borderline ovarian tumor
Introduction
Introduction to ovarian borderline tumors Ovarian borderline tumors are less malignant. The WHO defines ovarian borderline tumors as: between the tumors of the same benign and obvious malignant growth and cytological characteristics, non-destructive interstitial infiltration, and compared with the same clinical stage of ovarian cancer, most It is a much better prognosis for ovarian tumors. Lymph node metastasis exists in ovarian borderline tumors, and the affected lymph nodes of lymph node metastasis are mostly pelvic and para-aortic lymph nodes. basic knowledge The proportion of illness: 0.0025% Susceptible people: women Mode of infection: non-infectious Complications: tissue necrotic lymphadenitis
Cause
Ovarian borderline tumor etiology
(1) Causes of the disease
The etiology of ovarian borderline tumors is still unclear. Peritoneal pseudomyxoma with borderline tumors was previously thought to originate in the ovary, and the most likely source is now the appendix.
(two) pathogenesis
The main pathological types are serous and mucinous, as well as endometrial-like, clear cells, etc., but they are very rare.
1. The histological diagnosis of serous borderline tumors generally uses the criteria proposed by Katzenstein et al:
1 Epithelial cells are layered and/or budded.
2 cell atypia.
3 nuclear division.
4 Without interstitial infiltration, Russell believes that under the premise of no real interstitial infiltration, more than two points must be diagnosed in these four points. On this basis, many scholars continue to supplement, and interstitial infiltration is sometimes difficult to judge and Identification, a part of serous borderline tumors have peritoneal implantation, the diagnosis should be based on the shape of the primary tumor. In recent years, there have been reports of microscopic focal infiltration of serous borderline tumors, Bell and Scully defined microinfiltration as: Typical forms of serous borderline tumor stroma exist in focal or multifocal, appearing as single cells, irregular small nests, papillary or mesh-like cell nests, cells present atypical, but to the surrounding interstitial Does not constitute destructive without interstitial reaction, the lesion range is less than 3mm in diameter or less than 10mm2 in area. At present, most studies believe that microinfiltration does not affect the prognosis, and is still included in the scope of borderline tumors. Scudly also proposed that when The focal tumor cells present a disordered growth pattern in the stroma and have malignant features in the cytology, which cause a certain degree of damage to the surrounding interstitial or cause interstitial When the reaction, it should be diagnosed as "micro-invasive cancer", especially when combined with extra-ovarian lesions, it is a threat to patients.
2. Histological diagnosis of mucinous borderline tumors Piura et al.'s diagnostic criteria for mucinous borderline tumors are: epithelial hyperplasia, no interstitial infiltration, and have two of the following three:
1 villi-like glandular hyperplasia.
2 mitotic figures or cells are not typical.
3 cells do not exceed 4 layers.
In recent years, Rutgers and Seully have classified mucinous borderline tumors into intracervical models and intestinal types. Scully proposed ovarian borderline endocervical mucinous tumors, which are similar in structure to borderline serous tumors, but the nipples are rich in interstitial and There is cell sprouting, which may be implanted in the peritoneum and metastasized to the lymph nodes, but not associated with peritoneal pseudomyxoma. The peritoneal dissemination is a scattered nodule, which consists of mucous gland and fibrous interstitial. The prognosis is better than intestinal type, Riopel et al. Proposed diagnostic criteria for intestinal mucinous tumors:
1 Mucous epithelium is stratified and clustered, but no interstitial infiltration.
2 with micro-invasion often manifested as gland crowded, fusion growth or back-to-back, lack of fibrous interstitial, or sieve-like structure, with necrosis, mitotic like <5/10HPF, infiltration range <5mm, with peritoneal pseudo-mucus Most of the tumors are intestinal type, and the interstitial infiltration of Riopel on intestinal junctional mucinous tumors has been relaxed from <3 mm to <5 mm, because there is no significant difference in the prognosis between the two.
3. The traditional view of peritoneal implantation treats extraovarian lesions as planting. This classification method is flawed. Bell proposed that the epithelial components in non-invasive implants are sparse and surrounded by surrounding reactive fibroblasts, allowing epithelial and mesenchymal cells. It is often fused and difficult to find; invasive planting has more epithelial components, showing highly complex hyperplasia or micropap structure and small cell nests are irregularly distributed in the interstitial. The diagnostic criteria for Sliva for peritoneal implantation are as follows:
1 Find single or clusters of epithelial cells in the stroma, and if they reach a certain number, they are called "invasive planting."
2 The peritoneal surface or apex has no fibrous tissue reaction, while the epithelial cells penetrate the underlying tissue, also known as "invasive implantation."
3 If the implant site is extensively fibrotic, only a few single cells are located in the interstitial, it is called planting with early infiltration, regardless of whether the peritoneal lesion is multi-center primary or planted, the former incidence is about 88%, and the 10-year survival rate is 95. % to 98%; the latter accounted for 12%, and the 10-year survival rate was only 33%, which is very similar to invasive cancer. Therefore, in recent years, it is advocated that regardless of the lesion on the ovary, peritoneal invasive growers are considered cancer.
Seidman counted 4129 cases of borderline serous tumors after 7.4 years (median) follow-up, the survival rate of non-invasive peritoneal implants was 95%, and that of invasive peritoneal implants was 66%. Invasive peritoneal implantation is currently the most prognostic. Reliable indicators, so it is hoped that doctors should carefully perform multi-point biopsy on the abdominal cavity during surgery to find the lesions. Infiltration in the serous borderline tumor is the only cause of death. Only such patients need chemotherapy.
In the mucinous borderline tumor, the intestinal peritoneal dissemination is mostly a diffusely distributed mucus pool. The floating mucous epithelium in the middle and the peritoneal pseudomyxoma with borderline tumors were thought to originate in the ovary. The most likely source is now the appendix. At present, the treatment of peritoneal pseudomyxoma is still not satisfactory. The borderline myxoma with peritoneal pseudomyxoma has poor biological behavior and poor prognosis. Interstitial infiltration >5mm is the only poor prognostic indicator.
Prevention
Ovarian borderline tumor prevention
Ovarian borderline tumors should be followed up like ovarian cancer. Vaginal ultrasound, gynecological examination and serum CA125 are routine items for postoperative follow-up. Vaginal ultrasonography is the most effective means of recurrence. CA125 is in many serous borderline tumors. In the middle, Gotlieb retrospectively analyzed 91 patients, 75% of patients with serous borderline tumors had an increase in preoperative CA125, with an average of 156 U/ml, while mucus was only 30%, with an average of 28 U/ml, stage Ia. The patient had only a 35% increase, with an average of 67 U/ml, and 89% of those with extraovarian dissemination, with an average of 259 U/ml. Engelen reported that 57% of mucinous borderline tumors had preoperative CA19-9 elevation, and suggested Mucinous tumors were followed up with CA19-9.
Complication
Ovarian borderline tumor complications Complications, tissue necrotic lymphadenitis
Adhesion of surrounding tissues, Scully proposed lymph node metastasis in ovarian borderline tumors, the incidence rate is 1% to 16%, and has nothing to do with clinical stage.
Symptom
Ovarian borderline tumor symptoms common symptoms pelvic mass
Lymph node metastasis exists in ovarian borderline tumors. The lymph nodes involved in lymph node metastasis are mostly pelvic and para-aortic lymph nodes. The lesions of the affected lymph nodes are similar regardless of whether the tumor is accompanied by implantation. Seidman counts 43 cases of borderline serous tumor with lymph node metastasis. After 6.5 years (median) follow-up, the survival rate reached 98%. There is no evidence that pregnancy will aggravate the clinical progression of ovarian borderline tumors.
In the classification of WHO ovarian tumors in 1973, the diagnostic criteria have been controversial for many years. In recent years, some changes have taken place and gradually become uniform, with histopathological diagnostic criteria as the diagnostic criteria.
Examine
Examination of ovarian borderline tumors
Vaginal ultrasound, gynecological examination, examination of tumor markers such as serum CA125, CA19-9.
Histopathological examination.
Diagnosis
Diagnosis and diagnosis of ovarian borderline tumor
diagnosis
The basic diagnostic criteria for WHO (1999) ovarian borderline tumors are:
1 Borderline tumor cell nuclear abnormalities and mitosis are between this type of benign and affirmative malignancy.
2 Some atypical stratified epithelial cell masses are detached from the original site.
3 lack of obvious interstitial infiltration.
It must be emphasized that when the suspicious borderline is used, a slice should be made every 1~2cm. When metastasis or recurrence, the tumor still maintains the original borderline tissue morphology. Table 1 lists the boundaries of histomorphology, which can not be diagnosed in the past. Sex, but invasive.
Differential diagnosis
It should be differentiated from borderline serous tumors in ovarian epithelial tumors.
