ovarian fibrous tissue-derived tumor
Introduction
Introduction to ovarian fibrous tissue-derived tumors Ovarian fibrous tissue-derived tumors are one of the ovarian non-specific tumor tissues. Fibrous tissue-derived tumors are rare in the ovary. There are four types of fibrotic tissue-derived tumors: ovarian fibroma, multicellular fibroma, fibrosarcoma, and primary myxoma. Clinical manifestations vary by type. Probably the mesenchymal tissue cells with a tendency to differentiate into fibroblasts in the ovarian stroma. basic knowledge Proportion of disease: 4% of ovarian tumors Susceptible people: women Mode of infection: non-infectious Complications: fibrosarcoma
Cause
Ovarian fibrous tissue-derived tumor etiology
(1) Causes of the disease
1. The organization of ovarian fibroma is still controversial. The most likely source is mesenchymal cells with ovarian interstitial fibroblast differentiation. It is suggested that fibroma is derived from fibroblastic cell tumor or Bolunna tumor. It is believed that fibroids are derived from connective tissue in the ovary. The original site is the ovarian stroma or the walls of blood vessels and lymphatic vessels. Although it is difficult or even impossible to identify fibroids and fibroblastic cell tumors, they should try their best to identify them. .
2. Fibrosarcoma may be derived from the ovarian stroma or from malignant transformation of fibroids.
3. Ovarian primary myxoma The majority of myxoma originates in connective tissue, but the tissue source is still controversial. The tissue origin of ovarian myxoma is still unclear. Costa et al. (1993) compared ovarian myxoma with ovarian follicles. The histological and immunochemical characteristics of membranous cell tumors and fibroids suggest that myxomas may be a specific stage of differentiation of follicular-fibroblastoma.
(two) pathogenesis
1. Ovarian fibroids Small ovarian fibroids can be 1 ~ 2cm in diameter, large can weigh up to 13kg, often round or oval, solid, gray-white, hard and uniform hardness, sometimes the surface can be round The shape is convex or lobulated, but most of the surface is smooth, the cut surface is uniform, white or grayish white, accompanied by a swirling structure, focal hemorrhage or necrosis can be seen in the large mass, and sometimes the cystic cavity is formed.
Microscopically: the tumor is composed of short spindle cells, the nucleus is oval, with little or no mitotic figures, the cells are bundled, and often cross-arranged, often with glassy and mucoid degeneration, calcification, edema, Bleeding and necrosis, except for necrotic areas, often have no fat tissue.
2. The diagnostic criteria for multicellular fibroids are cell-rich, the nucleus is mild to moderately heteromorphic, and the mitotic image is <4/10HPF.
3. Ovarian fibrosarcoma is similar in appearance to ovarian fibroma, but the tumor is usually larger, and the literature reports ranging from 9 to 35 cm.
Microscopically: Ovarian fibrosarcoma, like the typical microscopic features of fibrosarcoma occurring elsewhere, usually exhibits pronounced cellular pleomorphism and active mitosis.
4. The primary ovarian mucinous tumor has a maximum diameter of 5-22 cm, has a capsule, grayish white, soft, and the cut surface is cystic, the solid part is mucous, while the cyst contains viscous and transparent jelly. Sample material.
Microscopically: A typical myxoma consists of a loose myxoma-like matrix scattered in stellate or fusiform cells, some of which contain densely stained nuclei, no obvious cell abnormalities, no schizophrenia, and intravascular tumors. Different, can be formed without blood vessels, can also contain a small number of capillaries and no plexiform blood vessels, can also be expressed as tumor capillaries are very prominent, mucinoma matrix Alcian blue staining positive, fat staining negative, some areas of fibrosis, No other connective tissue, and the entire tumor looks uniform.
Prevention
Ovarian fibrous tissue source tumor prevention
Regular physical examination, early detection, early treatment, and good follow-up. 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 fibrous tissue-derived tumor complications Complications fibrosarcoma
Ovarian fibrosarcoma is more common with hemorrhage and necrosis; multicellular fibroma has a tendency to relapse late.
Symptom
Ovarian fibrous tissue-derived tumor symptoms Common symptoms Abdominal pain Abdominal pain Abdominal effusion Pelvic mass Ascites Uterine Bleeding Postmenopausal bleeding Vaginal bleeding Menstrual cycle Changes Uterine attachment mass
Ovarian fibroma
Ovarian fibroma is mostly unilateral, Sivamesaratnam et al (1990) reported 23 cases, all unilateral, of which 17 cases occurred in the left ovary (70%), 6 cases occurred in the right ovary, the literature reported 3% ~ 10% double Laterality, 10% is multiple.
Because most tumors are small (<4cm), they are often asymptomatic in clinical practice. When the tumor is large, abdominal enlargement, urinary symptoms and abdominal pain may occur. When the twist occurs, acute abdominal pain may occur, accounting for 5%, and ascites is more common. Common, tumor diameter > 5cm, 50% can be seen in the chest, ascites (Meig syndrome), but the typical McGon syndrome is only seen in 1% to 3% of cases, the chest after the tumor is removed, the peritoneal effusion can disappear Occasionally, symptoms associated with abnormal endocrine function, such as menstrual disorders, postmenopausal vaginal bleeding, infertility, etc., in 17 cases reported by Mancuso (1995), 47.18% of patients with lower abdominal pain, menstrual cycle changes and no Regular uterine bleeding accounted for 17.6%, and 5.9% had infertility. Michael (1966) reported a case of women with hypoglycemia, improved tumor resection, and hereditary basal cell nevus (Gorlin syndrome). There are more ovarian fibroids. These women's fibroids are often bilateral, and can also be malignant or relapse. Chen Zhongnian et al (1996) believe that the malignant rate of ovarian fibroids is 1% to 3%.
2. Multicellular fibroma
The main clinical manifestations are pelvic masses and/or abdominal pain, and there are many no adhesions and ruptures in the tumor.
3. Primary ovarian fibrosarcoma
Kraemer (1984) and others reported a case of sputum-like basal cell carcinoma, which is often seen in patients with abdominal pain and/or pelvic masses.
4. Ovarian primary myxoma
No special symptoms, more pelvic masses found during physical examination, may be associated with abdominal pain, mostly unilateral attachment mass, and the contralateral attachment is normal.
Examine
Examination of ovarian fibrous tissue-derived tumors
Laboratory examination
Immunohistochemical examination, tumor marker examination.
2. Other inspections
Histopathological examination, laparoscopy.
Diagnosis
Diagnostic diagnosis of ovarian fibrous tissue derived from tumor
Preoperative diagnosis of ovarian fibroma is not difficult, elderly women, pelvic solid mass, smooth activity, hard texture, should consider the possibility of ovarian fibroids, multicellular fibroma, primary ovarian fibrosarcoma, ovarian The diagnosis of myxoma can be diagnosed by clinical manifestations, histopathological examination, and immunohistochemical examination.
Differential diagnosis
1. Ovarian fibroma should be distinguished from follicular cell tumor, adenoma, cystic fibroma and fibroepithelial neoplasia. Lack of adipose tissue can be used to identify fibroids and follicular cell tumors, but it cannot be used to distinguish fibroids and Follicular fibroblastoma, these two types of tumors are often not very satisfactory, ovarian severe edema and fibroid-like disease (also often severe edema, and involving the entire ovary) can be confused with edema fibroids, should be identified, Patients with chest and peritoneal effusion should be distinguished from ovarian malignant tumors to avoid misdiagnosis. Perry et al (1996) reported that a 68-year-old breast cancer patient developed breast cancer ovarian fibroma metastasis. rare.
2. Ovarian multicellular fibroma and fibrosarcoma Summary 11 cases and 6 cases of ovarian fibrosarcoma reported by Prat and Scully, the main differences between the two are shown in Table 1.
3. Primary fibrosarcoma Ovarian fibrosarcoma should be differentiated from multicellular fibroids. Although differentiated fibrosarcoma is difficult to distinguish, mitotic figures are a good indicator of differentiation. Usually, fibrosarcoma nucleus is divided into 4 /10HPF.
4. Ovarian primary myxoma should be identified with the following diseases:
(1) fibroids with mucoid degeneration: certain areas of the disease contain normal fibrous tissue.
(2) severe edema of the ovary: the patient is often younger, the follicles at all levels are visible in the lesion, and the ovarian mucinoma is invisible.
(3) myxomatous liposarcoma (myxomatous liposarcoma): the tumor contains fat, blood vessel formation is more common, at least in some areas containing fat mother cells.
(4) Mucinous cystadenoma and mucinous cystadenocarcinoma: including primary and metastatic, these tumors contain epithelial cells, which can show glandular differentiation, no stellate and fusiform cells.
(5) Embryonic rhabdomyosarcoma (embryonal rhabdomyosarcoma): The tumor has uneven appearance, large cells, obvious cell abnormality, including rhabdomyoblasts, in addition, muscle fiber immunohistochemical staining, actin and knot of embryonic rhabdomyosarcoma Protein positive, Z band formation can be seen in the ultrastructure.
