ovarian serous tumor
Introduction
Introduction to ovarian serous tumors Ovarian serous tumors can be characterized by cystic masses, ranging from 1 to 20 cm in diameter, and more common in single-sex, but also in multiple rooms. The cystic fluid is clear, the grass is yellow, serous, even turbid, even with blood, growth patterns and morphological changes, especially papillary growth, and diversified ways, bilateral compared with other types of epithelial tumors More common, sarcoma (psomomaMies) can often be found under endoscopy. basic knowledge The proportion of sickness: 0.00256% Susceptible people: women Mode of infection: non-infectious Complications: ascites, abdominal pain
Cause
Ovarian serous tumor etiology
Single atrial serous cystadenoma (30%):
Because of its manifestation as a single-walled thin-walled cyst, often referred to as a simple cyst, the tumor has a smooth appearance and a thin wall with a size ranging from a few centimeters to tens of centimeters. The cut surface is a single cystic cavity with a smooth inner wall. Sometimes there are flat, blunt round nipples. The liquid in the cyst is transparent, pale yellow, serous, and occasionally viscous mucous material. The epithelium is a single-layer cuboid or column, often containing a small amount of fallopian tube epithelium.
Multi-room serous cystadenoma or serous papillary cystadenoma (25%):
The cystic cavity is divided into multiple compartments due to fibrous tissue, and the surface may be nodular. The size and texture depend on the size of the capsule and the tension of the cyst fluid. Generally, the capsule is slightly thick, grayish white and smooth; papillary growth can be seen in the chamber. The nipples can be endogenous, exogenous or internal and external. The epithelium is mostly oviduct type, the cells are arranged neatly, the size is the same, and there is no mitotic division (Fig. 1). The granules are sometimes seen between the tumor stroma and the nipple.
Serous surface papilloma (15%):
Less common, the nipples are all exogenous and vary in size. The ovarian interstitium or fibrous tissue can be seen under the microscope. The surface is covered with a single-layered cuboid or low columnar epithelium. Some cells have cilia. These tumors are benign. However, epithelial cells can be detached, planted on the surface of the peritoneal or pelvic organs, and even ascites should occur, which should be paid attention to in clinical practice.
Fibrocystic adenoma and adenoma (10%):
From the ovarian hair growth epithelium and its interstitial, adenoma is mainly fibrous interstitial, mostly solid, with a small amount scattered in the small cyst; cystic fibroids in half or most of the parenchyma, the rest are larger cysts Both are benign, average 9cm in size, generally unilateral, occasionally clustered large polygonal cells in the interstitial, luteal follicular cells, cystic glandular cavity covering a single layer of cuboidal epithelium or columnar epithelium .
Borderline serous tumors (20%):
Similar to benign serous cystic adenoma, but with more papillary processes, larger volume, more chances on both sides than benign.
Microscopic observation:
1 epithelial hyperplasia no more than 3 layers, can also proliferate clusters, often with nipple formation, fewer nipple branches, surface epithelium does not exceed 3 layers.
2 nuclear nucleus, darker staining, but limited to below the moderate range.
3 mitotic figures are less, no more than 1 in a high power field.
4 quality without infiltration (Figure 2).
(3) Serous cancer:
1 serous adenocarcinoma, serous papillary adenocarcinoma and serous papillary cystadenocarcinoma: serous adenocarcinoma is a malignant tumor of Miller's epithelium, whose cancer cells are often characterized by the formation of cystic cavities and nipples, but more or more Less remains the original tissue morphology, some tumors form large and irregular small cysts, and sometimes the epithelium protrudes into the cavity to form epithelial clusters or nipples (Figure 3).
Organization rating:
A. Highly differentiated (Grade I): 4 epithelial hyperplasia, obvious atypia, most of them have nipples, nipple branches are very fine, the epithelium of the nipple becomes obvious, sometimes the epithelial hyperplasia accumulates and replicates into a large number of new small glands. Sand granules are visible in the nipple or interstitium.
B. Moderate differentiation (Level II): It has a papillary structure, but its shape is strange, finger-like or cluster-like, some areas are glandular or sieve-like, and a small part is a substantial cell mass. The cell is heterogeneous and poorly differentiated. There are many splits.
C. Poor differentiation (Level III): The papillary structure disappears, and the tumor cells are substantially flaky or clumpy, that is, substantial adenocarcinoma, with large cell atypia, many mitotic figures, and few interstitial.
2 malignant adenoma and cystic adenoma: no difference in appearance from benign adenoma, microscopic epithelial components, active mitosis, or irregular size of the cyst, or solid tumors.
2. Ovarian serous tumor metastasis pathway
(1) direct diffusion: there are many opportunities for direct spread of serous papillary cystadenocarcinoma, such as peritoneum, peritoneal and abdominal peritoneal organs, including diaphragm, omentum, small intestine, rectum, uterus rectal fossa, The colon, the bladder transition to the peritoneum, and the serosal layer of the fallopian tube and uterus, about 2/3 of the patients have ascites, and the symptoms are as described above. Some patients can feel the abdominal circumference without any discomfort. The presence or absence of ascites is closely related to the prognosis. The 5-year survival rate of ascites in stage III and IV ovarian cancer has recently been reported to be five times higher than that in patients with ascites. The formation of ascites and lymphatic obstruction (mainly right lateral lymphatics) Tube), peritoneal stimulation, and imbalance of fluid flow in the abdominal cavity, cancer cells can not only be planted with the flow of liquid, but also the site of the abdominal wall puncture and ascites can grow cancerous at the puncture site, forming subcutaneous nodules or masses. Some patients are misdiagnosed as tuberculous peritonitis and cirrhosis due to ascites, and cancerous masses at the puncture site have not yet caused vigilance.
(2) Lymphatic metastasis: lymphatic metastasis has the highest incidence of ovarian serous papillary carcinoma, higher than mucinous carcinoma, and pathological grade has little effect, while clinical stage with retroperitoneal lymph node metastasis belongs to stage IIIC, pelvic lymph nodes and abdomen. The rate of metastasis of adjacent aortic lymph nodes was similar. Petru had performed 37 cases of left supraclavicular lymph node biopsy. Only one case was clinically accessible. Among them, 32 cases were stage III and IV, stage III positive rate was 12%, and stage IV was 57%.
(3) blood diffusion: blood diffusion in the past thought that lung and liver parenchymal metastasis is not much, but recent reports are not uncommon, even surgery, chemotherapy to some time also have metastasis, in 1995 Geisler reported that the incidence of brain metastases was 3.3% There was less vaginal metastasis. The gynecological oncology center of Peking University People's Hospital had treated patients with ovarian serous papillary carcinoma. When the external hospital was transferred, the uterus and accessory were removed. After admission, the cauliflower-like tissue was found at the vaginal end. For the metastasis of ovarian serous papillary adenocarcinoma, it is also possible that cancer cells fall off during planting.
Prevention
Ovarian serous tumor prevention
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 serous tumor complications Complications, abdominal pain, abdominal pain
Peripheral tissue adhesions such as intestinal adhesions, about two-thirds of patients with ascites.
Symptom
Symptoms of ovarian serous tumors Common symptoms Lower abdominal pain, bloating, dyspepsia, abdominal pain, ascites, intestinal adhesions, gastrointestinal symptoms, nodules, difficulty in bowel movements
1. Serous benign cystadenoma is mostly unilateral, but serous cystadenoma is more common than other epithelial tumors. When the tumor is small, the symptoms may not be obvious. When it is enlarged, it may cause compression symptoms. Acute abdominal pain may occur when the pedicle is reversed or the tumor is infected. If there is nipple growth, especially the surface ectophenotype, attention should be paid to pathological diagnosis and malignant identification. Tumor markers such as CA125 may be helpful for identification. The malignant rate is about 35%. However, the nipple-type malignant rate is higher, serous adenoma is rare, and occasionally endocrine disorders.
2. In addition to the symptoms of pelvic mass, borderline serous tumors have more chances of ovarian spread, nipples are prone to bud-like hyperplasia, easy to fall off planting, or cause ascites, intestinal adhesions and other complications.
3. Serous cancer Because the ovary is deep in the pelvic cavity, the early tumor volume is not large, and it is difficult to have symptoms when there is no metastasis or complication. Once there is ascites or metastasis, abdominal distension, gastrointestinal symptoms such as indigestion or defecation Difficulties, etc., due to the size and location of the tumor, there may be pain, or oppressive symptoms, manifested as difficulty or poor urination, etc., gynecological cancer patients emphasize the need for triple diagnosis, especially for postmenopausal women, due to vaginal uplift Shallow, double-combined diagnosis is not easy to find the tumor, especially in the posterior fornix with metastatic nodules, gynecological triad examination is often easy to find tumors.
Examine
Examination of ovarian serous tumors
Tumor marker examination: 80% of ovarian serous carcinoma serum CAl25 is positive, because other tumors and non-neoplastic diseases, such as endometriosis, etc. are also positive, so it is more meaningful for tracking and monitoring. To match other methods.
Histopathological examination.
Diagnosis
Diagnosis and differentiation of ovarian serous tumor
diagnosis
Diagnosis can be made based on clinical manifestations, signs and above.
In 1971, Barber first proposed postmenopausal palpableovary (PMPO), indicating that PMPO may have ovarian cancer. Of course, not all PMPO means ovarian cancer, but if the ovarian enlargement occurs after menopause, Should pay attention to further confirm the diagnosis, the normal ovarian premenopausal size is about 3.5cm × 2.0cm × 1.5cm, about 2.0cm × 1.5cm × 0.5cm after menopause, about 1.5 years after menopause, about 1.5 years after menopause Cm×0.75cm×0.5cm, among the 107 patients with PMPO over 50 years old in the Gynecologic Oncology Center of Peking University People's Hospital, 22.4% found ovarian malignant tumors.
Differential diagnosis
It is differentiated from other tumors in ovarian epithelial tumors such as ovarian mucinous tumors, ovarian endometrioid tumors, and transitional cell tumors.
