ovarian muscle tumor
Introduction
Introduction to ovarian muscle-derived tumors There are mainly the following types of ovarian muscle-derived tumors: 1. Leiomyoma of primary ovarian leiomyoma (leiomyomaoftheovary) has been reported, about 50 cases have been reported. However, it seems that many cases have not been reported, especially when the tumor is small and accidentally discovered, so the actual incidence may be much higher. 2. Leiomyosarcomaoftheovary is a rare leiomyosarcomaoftheovary. The literature only reports more than 10 cases. 3. The cases reported in the rhabdomyosarcoma are not all pure rhabdomyosarcoma, some are malignant mesodermal mixed sarcoma, some are teratoma with significant striated muscle cell components, so should pay attention to distinguish. basic knowledge Probability ratio: female incidence rate is about 0.003%-0.005% Susceptible people: women Mode of infection: non-infectious Complications: uterine fibroids leiomyosarcoma rhabdomyosarcoma ascites
Cause
Ovarian muscle origin tumor etiology
Leiomyoma (25%):
It may be derived from vascular smooth muscle of the ovarian cortex or luteal interstitial, or smooth muscle of the vascular wall where the ovary ligament meets the ovary, but the value of the above sources is not certain. (1) General: often unilateral, only Kandalaft reported that a 21-year-old woman with bilateral giant ovarian leiomyoma, the mass is solid, hard, round or oval, smooth surface, white visible Or gray-white solid swirling structure, sometimes visible bleeding, degeneration and necrosis, due to necrosis, can form a cystic cavity, can also appear calcification.
(2) Microscopically: The tumor has the appearance of a typical leiomyomas, which is the same as uterine leiomyoma. The tumor consists of heterogeneous fusiform or long strips of leiomyomas, containing long, blunt nucleus at both ends. Also known as cigarshaped nuclei, the nucleus can be arranged in a fence, and sometimes prominent, with no nucleus splitting or very few, the heterogeneity of cells and nucleus is not characteristic, the tumor cells are bundled, and the fibrous interstitial space is interspersed. It can be very wide and has obvious glassy changes. Other degeneration seen in uterine leiomyoma can also exist. Special staining and immunohistochemical staining can confirm the tumor leiomyomas. Mira reported a case of 63-year-old woman. Suffering from ovarian giant fat leiomyoma, the tumor almost occupies the entire ovary, the adipose tissue replaces and divides the smooth muscle in the tumor, and there is no uterine leiomyoma.
Leiomyosarcoma (25%):
May be a smooth muscle source. (1) Gross: The mass is usually large, grayish yellow, soft, muscular, common bleeding, necrosis. (2) Microscopically: unlike leiomyomas, mitotic figures, cell and nuclear atypia, differentiated leiomyosarcoma and multicellular leiomyoma are distinguished. The only one that relies on mitotic figures is now considered to be good and malignant. In contrast, mitotic figures are much more important than the heterogeneity of cells and nuclei.
Nogales et al. proposed a very rare special type, myxoid leiomyosarcoma of the ovary, which reported that all three tumors were large, jelly-like, with cystic changes, necrosis and hemorrhage. However, the uterus, ligament and contralateral attachments were normal. The tumor showed a prominent elongated cell network structure under the microscope. It was surrounded by abundant basophilic substances and stained with anti-smooth muscle actin monoclonal antibody, which can be confirmed as smooth muscle source. .
Rhabdomyosarcoma (20%):
The source of the tissue is uncertain and may be derived from the connective tissue of the ovary; it may be a one-way development of a teratoma; it may also be a malignant transformation of a mature cystic teratoma with malignant growth; or a one-way development Malignant mesodermal mixed tumor.
(1) Gross: The tumor is unilateral, but the tumor metastasis is also involved and the contralateral ovary is involved. It should be differentiated from bilateral involvement. The tumor is usually larger, the diameter is more than 10cm, solid, soft, fish-like, dark pink to tan. Some areas of bleeding, necrosis, but also bleeding, necrosis is very significant.
(2) Microscopic: The whole tumor is composed of striated muscle cells, which are divided into embryonic type, grape cluster type and polymorphic type. The first two types are more common in children and young women, while the polymorphic type is more common in elderly women, and the diagnosis of polymorphism Rhabdomyosarcoma is not very difficult, because it is easier to find typical rhabdomyoblasts that exhibit horizontal stripes, and the diagnosis of embryonal rhabdomyosarcoma is much more difficult because of poor cell differentiation, making the identification of rhabdomyoblasts very difficult, in addition, It is not easy to recognize the characteristic acinar or grape cluster type. Embryonic rhabdomyosarcoma is composed of rhabdomyoblasts at various stages of differentiation, and at least some small round cells are aggregated, and the cytoplasm is small, forming a narrow margin. Poor differentiation, so it is difficult to distinguish from poorly differentiated small cell carcinoma, malignant lymphoma, neuroblastoma and leukemia. In small round cells, occasionally, well-differentiated cells are accompanied by obvious eosinophilic cytoplasm and eccentricity. Nuclear, occasionally visible large, more typical rhabdomyoblasts, the presence of horizontal stripes is not necessary for diagnosis, but the cells that make up the tumor can differentiate well. Showing horizontal stripes, it has been confirmed that X-band or its precursors are helpful for diagnosis under electron microscopy. Immunocytochemistry confirms that myoglobin and desmin are also helpful in diagnosis. Tumors are often edematous and hemorrhagic. The effect of necrosis is more difficult to diagnose in this case. Therefore, thorough examination and material extraction are extremely important for correct diagnosis. The tumor may not be as small as people believe, but may be divided into undifferentiated ovaries due to poor differentiation. Tumors, or diagnosed as other tumors, therefore, when young women with undifferentiated, small round cell ovarian tumors, should consider whether it is embryonic rhabdomyosarcoma, the current diagnosis should also exclude the presence of other tumor components.
Prevention
Ovarian muscle source tumor prevention
1. Ovarian leiomyoma is less common in menopausal and postmenopausal women but sometimes in young women. The age range is 20 to 65 years old.
2. Ovarian leiomyosarcoma is rare. It accounts for about 0.1% of all ovarian malignancies. Often occurring in postmenopausal women but also in young women.
3. Rhabdomyosarcoma is also a rare disease. The age of onset is 25 to 84 years old. Because there are too few cases, it is difficult to tell which age group is good, but the occurrence of rhabdomyosarcoma in other parts can be used as a reference. Polymorphism often occurs in elderly patients, while embryonic and grape cluster (acinar type) occur mostly in young patients. Women.
Complication
Ovarian muscle-derived tumor complications Complications Uterine fibroids, leiomyosarcoma, rhabdomyosarcoma, ascites
1. Leiomyoma often has uterine fibroids.
2. leiomyosarcoma common bleeding, necrosis.
3. Rhabdomyosarcoma is often accompanied by bloody ascites, metastasis is common.
Symptom
Ovarian muscle source tumor symptoms common symptoms abdominal pain vaginal bleeding menopause abdominal mass pleural effusion
1. The leiomyomas are often asymptomatic, mostly accidental findings. When symptoms appear, they are often associated with tumors that are present in the attachment. They are characterized by abdominal enlargement and abdominal pain, which can cause acute abdominal pain due to reversal. Some scholars have reported that a case is 68 years old. Patients with ovarian leiomyoma, who have been treated for a small amount of vaginal bleeding for 15 years after menopause, can often find ovarian solid masses, ascites are rare, and no reports of pleural effusion have been reported, often with uterine fibroids.
2. The symptoms and signs of leiomyosarcoma are related to the abdomen and pelvic mass.
3. The symptoms of rhabdomyosarcoma are often caused by large tumors, usually growing faster, and abdominal masses can be found.
Examine
Examination of ovarian muscle-derived tumors
Tumor marker examination, immunohistochemistry. Histopathological examination, laparoscopy.
Diagnosis
Diagnosis and diagnosis of ovarian muscle-derived tumor
Diagnosis can be made based on clinical manifestations, symptoms, and related tests.
Differential diagnosis
1. Leiomyoma subserosal uterine fibroids can sometimes fall off on their own, no longer connected to the uterus, but connected with the ovary to obtain blood supply, forming a parasitic leiomyomas, which should be smooth with the primary ovary The identification of fibroids, some cases should be differentiated from follicular cell tumors, the latter's tumor cells are usually more slender, the cells are densely arranged, the cells are round or polygonal when the luteinization occurs, the cytoplasm is rich, visible vacuoles, The disease should also be differentiated from ovarian fibroids. Van Gieson stained collagen fibers were red and myofibrils were yellow; Masson-stained collagen fibers were green and myofibrils were red.
2. Leiomyosarcoma Primary ovarian leiomyosarcoma should be identified with the following diseases:
(1) Malignant mesodermal mixed tumors containing significant leiomyosarcoma components.
(2) Immature teratomas containing significant leiomyosarcoma-like tissue components.
(3) The primary leiomyosarcoma of the uterus or other parts is transferred to the ovary.
(4) poorly differentiated sarcoma and carcinosarcoma that are primary or metastatic to the ovary.
(5) Mucin-like leiomyosarcoma should also be differentiated from other ovarian mucin-like tumors, such as ovarian edema, myxoma, endodermal sinus tumor, and carcinosarcoma.
3. Rhabdomyosarcoma should be differentiated from embryonal rhabdomyosarcoma, small cell carcinoma, malignant lymphoma, neuroblastoma, leukemia, etc.
