mesenteric tumor
Introduction
Introduction to mesenteric tumors Primary mesenteric tumors are rare diseases that occur in mesenteric tissues. Limited domestic data indicate that they are more common in men and can occur at any age. The disease is insidious, often without specific manifestations in the early stage, and the rate of clinical misdiagnosis is high. About 2/3 of the patients are misdiagnosed as other diseases or diagnosed as inconclusive abdominal masses. basic knowledge The proportion of the disease: the probability of population disease is 0.0032% Susceptible people: no specific people Mode of infection: non-infectious Complications: peritonitis, blood in the stool, ascites
Cause
Mesenteric tumor etiology
(1) Causes of the disease
Primary mesenteric tumors are rare and can occur from any cellular component in the mesentery. There are seven possible sources: lymphoid tissue, fibrous tissue, adipose tissue, nerve tissue, smooth muscle, vascular tissue, and embryonic remnants.
(two) pathogenesis
Mesenteric tumors are benign and malignant. The ratio of benign tumors to malignant tumors is about 2:1. Malignant tumors are most common in fibrosarcoma and leiomyosarcoma, mostly in the small mesentery and around the mesorectum. In the sigmoid colon and mesenteric membrane.
Cysts come from congenital dysplasia, such as intestinal cysts, serous cysts, dermoid cysts, etc.; also belong to new biological tumors, such as cystic lymphangioma; in addition there are parasitic cysts, traumatic (hemorrhagic) Cysts, inflammatory cysts, etc., intestinal cysts covered with mucosal epithelium of the intestine and other layers of the intestinal wall, most commonly found in the ileum mesentery, can also occur in the jejunum or small mesenteric root, the serous cyst is covered Endothelial cells, mostly in the transverse colon and sigmoid mesenteric, cysts vary in size, ranging from a few centimeters to 20cm, mostly single cysts. The fluid in the capsule is usually yellow-white or yellow-yellow transparent liquid, if there is bleeding or Secondary infection can be dark red liquid or purulent liquid. If the ulceration can cause peritonitis, the dermoid cyst is a semi-formed gelatinous substance, and hair can also be seen. The cystic lymphoma is composed of most dilated lymphatic vessels. Different milky white cyst-like structures, ranging from 1 to 10 cm in diameter, occur mostly in the ileum mesentery, sometimes diffusely covering the entire small mesentery, possibly due to a collection of lymphatic obstruction, with a transparent or chyle-like solution .
Benign tumors include neurofibroma, fibroids, lipoma, leiomyoma, hemangioma, etc. The mesenteric tumors are mostly malignant, with the highest incidence of lymphosarcoma, others with leiomyosarcoma, liposarcoma, fibrosarcoma, mesothelium. Tumors, etc., lymphosarcoma showed nodular fusion to form large masses, or scattered nodules of varying sizes, all of which are diffuse under the microscope, belonging to B lymphocyte-derived, mainly plasma cells, and the appearance of liposarcoma Lipoma-like mucus-like and fish-like samples are divided into four types: well-differentiated, mucin-like, round cell type and polymorphic. The first two types have good prognosis and can be judged according to the number of mitotic images under the microscope. The degree of tumor differentiation is also closely related to the metastasis of the tumor. The rate of metastasis in each high power field is 11% for one mitotic image, and 33% for 10 or more.
Prevention
Mesenteric tumor prevention
According to different symptoms, there are different dietary requirements, ask the doctor specifically, and set different dietary standards for specific diseases.
Complication
Mesenteric tumor complications Complications, peritonitis, blood in the ascites
1. Tumor hemorrhage or spontaneous rupture can cause acute peritonitis and cause severe pain.
2. Malignant tumors have invaded the intestines causing intestinal bleeding and blood in the stool.
3. Tumor compression of ascites caused by inferior vena cava or iliac vein, abdominal varicose veins, lower extremity edema.
Symptom
Symptoms of mesenteric tumors Common symptoms Acute volvulus and abdominal pain Low fever around the appendix Abdominal perforation Peritonitis Tumors Pulling intussusception Mesenteric cysts Ovarian cysts
The clinical manifestations vary according to the pathological type, growth site, size and relationship with adjacent tissues and organs. The symptoms are complex and non-characteristic. When the tumor is small, it is asymptomatic, and it is occasionally found when it is open due to other diseases. Mesenteric cysts are more common in children, and tumors are more common in adults, benign or malignant. Symptoms occur when the tumor develops to a considerable extent. Common symptoms are:
1. The abdominal mass is the earliest and most common symptom. The mass can be cystic or substantial. If the mass is hard, the surface is not smooth and nodular and tender, often suggesting a malignant tumor.
2. Abdominal pain is mostly pain and discomfort, which is caused by the tumor pulling the peritoneum or squeezing the abdominal internal organs. If the tumor is bleeding or spontaneously ruptured, it may cause acute peritonitis and cause severe pain.
3. Fever is more common in malignant tumors. The first symptom of many patients with lymphosarcoma is unexplained fever, highly malignant soft tissue sarcoma, secondary infection after partial necrosis and tumor toxin reaction can cause irregular fever or low fever.
4. Blood in the stool indicates that the malignant tumor has invaded the intestinal tract and caused intestinal bleeding.
5. Other manifestations such as loss of appetite, weight loss, anemia, fatigue and other systemic reactions of malignant tumors.
In addition, the tumor can also compress the ureter and cause hydronephrosis, which is manifested as backache, pain or discomfort or frequent urination, but also can cause ascites caused by inferior vena cava or iliac vein, abdominal varicose veins, lower extremity edema, etc., a few primary mesenteric malignancy Tumors with metastases are the first symptoms, such as chest tightness and chest pain when transferred to the lungs; headaches, dizziness, etc. when transferring to the brain, the position, texture, nodules and mobility of the mass should be noted in order to determine the mass. Whether it is located in the mesentery and its nature, the mesenteric tumor activity is relatively large, and the left and right activity is greater than the upper and lower activity. Some studies have shown that the lateral activity of the mass is a major feature of mesenteric tumor, but the palpation of the mass does not help. To identify the benign and malignant tumors, malignant tumors that grow at the edge of the mesentery, if there is no adhesion infiltration, the activity is greater, and conversely, benign tumors located at the roots of the mesentery, such as large volume or secondary infections causing adhesions, palpation More fixed, so the size of the tumor activity depends mainly on the growth site of the tumor.
Some mesenteric tumors are characterized by acute abdomen symptoms and signs. Some people advocate that mesenteric tumors can be divided into latent type, abdominal mass and acute abdomen type. Due to mesenteric tumor tumor traction, acute intestinal torsion can be caused, secondary infection can be broken. The collapsed tumor can cause peritonitis, infiltration of the intestine can cause intestinal perforation, hemorrhage, etc., reported in the literature are complicated intestinal obstruction, intestinal torsion, intussusception, intestinal perforation, rupture caused by peritonitis, secondary infection and gastrointestinal bleeding, etc. In addition, sigmoid mesenteric cyst, ileal mesenteric cyst, mesenteric root giant cyst similar to the anatomical site or due to the tumor's own weight falling adhesions fixed in the pelvic cavity or due to huge tumors extending downward, easy to make mesenteric cyst misdiagnosed as ovarian cysts, when the cyst secondary Infection is easy to reminiscent of ovarian cyst pedicle torsion, the literature reported mesenteric cyst misdiagnosed as ovarian cysts up to 19%, at the same time, there are reports of mesenteric tumors misdiagnosed as acute appendicitis or abscess around the appendix.
Examine
Examination of mesenteric tumors
For those who have not been diagnosed before surgery, intraoperative frozen pathological examination is a must.
1. X-ray barium meal examination can show the performance of intestinal tube pressure displacement, such as calcification may be teratoma, barium enema angiography can distinguish intestinal intestinal, can show tumor size, location, density, and intestinal invasion It is helpful to determine whether it is a parenteral mass. Sometimes, when the mesenteric malignant tumor invades the intestinal wall, the intestinal wall may be stiff, the mucosal folds may be thickened or interrupted, and the expectorant may pass slowly;
2. B-ultrasound can show abdominal mass and differentiated cystic solid, mesenteric cyst see liquid dark area, border echo is clear, and there are obvious envelope echo and posterior enhancement effect, benign tumor capsule is clear and complete, and the interior is even and rare. Low echo zone, sometimes or partially silent zone, such as lipoma, fibroids and schwannomas, malignant tumor envelope echo area with or without, internal echo is different, uneven distribution, and irregular shape The echo-free zone.
3. CT examination can directly understand the size, texture, boundary and adjacent relationship of the mass, which can clearly show whether the surrounding tissues and organs are invaded, especially the relationship between the intestine and the mass, which is very beneficial for preoperative diagnosis and can be used for follow-up evaluation. The effect and understanding of recurrence, the correct rate of preoperative diagnosis of mesenteric tumors was 9.38% to 40.2%.
4. Laparoscopy can determine the location of the tumor, but also biopsy to determine the nature of the tumor.
Diagnosis
Diagnosis and differentiation of mesenteric tumor
Clinically encountered asymptomatic or with lateral active mass in the abdomen with local dull pain or pain or intestinal obstruction, imaging examination shows that the extrinsic tumor closely related to the intestine should consider the possibility of mesenteric tumor, can Select small intestine angiography, B-ultrasound and puncture cytology to determine the diagnosis, but because the disease is rare, the onset is concealed, and the lack of specific symptoms and signs, the diagnosis and treatment of this disease has brought certain difficulties, despite the imaging Development provides an objective basis for its diagnosis, but the diagnostic coincidence rate is still less than 30%. In recent years, laparoscopic surgery has been used more frequently in clinical practice to further improve the diagnosis rate of mesenteric tumors. For adult patients, such as shorter duration and appetite Decreased, weight loss, fatigue, and other medical history, the mass is hard, the surface is uneven and there is obvious tenderness, and the mobility is poor, should be considered as a malignant tumor, timely decisive exploratory laparotomy and biopsy to confirm the diagnosis, so as not to delay the treatment timing , affecting the prognosis.
Differential diagnosis
1. Chronic bacterial dysentery generally has a history of acute sputum disease. Multiple times of fresh fecal culture can isolate dysentery bacilli, and antibacterial treatment is effective.
2. Colonic schistosomiasis has a history of contact with effusion, often with hepatosplenomegaly. Chronic rectum may have granuloma-like hyperplasia, which may have a tendency to malignant transformation. Fecal septic eggs can be found in fecal examination, hatching plaque is positive, and colonoscopy is in the acute phase. Mucosal yellow-brown granules can be seen, and schistosomiasis eggs can be found by biopsy or by histopathological examination.
3. Crohn's disease Colonic Crohn's disease has abdominal pain, fever, elevated peripheral blood leukocytes, abdominal tenderness, abdominal mass and other manifestations, fistula formation is characteristic, these symptoms, signs similar to diverticulitis Endoscopy and X-ray examination can find mucosa with altered paving stones, deep ulcers, and a "jumping" distribution of lesions to help identify. Endoscopic mucosal biopsy has diagnostic value if non-caseous granuloma is found.
4. Ulcerative colitis can be expressed as fever, abdominal pain, bloody stools, peripheral blood leukocytosis, colonic microscopic mucosal diffuse inflammation, congestion, edema, with the development of the disease, can appear erosion, ulcers, pseudopolyps, ulcers The residual mucosa was atrophied, and the intestinal lumen was narrowed in the late stage, and the colonic bag disappeared. The lesions showed changes in goblet cells and crypt abscesses.
