Pediatric Ewing Sarcoma
Introduction
Introduction to pediatric Ein sarcoma At present, most scholars believe that Ewingssarcoma includes Ewing's tumor of bone (formerly known as Ewing's sarcoma), extra-osseous Ewing tumor, namely neuroectodermal tumor (neuroepithelial neoplasm) and Askin tumor (malignant small cell of thoracic lung). Tumor), immunohistochemical labeling, cell formation and tissue culture studies showed that all three types of tumors originated from primitive stem cells, ranking second in primary malignant bone tumors in children. The age of good hair is 10 to 15 years old. Children under the age of 5 are often diagnosed with neuroblastoma, which is more common in boys than in girls. The most common sites are the tibia, femur, tibia, fibula and tibia. When the long tubular bone is invaded, it often occurs in the backbone. Occurs in the ribs, shoulder blades, clavicle and vertebral bodies. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: anemia
Cause
Pediatric Ein sarcoma cause
Causes
Undifferent reticulocyte sarcoma, which evolved from Ewing tumor-bearing mesenchymal scaffold cells, originated from primitive stem cells.
Pathogenesis:
The naked eye sees the tumor as a gray-white soft mass in the medullary cavity. The tumor often has necrotic liquefaction and hemorrhage. The size of the tumor is larger than that of the X-ray photograph. Therefore, the radiotherapy should emphasize the total length of the diseased bone and the destruction of the tumor tissue. The diseased bone and the epicardium are exposed and have many perforations. Therefore, the soft tissue tumor is often larger than the primary tumor of the medullary cavity. When the tibia is involved, the soft tissue mass protrudes into the pelvis and even into the abdominal cavity.
Histological examination showed dense multi-faceted small polyhedron or oval cells, shallow cytoplasm, unclear cell membrane boundary, dark nuclear color, uniform size, round or oval, with chromosomes, occasionally chrysanthemum Or a pseudo-purple group, this cytology is like a neuroblastoma or a malignant lymphoma.
Because of the extensive diagnosis of necrosis and degenerative changes, each time the biopsy results can not help to confirm the diagnosis, bleeding will make people think of whether the tumor is secondary to infection, or even mistaken for infection.
Ewing's sarcoma does not contain reticular fibers. Another histochemical chemistry of this disease is the presence of glycogen in the cells. Histological manifestations and electron microscopy also have characteristics, such as the presence of glycogen granules in the cells. Conversely, reticular cell sarcomas The cells contain no glycogen.
Prevention
Pediatric Ein sarcoma prevention
1. Avoid harmful substances (promoting factors)
It is able to help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors
Can help to strengthen and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100u of vitamin E. It can be inferred that the antioxidant effect in fruits and vegetables is far better than what we know. The effect of vitamins is strong, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric Ein sarcoma complications Complications anemia
The tumor is a gray-white soft mass in the medullary cavity, and there are often necrotic liquefaction and hemorrhage areas in the tumor. The size of the tumor is larger than that shown by the X-ray photograph. Therefore, the emphasis should be placed on the total length of the diseased bone during radiotherapy. The tumor tissue destroys the diseased bone, and the epicardium is lifted up and has many perforations. Therefore, soft tissue tumors are often larger than the primary tumor of the medullary cavity. When the humerus is involved, the soft tissue mass protrudes into the pelvis and even into the abdominal cavity. Common complications include limited movement, and there may be dysfunction of the stool and secondary anemia when the lesion is invaded into the pelvic cavity.
Symptom
Children with Ein sarcoma symptoms Common symptoms ESR increased neuralgia tumor block compression pleural effusion
Symptom
The prominent complaint is local pain. Other symptoms depend on the location of the lesion. When the ribs are involved, there will be pleural effusion. When the long tubular bone is involved, the adjacent joints tend to have a certain degree of motion limitation. If the lumbar spine has lesions, it will affect the nerve trunk. Sciatica is weak and weak, and pelvic lesions may cause dysfunction when invading the pelvic cavity.
2. Physical examination
It can touch the mass and tenderness. If the tumor is larger than the tumor shadow on the X-ray film during the physical examination, it indicates that the tumor has penetrated the cortical bone and formed a soft tissue tumor. The lesions invading the pelvis account for about half. If the bone and the ischial bone are involved, the rectal finger An irregular spherical mass can be found in the diagnosis. The humeral lesion can reach the mass in the lower abdomen or groin.
Children often have irregular fever, secondary anemia, increased white blood cells and increased erythrocyte sedimentation rate.
Examine
Examination of pediatric Ein sarcoma
Histological changes: tumor cells of the same size, tightly arranged, less cytoplasm, lightly stained, unclear cell boundaries, nuclear round or oval, 2 to 3 times more lymphocytes, fine chromatin, less obvious nucleoli There are a few split images, few interstitial cells, no reticular fibers, often significant bleeding and necrosis, arranged in a pseudo-Chrysanthemum-like structure, positive for PAS staining of tumor cells, not resistant to amylase digestion, confirmed by SEM in cytoplasm Contains a large amount of glycogen, no neurosecretory granules, immunohistochemical vimentin Vimentin, HBA-71 and 0-13 positive.
The X-ray film is characterized by the sparse bone of the cancellous bone and cortical bone of the affected area, indicating the destruction of the bone, the bone of the lesion is slightly expanded, and the new bone is often multi-layered after the epithelium is picked up. Onion skin-like, but this phenomenon is not unique to Ewing's tumor. There are often soft tissue tumor shadows around the bone destruction, indicating that the tumor has penetrated the cortical bone and appears in the soft tissue. The lesion of the long tubular bone is mostly located in the backbone. A wide range, pathological fractures are rare.
Diagnosis
Diagnosis and diagnosis of pediatric Ein sarcoma
diagnosis
Before biopsy, X-ray and chest radiographs should be taken first, and intravenous pyelography and bone marrow puncture should be performed. The final diagnosis should be confirmed by surgical biopsy. The tissue taken by biopsy should be sufficient, and sometimes the X-ray photo should be used to check the biopsy. Whether the specimen is correct or not, frozen slices are sometimes helpful.
Differential diagnosis
For the differential diagnosis of this disease, should consider eosinophilic granuloma, reticulum sarcoma, malignant lymphoma, osteolytic osteosarcoma, metastatic neuroblastoma and leukemia, and this disease should also be differentiated from osteomyelitis, tumor The degenerative changes are similar to purulent secretions, and the images of X-ray films are also easily confused with osteomyelitis.
