ovarian mucinous tumor
Introduction
Introduction to ovarian mucinous tumors Ovarian mucinous tumors are second only to serous tumors in ovarian epithelial tumors, which are more benign, accounting for 77% to 87%, borderline is about 10%, and the rest are malignant. About 5% of mucinous tumors are mixed with teratomas. The benign and borderline are almost cystic, and the typical lesions are multi-atrial. Mucinous carcinoma may be cystic or may be solid. The characteristics of the lesion are often benign, borderline and malignant simultaneously in a tumor. Histologically benign and borderline is divided into cystadenoma, adenoma and cystic fibroma, malignant and divided into adenocarcinoma, cystadenocarcinoma, adenocarcinoma and cystic fibroma. basic knowledge Sickness ratio: 0.0012% Susceptible people: good for adult women Mode of infection: non-infectious Complications: peritoneal pseudomyxoma abdominal pain abdominal distension intestinal obstruction
Cause
Ovarian mucinous neoplasms
Benign mucinous cystadenoma
Most of them are multi-room, generally medium-sized, can also grow up to fill the entire abdominal cavity, the diameter is up to 50cm, the tumor is gray and shiny, the wall is slightly thick, elastic, and sometimes there are several cystic protrusions on the outer wall, the surface is slightly yellowish. The contents of the capsule are mucoid, opaque, the viscous liquid is jelly-like, and the white is slightly light blue. The solid parts touched during the inspection are often the accumulation of most honeycomb small houses, which can be found by incision, and the size of the room varies greatly. The distribution can be sparse and dense, often in one room with one or several ovary, the mucus in the tumor is mucin or glycoprotein, so in the past "false mucinous cystadenoma" has been renamed mucinous cystadenoma. The tumor epithelium is a single-layered high column with a nucleus at the base, arranged regularly, and the same as the cervical mucus epithelium (Fig. 1). Sometimes the intestinal epithelium can be found, including goblet cells, Panett cells and The argyrophilic cells, mucinous cystadenoma often occur simultaneously with other ovarian epithelial tumors, such as serous, endometrioid or sex cord stromal tumors, PeutzJeghers syndrome (Chen KT, 1986) is the skin mucosal pigmentary dark spot. ,with There are multiple gastrointestinal polyps, these symptoms can sometimes accompany this tumor appeared, but need to watch for malignant problem.
Borderline mucinous cystadenoma
Compared with borderline serous tumors, it is multi-atrial, can be seen in the thickened area of the wall or nipple, and most of the nipples are small, can also be polypoid, microscopic features: 1 epithelial stratification reaches 2 to 3 layers , but no more than 3 layers, accompanied by the formation of nipple and epithelial clusters. 2 cells are mild, moderately atypical, with reduced mucus secretion, showing goblet cells. 3 mitotic divisions do not exceed 5 per 10 high power field views. 4 tumor cells do not invade the stroma.
Peritoneal pseudomyxoma
That is, peritoneal myxoma, which is a reaction of peritoneal implantation caused by mucus in the peritoneal cavity, often combined with appendicitis and ovarian mucinous neoplasms. It is widely accepted that peritoneal pseudomyxoma is derived from mucinous tumors of the ovary and appendix. Epithelial cells are classified as a borderline tumor with atypical and stratified, 10.6% to 29% of appendix mucinous neoplasms with peritoneal pseudomyxoma, 3.5% to 12% of ovarian myxoma with peritoneal pseudomyxoma, 1/3 of peritoneum Patients with pseudomyxoma have mucinous tumors in the ovary and appendix. If both have tumors, the ovary is likely to be metastatic. The ovarian tumor with peritoneal pseudomyxoma is 71.4% of the data of Shanghai Medical University. In general, only 10% of primary ovarian mucinous tumors are bilateral.
Mucinous cystadenocarcinoma
More multi-atrial, although not many on both sides, but more benign in ovarian mucinous tumors, 5% to 40%, smooth appearance, round or lobulated, sacral cystic, multi-room, with real In the sexual area, the nipple can be seen on the inner wall of the capsule, but it is less than serous carcinoma. The nipple and solid area are more benign or borderline mucinous cystadenoma. The cystic cavity contains bloody gelatinous mucus, and the solid area is often hemorrhagic and necrotic.
The characteristics under the microscope are: 1 epithelial multi-layer more than 3 layers. 2 severe epithelial atypical hyperplasia with abnormal mucus secretion. 3 glands have back-to-back phenomenon. 4 nuclear division is active. 5 interstitial infiltration.
Tissue grading of mucinous cystadenocarcinoma:
(1) Highly differentiated (Grade I): high epithelial columnar shape, epithelial hyperplasia more than 3 layers, slender nipple branch, irregular shape, minimal interstitial, porphyrous surface cells lose polarity, no arrangement, no nuclear size There are many schizophrenias, and sometimes the secretion of mucus escapes out of the cell, causing the cytoplasmic boundary to disappear.
(2) moderate differentiation (grade II): epithelial columnar or low columnar, forming a common wall, a small amount of mucus in the cell, a large number of cell nest infiltration in the interstitial, and more mitotic figures.
(3) poorly differentiated (grade III): the adenoid structure is not obvious, the epithelial cells are cluster-like or diffuse, the nuclear atypia is obvious, the mitotic figures are more, the intracellular mucus is very rare, and sometimes it is difficult to metastasize with the gastrointestinal tract. the difference.
Prevention
Ovarian mucinous tumor prevention
Epidemiology 1. Benign mucinous cystadenoma Ovarian mucinous benign tumors account for 20% of all ovarian benign tumors. The age of good hair is 30 to 50 years old.
2. About 8% of patients with borderline mucinous cystadenoma are bilateral lesions.
3. Mucinous cystadenocarcinoma accounts for the third place in ovarian malignant tumors, which is 8% to 10% of primary ovarian malignant tumors. The high age is 40 to 60 years old.
Prognosis: 1. Benign mucinous cystadenoma has a good prognosis.
2. The prognosis of borderline mucinous cystadenoma is still good.
3. The 5-year survival rate of peritoneal pseudomyxoma is 45% to 54%, and the 10-year survival rate is 18%. Affect the peritoneal pseudomyxoma.
The prognostic factors are as follows:
(1) Whether there are tumor cells in the mucus.
(2) If a glandular structure is embedded in the tissue, it is destroyed by the local structure.
(3) The extent of lesion involvement at the time of initial surgery and the time of recurrence after the initial surgery.
Complication
Ovarian mucinous tumor complications Complications, peritoneal pseudomyxoma, abdominal pain, abdominal distension, intestinal obstruction
Occasionally combined with appendix mucinous cysts and peritoneal pseudomyxoma.
1. Benign mucinous cystadenoma should pay attention to the presence or absence of borderline or malignant mucinous carcinoma. The chance of pregnancy is 3 to 4 times more than that of serous cystadenoma.
2. Junctional mucinous cystadenoma may have abdominal pain or bloating.
3. Peritoneal pseudomyxoma is prone to intestinal adhesion or intestinal obstruction after surgery.
4. The incidence of mucinous cystadenocarcinoma with pregnancy is low.
Symptom
Ovarian mucinous neoplasm symptoms Common symptoms Decaying cachexia pelvic mass follicles increase abdominal pain ascites bloating
1, benign mucinous cystadenoma
There are very few sides and the number is multiple rooms. Generally larger, prone to compression symptoms.
(1) Signs:
1 Peutz Jeghers syndrome (Chen KT86), a pigmented dark spot on the skin.
2 have multiple polyps in the gastrointestinal tract.
3 often have other ovarian epithelial tumors, such as serous, endometrioid or sex cord stromal tumors.
(2) Tumor characteristics:
Gray and shiny, the wall of the capsule is slightly thick and elastic, and sometimes there are several cystic protrusions on the outer wall, and the surface is slightly yellowish.
The contents of the capsule are mucoid, opaque, viscous liquid like jelly, white slightly blue, mucin or glycoprotein.
(3) Inspection
The solid part is the accumulation of most honeycomb small houses, the size of the room is very different, the distribution can be dense and dense, often one or several ovaries are set in one room.
The epithelium is a single-layered high column, with the nucleus at the base, arranged in a regular pattern, and the same as the cervical mucus epithelium. Intestinal epithelium can sometimes be found, including goblet cells, pannet cells, and argyrophil cells.
2. Junctional mucinous cystadenoma
For multi-room sex.
(1) Signs:
There is a pelvic mass and ascites, which may have abdominal pain or bloating.
(2) Tumor characteristics:
The wall of the capsule is thickened or the nipple appears, and most of the nipples are small and can also be polypoid.
(3) Microscopic features:
1 tumor cells do not invade the stroma.
2 nucleus splits do not exceed 5 per 10 high power field views.
3 epithelial stratification reaches 2 to 3 layers, accompanied by nipple and epithelial cluster formation.
4 cells are mild, moderately atypical, with reduced mucus secretion, showing goblet cells.
3, mucinous cystadenocarcinoma
Symptoms are similar to serous carcinoma, with more unilateral than serous cancer. Multi-room and benign.
(1) Signs:
Abdominal mass, bloating, abdominal pain or compression symptoms.
Late stage, cachexia, weight loss, and occasional menstrual changes.
(2) Tumor characteristics:
The appearance is smooth, round or lobulated, and the cut surface is cystic and multi-room with a solid area.
The lining of the inner wall of the capsule is less than that of serous carcinoma, and the nipple and solid area are more benign or borderline mucinous cystadenoma.
The cystic cavity contains bloody gelatinous mucus, and the solid area is often hemorrhagic and necrotic.
(3) Microscopic features:
1 Epithelial stratification over 3 layers, severe atypical hyperplasia, accompanied by mucus secretion abnormalities.
2 nuclear division is active.
3 glands have back-to-back phenomenon.
4 interstitial infiltration.
(4) Organization rating:
1 high differentiation (Grade I): high columnar epithelium, epithelial hyperplasia more than 3 layers. The nipple branches are slender, irregular in shape and rarely interstitial. The cells on the surface of the nipple lose their polarity, are arranged in an unordered manner, have different nuclear sizes, and have many divisions. Excessive mucus secretion can escape from the cell, causing the cytoplasmic boundary to disappear.
2 moderate differentiation (grade II): epithelial columnar or low columnar, forming a common wall, a small amount of mucus in the cell, a large number of cell nest infiltration in the interstitial, more mitotic figures.
3 poorly differentiated (grade III): the adenoid structure is not obvious, the epithelial cells are clustered or diffuse, the nuclear atypia is obvious, and the mitotic figures are more. There is very little intracellular mucus.
4, peritoneal pseudomyxoma
There is a reaction in the peritoneal cavity caused by mucus in the peritoneal cavity.
The course of the disease is prolonged, and it is very easy to relapse. It often combines mucosal tumor diseases of the appendix and ovary.
It is currently believed to be a mucinous tumor derived from the ovary and appendix.
Examine
Examination of ovarian mucinous tumors
1, tumor marker detection
2, histopathological examination
3, electron microscopy
The covered epithelium mostly resembles the endocervix of the cervix, and small, short and short microvilli are visible at the tip of the cell, which protrudes into the luminal surface in an irregular manner. The apical membrane between the microvilli is smooth and lacks pinocytosis.
The upper part of the cell wall is smooth and closely connected to adjacent cells, occasionally bridge particles. The base of the membrane has complex villous processes that intersect with adjacent cells, often without bridge particles.
The base cell membrane is mostly smooth or slightly flexed. The nucleus is located at the base and often contains a nucleolus. The core is filled with round or elliptical sticky droplets. The mitochondria are small and located in the body of the cell. The Golgi apparatus is well developed, with no smooth endoplasmic reticulum, a number of rough endoplasmic reticulum and free ribosomes, lack of glycogen, and no lysosomal-like structure.
Ultrastructure: Basically like mucinous cystadenoma.
4, light microscopy
(1) coated with highly differentiated monolayer high columnar epithelium, rich in cytoplasm, containing mucin, and located on the nucleus.
Cup cells are seen between mucous epithelial cells. About 20% of tumors contain argyrophilic cells, occasionally Panett cells. If there is significant stratification of epithelial hyperplasia (no more than three layers of borderline tumor cells), budding and bypass, nuclear atypia and mitotic phase, it suggests borderline or erosive cancer.
(2) Highly differentiated type: covered with high columnar mucous epithelium, mildly shaped, cancer cells invade the interstitial, glandular tube is more regular; moderately differentiated, tumor cells are obviously shaped, invade interstitial, irregular glandular duct, epithelium Protuberance structure; poorly differentiated type, cancer cells secrete mucus, pleomorphic, cells are obviously shaped, and glandular structures can be seen.
Diagnosis
Diagnosis and differentiation of ovarian mucinous tumor
diagnosis
Diagnosis based on cause, symptoms and related tests
Differential diagnosis
1, identification with ascites: when the abdominal bulging is obvious, detect the presence of mobile dullness.
2. Identification with mucinous cystadenoma:
Characteristics of mucous cystic adenoma color ultrasound image:
(1) Mostly single-sided, multi-room.
(2) Larger than serous cystadenoma.
(3) It can be seen that scattered spots and light groups are mostly separated by coarse mesh.
(4) The blood flow signal is generally richer than the blood flow signal of the serous cystadenoma.
3. Identification with borderline cystadenoma and cystadenocarcinoma:
The patient is older, especially in postmenopausal women, or has irregular vaginal bleeding after menopause.
Solid cysts, solid parts are diverse and irregular.
The thickness of the capsule wall is uniform or uneven, and the thickness is mostly more than 3 mm. The papillary wall nodules can be seen in the capsule.
Unclear boundaries with surrounding organizations.
