Gastrointestinal cancer metastases to ovary
Introduction
Brief introduction of gastrointestinal tract metastasis Ovarian metastatic tumors are most common in gastric cancer metastasis to the ovary, accounting for 67% of ovarian metastatic tumors and 5.4% of ovarian malignant tumors. It accounted for 1.3% of all ovarian tumors. It was first reported by Krukenberg (1896). Since then, Kukenberg has been used as a synonym for ovarian metastasis. Some people have called ovarian metastases originating from the digestive tract as Kukenboma. There is a lot of confusion in concept. In fact, the mucus cells containing mucin and small peripheral nucleus, the Kukenbo tumor of the signet ring cell, are only an important type of ovarian metastasis, which can not represent various metastases from the digestive tract, and can not represent all A variety of metastatic ovarian tumors. basic knowledge The proportion of illness: 0.005% - 0.008% Susceptible people: women Mode of infection: non-infectious Complications: tubal adhesions
Cause
Gastrointestinal cancer metastasis ovarian cause
(1) Causes of the disease
Most of our Kukenbo tumors originate from the stomach, mainly explained by the strong function, and the blood supply-rich ovaries are more suitable for the growth of metastatic tumors.
(two) pathogenesis
General form
Gastric cancer metastasizes to the ovary, the ovary generally maintains the original shape, is kidney-shaped or oval, smooth surface, no adhesion, common nodular bulge, intact but thin, often gray-yellow or light brown, shiny, tumor The size ranges from 3cm×3cm×3cm to 30cm×26cm×20cm. The bilateral side accounts for the vast majority. It can also be seen on one side. The cut surface is white, the tumor is basically substantial, medium hardness, translucent gelatinous, tumor. There are necrosis, hemorrhage and cystic changes, forming a small cystic cavity of varying size, which contains mucus or bloody fluid. The whole tumor is cystic.
2. Under the microscope
Microscopic performance is diverse, but the basic structure of each part is still typical. The tumor cells are mucous cells, containing mucus, positive staining with PAS and mucus card red. The shape of the cells varies with mucus content, and the quality of the tumor varies. The structure is dense and loose, and the following main images are seen under the microscope:
(1) Signet ring cell structure: a large amount of mucus is produced in the cell, and excessive mucus pushes the cell nucleus to the edge of the cell, and the nucleus becomes slender, and the cell membrane is half-moon-shaped, such as a ring shape, which is a typical signet ring cell.
(2) Cable-like structure: the number of mucous cells varies, and they are scattered in the interstitial, aggregated into a pile, and arranged in a cable shape.
(3) Mucinous adenocarcinoma: mucous cells are small round, polygonal or irregular, cytoplasm rich, eosin staining, nuclear chromatin staining, alveolar in the interstitial.
Interstitial cells are aggregated or cross-shaped, surrounding the tumor cell population. There are time-like cells in the form of flaky hyperplasia. Because a large number of fusiform cells cover up the signet cells scattered in them, they are easily misdiagnosed as fibroids, mucus Fibroids, etc., if the interstitial cells are loose and have obvious edema, the nuclear staining is deep and irregular, it is easy to be misdiagnosed as sarcoma.
Prevention
Gastrointestinal cancer metastasis prevention
For female patients with gastrointestinal tumors, regular gynecological follow-up work should be done to prevent the occurrence and development of ovarian cancer metastasis, and active treatment should be carried out for follow-up work.
Complication
Gastrointestinal metastasis Complications tubal adhesions
Adhesion and infiltration.
Symptom
Gastrointestinal cancer metastasis ovarian symptoms common symptoms abdominal pain gastrointestinal symptoms vaginal bleeding bloating edema hypoproteinemia vaginal pelvic mass ascites
1. Childbearing situation
The fertility status reflects the best indicator of ovarian function. The vigorous fertility indicates normal ovarian function. Shi Yifu reported that a group of gastrointestinal metastases of ovarian cancer were born, no primary infertility, Beijing Union Medical College Hospital reported 82.1% For more than 2 births, the vast majority of patients have good fertility.
2. Symptom
Ovarian metastases are asymptomatic as other early ovarian cancers, often accompanied by some symptoms of primary lesions. The primary gastrointestinal tract may have abdominal pain, bloating, intestinal symptoms or weight loss; primary endometrial cancer Patients may have irregular vaginal bleeding or a history of increased vaginal discharge. The symptoms of secondary tumors are more prominent than those of primary tumors, and those with pelvic symptoms, especially abdominal pain and abdominal masses.
3. Ascites
There are many ascites in metastatic ovarian cancer. Interstitial edema and lymphatic tumor thrombus are often seen in pathological examination. It is estimated that lymphatic drainage obstruction and metastatic tumor exudate are the main causes of ascites. Some cases may have omentum. And the tissue of the peritoneal implant metastasis can also be caused by hypoproteinemia. Shi Yifu once reported that a group of 80% had ascites, ascites up to 9000ml, >500ml accounted for 60%, and ascites was yellow and bloody. More, also see a case of chyle-like ascites, half of the ascites can be found in the cytological examination of signet ring cells, ascites chromosome examination is also aneuploidy, both number and structural abnormalities.
4. Pelvic mass
Almost all cases can touch the abdominal mass, and the patients themselves touched a lot. The rest were diagnosed by doctors. It was found that some patients with ovarian enlargement or abdominal wall hypertrophy were difficult to find when they were pelvic examination, but if they were B-ultrasound, especially the vagina. B-ultrasound is not difficult to find.
The pelvic mass is more common in bilateral, accounting for 75%, the activity is still good, and a small number of adhesions due to adhesion, infiltration and poor mobility.
5. History of primary tumor
Only a part of patients with metastatic ovarian tumors have a history and symptoms of primary tumors, and then there are symptoms of ovarian metastases, but more patients have not paid attention to the symptoms of the primary lesions, so they are treated with metastatic tumor symptoms. Shi Yifu (1988) reported 48.6% of patients with history of gastric cancer, 13.5% of history of gastric ulcer, and 35.1% of history of stomach disease. More than 50% of patients had gastric or intestinal surgery outside the hospital, from stomach and colon cancer. After surgery, ovarian metastatic carcinoma was performed in 9 patients from 0.5 to 1 year, 5 patients in 1 to 2 years, 4 patients in 2 to 3 years, and 2 patients in >3 years. The history of primary tumors was also difficult to check.
Examine
Gastrointestinal cancer metastasis examination
1. ESR: Although non-specific, it also has a certain reference value.
2. Tumor marker examination: Carcinoembryonic antigen (CEA) measurement is also mostly increased.
3. Vaginal B-ultrasound examination.
4. CT examination.
Those with ascites can often find signet ring cells and check for chromosome number and structural abnormalities.
Diagnosis
Diagnostic diagnosis of gastrointestinal cancer metastasis
The preoperative diagnosis rate of ovarian metastatic tumors is not high, the reasons are: 1 long-term thought that such tumors are rare, less consideration before diagnosis, so easy to miss diagnosis or misdiagnosis; 2 unfamiliar with the clinical features of such tumors; 3 Patients often seek medical treatment after symptoms or signs of metastatic tumors, ignoring the symptoms and complaints of primary cancer; 4 medical staff sub-disciplinary treatment, are focused on and consider the undergraduate disease, so the preoperative diagnosis rate is not high, only 20% Left and right preoperative diagnosis of ovarian metastatic tumors.
Anyone who has bilateral, solid activity attachments, regardless of the presence or absence of ascites should consider the possibility of ovarian metastatic tumors, carefully question the past history of malignant tumors in the digestive tract, breast and other parts, combined with symptoms and signs Can improve the preoperative diagnosis rate.
In order to improve the diagnostic accuracy of ovarian metastases, especially those from gastrointestinal metastasis, Shi Yifu once proposed:
1. Where the internal and surgical treatment of female digestive tract diseases, especially for cancer patients, should be consulted by gynecology or routine pelvic examination.
2. For female gastrectomy, it is advisable to routinely explore the pelvic cavity, touch the pelvic tissue with your hand or clamp the uterine horn with a non-toothed egg-cone to peep into the pelvic cavity and ovary. If the lesion is suspected, it can be further treated for medical examination to avoid missed diagnosis.
3. When gynecological examination reveals bilateral solid tumors in the lower abdomen, ovarian metastatic tumors should be considered first. If the growth is rapid, the possibility is high. Those with gastrointestinal symptoms should consider the disease and further make gastrointestinal angiography. Gastroscopic or colonoscopy, as well as early detection of primary lesions.
4. Gynecological surgery found bilateral ovarian substantial tumors, should also routinely explore the gastrointestinal.
5. Women with a history of gastrointestinal tumor surgery should be followed up regularly for gynecological follow-up.
In short, both internal and external, gynaecologists should be highly vigilant, recognize the disease, and cooperate with each other, not only can reduce missed diagnosis, but also enable patients to get correct treatment in time, so that some patients are free from surgery, gynecological two operations, but also To understand the exact incidence of ovarian metastatic tumors, and actively prevent and treat primary gastrointestinal tumors in women, it is beneficial to reduce the occurrence of ovarian metastatic tumors and prolong survival in the future. Internal and external, gynecologists should prevent this disease from happening. Play a leading role.
It is sometimes not easy to find the primary cancer in the diagnosis process. In a few cases, even if the gastroscope, angiography or intraoperative exploration is used, there is no abnormal discovery, and the primary cancer cannot be found, but the primary disease is actively searched for the metastasis. Diagnosis, treatment planning and prognosis observations are all helpful.
Should pay attention to the identification of sarcoma.
