Malignant mixed mesodermal tumor of the ovary
Introduction
Brief introduction of ovarian malignant mesodermal mixed tumor Ovarian malignant mesodermal mixed tumor is rare in clinical practice, and the degree of malignancy is extremely high, accounting for only 1% to 2% of ovarian malignant tumors. Generally seen in unfertile postmenopausal women, about 10% are bilateral, more common on the right side. The cause of ovarian malignant mesodermal mixed tumor is unknown. Most scholars believe that it may originate from the ovarian surface epithelium and ovarian stroma or endometrium that occurs in ovarian ectopic. Some scholars have reported that ovarian cancer sarcoma may be related to radiation therapy, and the exact cause remains to be explored. basic knowledge The proportion of the disease: the incidence of the disease in a specific group is 0.005% Susceptible people: women Mode of infection: non-infectious Complications: shock bacterial infection
Cause
Ovarian malignant mesodermal mixed tumor etiology
(1) Causes of the disease
The cause of ovarian malignant mesodermal mixed tumor is unknown. Most scholars believe that it may originate from the ovarian surface epithelium and ovarian stroma or endometrium that occurs in ovarian ectopic. Some scholars have reported that ovarian cancer sarcoma may be related to radiation therapy, the exact cause In 1988, WHO classified ovarian cancer sarcoma as a subtype of ovarian endometrial adenocarcinoma, which belongs to ovarian epithelial malignant tumor. Recently, Moritani et al reported that a patient with ovarian endometrial adenocarcinoma turned to ovarian carcinosarcoma after recurrence. It suggests that ovarian carcinosarcoma may be derived from endometrioid adenocarcinoma in histogenesis.
(two) pathogenesis
1. The general characteristics of the tumor are mostly solid or cystic, the surface is irregular, grayish white, with bleeding area, the cut surface sometimes shows a solid yellow-white area, showing extensive hemorrhage and necrosis, mostly with pots, extensive infiltration of the abdominal cavity, and bloody ascites.
2. The characteristics of the microscope are similar to those of the uterus malignant mesodermal mixed tumor. The ovarian malignant mesodermal mixed tumor is also composed of malignant epithelial components (adenocarcinoma) and sarcoma components, mainly poorly differentiated endometrial adenocarcinoma and serous gland. Cancer, a small number may have mucinous adenocarcinoma or clear cell carcinoma components, homologous sarcoma components similar to endometrial stromal sarcoma, fibrosarcoma or leiomyosarcoma, heterologous sarcoma may contain heterologous components, such as immature cartilage tissue Etc., commonly known as chondrosarcoma, osteosarcoma, rhabdomyosarcoma and so on.
The phenotypic composition of carcinosarcoma is complex. The genetic heterogeneity analysis of the internal tissues of the tumors reveals the loss of homotypic alleles, and the different patterns of allelic deletions are also related to the genetic changes in the process of clonal origination. Consistent, immunohistochemistry, cell culture, molecular genetic studies, etc., prove that carcinosarcoma is a monoclonal origin. Sonoda et al. used microdissection and molecular genetic analysis to find out the cancerous components of ovarian carcinosarcoma and the wild-type BRCA2 of sarcoma components. The same mutation in the gene and the TP53 gene also confirmed that the cancer and sarcoma components are of monoclonal origin.
Prevention
Ovarian malignant mesodermal mixed tumor prevention
1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.
2. Maintain emotional stability and avoid emotional excitement and tension. 3. Keep the stool smooth, avoid using stools, eat more fruits and high-fiber foods. 4. Avoid cold irritation and keep warm.Complication
Ovarian malignant mesodermal mixed tumor complications Complications, bacterial infections
Titty twisted. More common, is one of the gynecological acute abdomen. It is more common in cystic tumors with long tumor size, moderate size, large mobility, and one side of the center of gravity. It occurs mostly in sudden changes in body position, early pregnancy or postpartum. After the pedicle is reversed, the tumor venous return is blocked, causing congestion, purple-brown, and even rupture of blood vessels. Necrosis and infection may occur due to arterial obstruction. When the acute pedicle is reversed, the patient suddenly has severe pain in the lower abdomen. In severe cases, it may be accompanied by symptoms of nausea, vomiting, and even shock.
Symptom
Ovarian malignant mesodermal mixed tumor symptoms Common symptoms Abdominal pain Ascites bloating pelvic mass Lower abdomen masses Painful abnormal uterine bleeding
Ovarian malignant mesodermal mixed tumors develop rapidly, clinical manifestations of abdominal pain, abdominal distension, stomach discomfort, abdominal mass and other cancer metastasis symptoms, some patients may have abnormal vaginal bleeding and drainage, 80% of patients have been treated In the advanced stage, the examination can touch the pelvic mass, generally above 10cm, and may have ascites and anemia.
Examine
Examination of ovarian malignant mesodermal mixed tumor
Tumor marker detection.
First, histopathological examination.
1, general characteristics
Mostly solid or cystic, irregular surface, grayish white, with bleeding area.
section:
(1) There are many infiltrations in the basin and abdominal cavity, and there is bloody ascites.
(2) It can be a solid yellow-white area with extensive bleeding and necrosis.
2, the characteristics of the microscope
(1) Composition: consists of a malignant epithelial component (adenocarcinoma) and a sarcoma component.
Mainly: poorly differentiated endometrial adenocarcinoma and serous adenocarcinoma.
Second, genetic heterogeneity analysis
The phenomenon of homotypic allele deletion.
Cell culture, immunohistochemistry, and molecular genetic studies have proven to be of monoclonal origin.
Diagnosis
Diagnosis and diagnosis of ovarian malignant mesodermal mixed tumor
diagnosis
Preoperative diagnosis of ovarian malignant mesodermal mixed tumor is difficult, mainly by postoperative histopathological diagnosis. It has been reported that MRI and tumor markers CA125, LDH, -HCG are involved in the diagnosis and treatment of ovarian carcinosarcoma. The condition showed a consistent change, but imaging studies and tumor marker detection have limited reference value for diagnosis.
Differential diagnosis
Identification with epithelial ovarian cancer.
