duodenal leiomyosarcoma
Introduction
Introduction to duodenal leiomyosarcoma Duodenal leiomyosarcoma is a myometrial tumor originating from the muscular layer of the duodenal mucosa or the muscularis propria, or the wall of the intestinal wall. According to its histological features, it is divided into leiomyoma and leiomyosarcoma. ) and epithelioid leiomyoma (smooth muscle myoma) leiomyoblastoma, the latter rare. There is no significant difference in the expression of leiomyomas and leiomyosarcoma, and it is difficult to distinguish their properties from a general view, so they are often discussed together in clinical practice. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: gastrointestinal bleeding
Cause
Causes of duodenal leiomyosarcoma
1. Pathological classification:
According to the growth pattern of duodenal leiomyosarcoma, the pathological types can be divided into 4 types: extraluminal, intraluminal, intraluminal and interluminal, and leiomyosarcoma is mainly found in extraluminal and intraluminal.
2. Pathological morphology:
The tumor is mostly single, occasionally multiple, the tumor is nodular, the perimeter is clear, no fibrous envelope, the cut surface is grayish white, the texture is soft, the capsule can be formed when the tumor is hemorrhage, and the cyst often has sinus It is connected with the intestinal lumen. Microscopic examination shows that the tumor is composed of poorly differentiated smooth muscle cells. The tumor cells are medium-density or high-density, rhomboid or irregular. The tumor cells are large and deeply stained, and they are heteromorphic and polymorphic. Elephant enlargement is a hallmark of leiomyosarcoma, and more than half of them see peritumoral invasion.
3. Pathological diagnosis criteria:
There is no uniform standard for distinguishing between benign and malignant tumors. It is generally considered that tumors larger than 10 cm in diameter or have metastasis can be diagnosed as sarcoma; diameters larger than 8 cm, brittle, blood supply is abundant, sarcoma is likely to be large, and intraoperative rapid section pathological examination is sometimes difficult To correctly determine the good and malignant, the number of mitotic figures should be observed by paraffin section as the main basis for diagnosis. 1The mitotic image is more malignant in each high-power field. 2The mitotic image exceeds every 10 high-power fields. 5 were sarcomas; 3 nucleus splits in 1 to 5 of 25 high-power fields were low-grade, more than 5 were sarcomas; 4 had atypical mitotic figures, and the pleomorphic and staining depth of the nucleus was The basic characteristics of sarcoma; 5 nucleus splitting number 4 per 25 high power microscope fields, more than 20% of round nucleus is sarcoma.
4. Malignant transformation and transfer:
It is unclear whether leiomyomas can be malignant. In the past, epithelioid leiomyoma is a benign tumor with a malignant tendency. It is believed that this type of tumor is benign and malignant, with less malignancy. The latter is multi-directional liver metastasis or peritoneal implantation. , leiomyosarcoma multi-directional liver metastasis or abdominal tumor bed planting, few lymphatic metastasis.
Prevention
Duodenal leiomyosarcoma prevention
1. Calcium supplementation can help prevent benign tumors in the intestine: Studies have shown that those who replenish calcium tablets every day have a 19-34% reduction in the risk of recurrence of intestinal polyps. Calcium-rich foods include milk and other dairy products, as well as broccoli. In addition, vitamin D (which helps the body's absorption of calcium) also shows a reduced risk of colorectal cancer.
2, fruits, vegetables and whole grains help prevent intestinal benign tumors: these foods are rich in cellulose, which can reduce the risk of intestinal polyps. In addition, fruits and vegetables are also rich in antioxidants that can prevent intestinal cancer.
3, no smoking, drinking can prevent intestinal benign tumors: smoking, excessive drinking will increase the risk of intestinal polyps and intestinal cancer. Women should not drink more than 150 ml of wine per day, or 360 ml of beer, or 40 ml of white wine, while men should not exceed twice as many as women. If you have a family history of bowel cancer, you should especially reduce smoking and drinking to reduce the risk.
4, adhere to physical exercise, maintain a healthy weight: weight control can independently reduce the risk of intestinal disease. It is recommended to exercise at least 30 minutes each time, five times a week. If you have 45 minutes of moderate-intensity exercise every day, it will work better in reducing the risk of bowel cancer.
5, have a good attitude to deal with stress, work and rest, do not fatigue. Visible pressure is an important cause of cancer. Chinese medicine believes that stress leads to excessive physical weakness, which leads to decreased immune function, endocrine disorders, metabolic disorders in the body, leading to the deposition of acidic substances in the body. Stress can also lead to mental stress causing qi stagnation and blood stasis. Invagination and so on.
6, do not eat contaminated food, such as contaminated water, crops, poultry fish eggs, moldy food, etc., to eat some green organic food, to prevent disease from mouth.
Complication
Duodenal leiomyosarcoma complications Complications, gastrointestinal bleeding
Sudden or intermittent bleeding.
Symptom
Duodenal leiomyosarcoma Symptoms Common symptoms Abdominal mass
Symptoms and signs of duodenal smooth muscle tumors are similar to other duodenal and malignant tumors, but hemorrhage and abdominal masses are more prominent. The incidence of statistical sarcoma is about 80%, and the fibroids are about 50. %, can be a small amount, continuous or intermittent major bleeding, bleeding or not and the degree of bleeding is not directly related to tumor size, the mass is mostly in the right upper abdomen, the surface is smooth, hard or sac sexy, poor mobility, individual mass can be touched in the right lower abdomen .
Examine
Examination of duodenal leiomyosarcoma
X-ray barium meal angiography
X-ray images vary depending on the tumor growth pattern and size. Endoluminal tumors can be characterized by smooth surface and clear filling defects. For example, ulcers are formed in the filling defect; extraluminal tumors are seen in the duodenum. Under pressure, the mucosal folds are disordered; if the tumor collapses and the intestine is connected, there is a huge diverticulum sign.
2. Duodenal endoscopy
Visible changes in the external pressure of the intestinal wall or submucosal uplift, mucosal erosion, duodenal descending lesions are easily missed, biopsy is also difficult to obtain due to limited diagnosis, to confirm the diagnosis.
3. CT examination
There is a clear and substantial mass in the duodenum. If there is contrast contrast agent and gas in the tumor, it is more helpful for diagnosis. The enhanced scan is a medium blood supply or blood supply. The tumor should be with the head of the pancreas. Tumor identification.
Diagnosis
Diagnosis and differentiation of duodenal leiomyosarcoma
The clinical symptoms and signs of duodenal smooth muscle tumors lack specificity, and it is necessary to confirm the diagnosis by gastrointestinal barium meal examination and histological examination.
Clinical needs to be differentiated from pancreatic head cancer.
