Pancreatic sarcoma
Introduction
Introduction to pancreatic sarcoma Pancreatic sarcoma refers to malignant tumors derived from the interstitial tissues of the pancreas. The primary pancreatic sarcoma reported in the literature has leiomyosarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, rhabdomyosarcoma, malignant schwannomas, angiosarcoma, Malignant hemangioperic tumors, etc., are reported in individual cases. Pancreatic sarcoma reported in the literature is most common in leiomyosarcoma. A total of 13 articles were collected from domestic literature CBM from 1994 to 2000. Among them, 8 cases of primary pancreatic sarcoma were reported, all of which were leiomyosarcoma (6 cases in total) and 5 cases of pancreatic metastatic sarcoma. . basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: jaundice intestinal obstruction peritonitis abdominal abscess
Cause
The cause of pancreatic sarcoma
Pathogenesis:
The main components of pancreatic sarcoma originate from the connective tissue of the pancreas, blood vessels, nerve tissue, whether lymphosarcoma is derived from the pancreas, whether it is really a pancreatic sarcoma, and the opinions are inconsistent. According to the general pathology, there are fibrosarcoma, leiomyosarcoma, and neurofibrosarcoma. , lymphosarcoma, liposarcoma, malignant schwannomas, reticular sarcoma, sarcoma, angiosarcoma, extramedullary plasmacytoma and rhabdomyosarcoma, of which fibroid sarcoma is the most common, sarcoma can occur in any part of the pancreas, its malignancy is more than pancreatic cancer low.
Prevention
Pancreatic sarcoma prevention
(1) Alcohol withdrawal: Although there is no conclusion on whether drinking alcohol can cause pancreatic sarcoma, reducing drinking, especially drinking less alcohol and not drinking high alcohol content can avoid pancreatitis, and may also avoid or reduce the possibility of pancreatic sarcoma. Sex. In addition, avoid the combined effects of smoking, drinking and eating a high-fat, high-protein diet.
(2) Quit smoking: In particular, educate young people not to smoke. The amount of cigarettes smoked per day and the length of the smoke were positively correlated with the occurrence of pancreatic sarcoma. Those who smoked from adolescence were more likely to develop pancreatic sarcoma.
(3) Promote low-fat, low-protein, high-fiber and high-vitamin diets: Experts have found that fresh fruits and vegetables prevent pancreatic sarcoma.
(4) Reduce environmental pathogenic factors, and good environmental factors play an important role in the prevention of pancreatic sarcoma. Radioactive materials should be reduced or avoided, and good protective measures should be taken for personnel engaged in radioactive work. Opportunities for viral infections should be reduced, especially for epidemic viral infections.
Complication
Pancreatic sarcoma complications Complications jaundice intestinal obstruction peritonitis abdominal abscess
Obstructive jaundice may occur when the head of the pancreas is compressed by the common bile duct; tumor invasion of the duodenum may cause duodenal obstruction; central necrosis, hemorrhage, cystic changes occur in the tumor growth, and there is tumor necrotic tissue infection in the literature. Misdiagnosed as peritoneal abscess surgery drainage and tumor rupture caused by peritonitis.
Symptom
Symptoms of pancreatic sarcoma Common symptoms Low heat-consuming weight loss nausea back pain
Pancreatic sarcoma can occur in various parts of the pancreas. The clinical symptoms are related to the size and location of the tumor. When the early tumor is small, there can be no symptoms. Occasionally, a pancreatic mass is found in B-ultrasound or CT examination. Most pancreatic sarcomas are found when the tumor is Very big.
The disease occurs in adolescents, even infants and young children. During the tumor growth process, patients may have pain and discomfort in the upper abdomen. Compression or invasion of the abdominal nerve fibers may cause back pain. Half of the patients may have a bump in the upper abdomen when they visit, and the texture is hard and moving. Degree difference, tumor compression or stimulation of gastrointestinal tract nausea, vomiting, patients with advanced disease, low fever, consumptive weight loss.
Examine
Examination of pancreatic sarcoma
Imaging examination is very important for the diagnosis of pancreatic sarcoma. B-ultrasound can find a huge solid mass in the pancreas, uniform density, clear boundary, and the digestive tract barium meal can detect the pressure or displacement of the stomach and duodenum, CT and MRI can find space-occupying lesions or local enlargement in the pancreas, the density of the mass is increased, uniform, and the boundary is clear. At the same time, the relationship between the mass and the large blood vessels and surrounding organs can be reflected. The ERCP examination can find that the pancreatic duct is under pressure, suddenly Interruption, distal pancreatic duct dilatation, etc., angiographic examination can find vascular reduction in the tumor area, similar to pancreatic cyst, cystadenoma and cystadenocarcinoma, B-ultrasound or CT-guided fine needle aspiration for pancreatic biopsy It is a better pathological diagnosis method, which can confirm the diagnosis, but it has certain risks. It may have the possibility of penetrating into the surrounding large blood vessels and organs. It requires a lot of experience from the operating physician, and it is not widely used at present.
Diagnosis
Diagnosis and differentiation of pancreatic sarcoma
Diagnostic criteria
Preoperative diagnosis is very difficult, patients often come to see a doctor after the symptoms of oppression, imaging examination can only find a substantial mass of the pancreas or left upper abdomen, its nature and source are still uncertain, even if the surgical exploration found that the mass is often extremely rare due to sarcoma However, it is mistaken for pancreatic cancer that grows rapidly, or because it is considered to be a pancreatic cystic adenocarcinoma or a retroperitoneal sarcoma because of its large size. Only a pathological examination can be used to determine the diagnosis.
Differential diagnosis
1. Pancreatic cystadenoma or cystadenocarcinoma Cyst adenoma or cystadenocarcinoma and pancreatic sarcoma are difficult to distinguish in clinical manifestations and imaging. Postoperative pathology is the final diagnosis.
2. Pancreatic sarcomatoid carcinoma is also a rare pancreatic malignant tumor, which is essentially an undifferentiated carcinoma derived from the pancreatic ductal epithelium, but the tumor under the microscope is a spindle cell type, a polymorphic giant cell type, a round cell type, etc. It is difficult to identify with sarcoma, immunohistochemical staining of Keratin, EMA and other epithelial antibodies, under the electron microscope, there are desmosomes in the cells, which can be differentiated from sarcoma, and sarcomatoid cancer has long-term survival after resection.
3. Pancreatic carcinosarcoma is a rare malignant tumor coexisting with cancer and sarcoma. It is the result of differentiation of pancreatic pluripotent stem cells into cancer and sarcoma. Immunohistochemical staining, expression of Vimentin, Actin, S-100, etc. in sarcoma area Mesenchymal or neural tissue markers, cancerous areas express epithelial markers such as Keratin, EMA, etc. Carcinosarcoma is highly malignant and has a poor prognosis.
