ovarian fibroma
Introduction
Introduction to ovarian fibroma Ovarian fibroids are benign tumors common in ovarian cord stromal tumors. Clinically, pelvic mass, pleural effusion, abdominal pain, menstrual disorders and other symptoms may occur. Some patients are asymptomatic and are accidentally found only during physical examination or surgery. Surgery is the main treatment. The cause of the disease is not clear. It may be related to the abnormality of certain chromosome numbers and structures, the role of oncogenes and tumor suppressor genes. basic knowledge The proportion of illness: 8.7% (the above is the probability of illness in middle-aged and elderly women) Susceptible people: women Mode of infection: non-infectious Complications: ascites
Cause
Cause of ovarian fibroma
(1) Causes of the disease
The pathogenesis of ovarian cord stromal tumors is still unclear. The study found that chromosome number and structure abnormalities were found at the cellular level; some oncogenes and tumor suppressor genes were found at the molecular level.
(two) pathogenesis
Fibroma
(1) gross examination: the tumor is mostly unilateral, bilaterally accounted for 4% to 10%, round, kidney-shaped or lobulated nodular, smooth surface, intact capsule, solid, hard texture, solid surface, The braided structure is obvious, gray or pinkish white, occasionally bleeding or cystic.
(2) Examination under the microscope: the tumor cells are long fusiform, with little cytoplasm, no lipid droplets, densely arranged cells, braided or mat-like, collagen fiber rich, can be accompanied by extensive glassy changes, tumor cells are not typical Shape, also no nuclear division icon (Figure 1).
2. Fiber (or vesicular cell) tumor fibroma (or vesicular cell tumor, fibroblastic cell tumor) containing sexual cord components occasionally see a small amount of sex cord cell components, generally only about 5% of tumor components, tumor The biological behavior of clinical manifestations is similar to that of fibroids, unlike tumors of the sex cord cell component (granulosa cell tumor or supporting cell tumor), which are called fiber (or vesicular cell) tumors containing sex components.
3. Cellular fibroma tumors are mainly composed of cell components, and there are few collagen fibers between cells. The tumor cells may have mild atypia, and the nuclear division in the most abundant region is 3/10HPFs.
The prognosis of cell fibroma is generally good, about 20% can recur, should be considered as a tumor with low malignant potential.
4. Fibrosarcoma When the tumor cells of cell fibroma appear obvious atypia, when the mitosis is >3/10HPFs, fibrosarcoma is diagnosed, the degree of malignancy is extremely high, and the prognosis is extremely poor.
Prevention
Ovarian fibroma prevention
Ovarian fibroids occur in middle-aged and older women over 40 years of age. The average age of onset is 46 to 48 years old. Chechia et al (2002) have a mean age of 46.83 years. The incidence of ovarian fibroids is generally considered to account for 2% to 5% of all ovarian tumors. Lang Jinghe et al (1994) reported 4.8% of all ovarian tumors, accounting for 76.5% of ovarian cord stromal tumors, and the incidence rate was the first in ovarian cord stromal tumors. Kamiyama et al (2001) reported that fibroids and Meig syndrome also occur in extra ovaries.
Complication
Ovarian fibroma complications Complications ascites
Ovarian fibroids alone have more ascites, accounting for about 41%, especially in patients with large tumors and edema of tumor stroma, the incidence is more obvious. Ascites is very rare in benign ovarian tumors, which is also a characteristic manifestation of ovarian fibroids. Clinical patients may have abdominal distension, abdominal enlargement, chest tightness, shortness of breath, difficulty in urinating, and the like. Ovarian fibroids are prone to twisting as the body position changes due to solidity, hard texture, and a certain weight. Nearly half of the patients in the clinic have symptoms of abdominal pain.
Symptom
Ovarian fibroma symptoms Common symptoms Follicle stimulating hormone (F... Ascites pelvic mass bloating ovarian amenorrhea abdominal pain chest tightness pleural effusion shortness postmenopausal bleeding
Pelvic mass
Although the size of ovarian fibroids varies greatly, most of them are medium-sized, with an average diameter of about 10 cm. The tumor is generally smooth and active, but the texture is hard. It is the hardest tumor in all ovarian tumors, which is a clinically important feature.
2. Ascites, pleural effusion
Ovarian fibroma with pleural effusion, ascites, pleural effusion after tumor resection, ascites disappear, is defined as Meigs syndrome, but it is rare in clinical practice.
Ovarian fibroids alone have more ascites, accounting for about 41%, especially in patients with large tumors and edema in the tumor stroma, the incidence is more obvious, ascites is very rare in benign ovarian tumors, which is also ovarian fibroma. The characteristic manifestations, clinical patients may have abdominal distension, abdominal enlargement, chest tightness, shortness of breath, difficulty urinating, etc., several authors (Abad et al, 1999; Spinelli et al, 1999; Santangelo et al, 2000; Bognoni et al, 1999) reported that patients can also There was an increase in CA125 and a postoperative decline.
3. Abdominal pain
Ovarian fibroids are solid, have a hard texture, have a certain weight, and are prone to twist when the patient's body position changes. Nearly half of the patients have clinical symptoms of abdominal pain.
4. Menstrual disorders
A small part of ovarian fibroma still has endocrine function, clinical patients may have menstrual disorders, postmenopausal bleeding, Foth et al (2001) reported a case of postmenopausal women with bilateral ovarian fibroma, and endometrial adenocarcinoma.
Examine
Examination of ovarian fibroma
1, physical signs: tumors are mostly unilateral, bilateral accounted for 4% to 10%. Round, kidney or lobulated nodules. The surface is smooth, the envelope is intact, solid, and the texture is hard. The cut surface is solid, the braided structure is obvious, gray or white, and occasionally hemorrhage or cystic change.
2, under the microscope examination: tumor cells long fusiform, less cytoplasm, no lipid drops. The cells are closely packed and woven or matted. Collagen fiber is rich and can be accompanied by a wide range of glass-like changes. Tumor cells have no typical shape and no mitotic figures.
3, other examinations: B-ultrasound, CT, laparoscopy.
Diagnosis
Diagnosis and diagnosis of ovarian fibroma
diagnosis
Some patients with ovarian fibroma (30% to 54%) have no obvious clinical symptoms and are often found by chance during physical examination or other abdominal surgery.
When the middle-aged and elderly women find smooth moving masses, the symptoms of endocrine disorders are not obvious, but the characteristics of the tumor are hard, it is not difficult to diagnose ovarian fibroids. Some patients with ascites, if the general condition is poor, and the symptoms of compression are obvious, Sometimes it is difficult to distinguish from ovarian cancer.
Differential diagnosis
Note the differentiation from ovarian cancer, ovarian vesicular cell tumor, fibroepithelial neoplasia, adenoma, when the solid component of the tumor predominates, the pelvic examination touches the solid, the hard mass is difficult to distinguish from the fibroid, often requires surgery Post-pathological examination can confirm the tissue source of the tumor.
