ovarian endometrioid tumor
Introduction
Introduction to ovarian endometrial tumors The tissue structure of the ovarian endometrioid tumor has the characteristics of endometrial epithelium and/or interstitial similarity, which can come from the ectopic endometrium and ovarian surface epithelium. In the past, there was insufficient understanding of such tumors and fewer diagnoses. In 1964, the International Obstetrics and Gynecology Association was officially named. In 1973, the international ovarian tumor histology classification was officially divided into benign, borderline and malignant. In addition to endometrial carcinoma, the latter includes adenosarcoma, mesenchymal mixed tumor or malignant Miller mixed tumor, endometrial stromal sarcoma. basic knowledge The proportion of illness: 0.005% Susceptible people: women Mode of infection: non-infectious Complications: septic shock
Cause
Ovarian endometrioid tumor etiology
Benign endometrial tumors (30%):
Simple endometrioid adenomas and endometrioid cystadenoma are rare, most of which are endometrioid adenofibroma and endometrioid cystadenofibroma, generally medium in size, smooth in surface, and serous glandular fibers. Tumor and cystic fibroma are similar, and the cut surface is solid fibrous connective tissue. There are scattered and different sizes of cystic cavities. The cystic wall is smooth or nodular, and the size is not large. The glandular epithelium is single. Layered or short columnar, similar to the proliferative endometrium, there are scattered endometrial glands in fibrous connective tissue, varying in size, sometimes showing glandular secretions, positive for PAS digestive enzyme staining.
Borderline endometrioid tumors (30%):
Occurred in adenoma and cystic fibroma, the appearance is similar to benign tumors, microscopic epithelial atypical hyperplasia can be seen under the microscope, according to glandular epithelial hyperplasia, nuclear atypia can be divided into light, medium and heavy grade 3, but No interstitial infiltration.
(1) mild atypical hyperplasia: large glandular lumen, irregular shape, mild stratification of the glandular epithelium and atypia.
(2) Moderate atypical hyperplasia: glandular arrangement is tight, glandular cavity size is irregular and irregular, glandular epithelium is obviously stratified, and there is obvious nuclear atypia.
(3) severe atypical hyperplasia: irregular glands are closely arranged, glands may have back to back, less interstitial, glandular epithelial stratification, disordered arrangement, nuclear atypia, occasionally mitotic figures, but no interstitial infiltration.
Malignant endometrial cancer (20%):
(1) Endometrioid adenocarcinoma: histologically similar to endometrial adenocarcinoma originating in the uterus, all types of the latter can occur, accounting for 16% to 31% of ovarian malignant tumors.
Pathological morphology: 55% to 60% is unilateral, cystic solid or most solid, sometimes accompanied by chocolate cysts, smooth or nodular shape, or surface nipple growth, varying in size, diameter 2 ~ 35cm; Grayish white, brittle, often with large pieces of bleeding, the shape of the nipple is often short and wide, rarely repeated branches, can be covered with a single layer or a few layers of hyperplastic epithelium (Figure 1), sometimes can be found in the squamous tissue under the microscope, individual cases resemble scales Cancer, simple ovarian squamous cell carcinoma is rare, and sometimes can find sand granules.
According to the morphology of the gland and the degree of cell differentiation, the tumor can be divided into three levels:
1 Highly differentiated (Grade I): Good differentiation, mainly glandular structure, with a small number of mitotic figures.
2 moderate differentiation (level II): the solid part accounts for about 1/2, the gland is irregular in shape, and a large number of small glands are connected to each other, and the mitotic figures are obvious.
3 poorly differentiated (level III): glandular structure has been rare, a large number of tumor cells proliferate and destroy the glandular cavity, forming a diffuse piece, and mitotic figures increase.
Relationship between ovarian endometrial carcinoma and endometrial adenocarcinoma: diagnosis of primary ovarian endometrioid carcinoma must exclude metastasis from endometrial adenocarcinoma because of the high incidence of endometrial adenocarcinoma, often Transfer, 5% to 29% of both can occur at the same time, the differential diagnosis is the primary standard. In 1987 Scully proposed the following: A. There is no direct connection between the two tumors; B. The tumor is mainly in the ovary and uterus Endometrium; C. Ovarian tumor is confined to the central part of the ovary, endometrial adenocarcinoma lesions are less than 2 cm; D. no myometrial invasion or only mild superficial myometrial invasion; E. no lymphatic vessels and vascular invasion; The endometrium has atypical hyperplasia at the same time; G. There is endometriotic lesion in the ovary.
(2) Mesoler mixed malignant tumor (Mullerian malignant mixed tumor):
Pathology: can be divided into homologous (homologous) and heterologous (heterologous), homology is mainly carcinosarcoma (carcinosarcoma), the tumor is medium-sized, irregular surface, lobulated or nodular, The adenocarcinoma and sarcoma components can be seen under the microscope. The heterologous is the mesodermal mixed tumor. There are adenocarcinomas in the tumor and various components derived from the mesodermal leaves, such as cartilage, striated muscle, bone and so on. organization.
(3) Endometrioid stromal sarcoma:
Pathology: tumors vary in size, round or irregular, and the cut surface is solid or cystic, often accompanied by hemorrhage and necrosis. It consists of round or oval cells, and the tumor cells surround the thick wall. Blood vessels, arranged in a spiral.
Prevention
Ovarian endometrial tumor prevention
Regular physical examination, early detection, early treatment, follow-up monitoring of tumor markers and tumor radioimmunotherapy after treatment. It is very important to maintain a good attitude. It is very important to maintain a good attitude, to maintain a good mood, to have an optimistic, open-minded spirit, and to be confident in the fight against disease. Don't be afraid, only in this way can you mobilize your subjective initiative and improve your body's immune function.
Complication
Ovarian endometrial tumor complications Complications , septic shock, fever
(1) The systemic symptoms are not obvious, and sometimes there may be low fever and fatigue. The course of the disease is longer, and some patients may have symptoms of neurasthenia.
(2) Scar adhesion and pelvic congestion caused by chronic inflammation can cause lower abdominal bulge, pain and soreness in the lumbosacral region, often exacerbated during exertion, sexual intercourse, and menstruation.
(3) due to pelvic blood stasis, patients may have increased menstruation, ovarian function damage may have menstrual disorders, tubal adhesions can cause infertility.
Symptom
Ovarian endometrioid tumor symptoms Common symptoms Menopausal irregular bleeding, vaginal bleeding, abdominal distension, abdominal pain, uterine bleeding, ascites, pelvic mass
1. Benign endometrial tumors are mostly unilateral, and common symptoms are pelvic masses and irregular vaginal bleeding.
2. Borderline endometrioid tumors are unilateral, or asymptomatic, or have mass and vaginal bleeding.
3. Malignant endometrial cancer
(1) endometrial adenocarcinoma: abdominal and pelvic mass and abdominal distension, abdominal pain, 10% to 15% of patients with ascites, irregular vaginal bleeding or postmenopausal bleeding and other symptoms more common than other ovarian epithelial cancer .
(2) ovarian mesodermal mixed tumor: occurs in postmenopausal women, the tumor grows rapidly, often accompanied by abdominal pain, 17% with ascites, compression symptoms are more obvious.
(3) ovarian endometrioid stromal sarcoma: stromal sarcoma (stroma sarcoma) is less common, the age of onset is 10 to 70 years old, an average of 54 years old, the symptoms are mostly abdominal mass or abdominal pain, due to adjacent organs or tissues Adhesions and even violations can cause gastrointestinal or urinary symptoms and occasional irregular uterine bleeding.
Examine
Examination of ovarian endometrial tumors
Laboratory examination
Tumor markers such as CA125 and the like.
2. Other auxiliary inspections
Histopathological examination, laparoscopy.
Diagnosis
Diagnosis and differentiation of ovarian endometrial tumors
diagnosis
Diagnosis can be made based on clinical manifestations and laboratory tests and histopathological examinations.
Differential diagnosis
It is differentiated from ovarian serous tumors and mucinous tumors.
