primary peritoneal carcinoma
Introduction
Introduction to primary peritoneal cancer Primary peritoneal carcinoma (PPC) refers to a malignant tumor that originates in the peritoneal mesothelial, showing multifocal growth and is rare in clinical practice. The histological features were consistent with the same type of tumor that was originally differentiated from the ovary, while the ovaries were normal or only superficially involved. The disease was first reported by Swerdlow in 1959 as "pelvic peritoneal mesothelioma resembles ovarian papillary cystadenocarcinoma" but has not received much attention. In 1977, Kannerstein reported 15 cases, first named "primary peritoneal papillary serous carcinoma", clearly distinguishing this disease from peritoneal malignant mesothelioma. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain, bloating
Cause
Primary peritoneal cancer
Cause of the disease (25%):
The cause of the disease is unknown, and the source of the tissue is still controversial. There are two theories: the ovarian tissue malignant from the embryonic migration path; the peritoneal epithelium and the ovarian epithelium originate from the same embryonic lobes, all from the embryonic body cavity epithelium (Embryonal Coelomic Epithelium) ), with the potential of the Mullerian tube differentiation trend, known as the Second Müllerian system, will be cancerous after a certain cancer-causing stimulus.
Pathogenesis (20%):
Because the peritoneum and Mullerian tube have a common source of embryos, and the female reproductive system is derived from the embryonic Müllerian tube, when a certain factor causes a primary peritoneal tumor, its tissue structure is consistent with that of the female Müllerian tube. However, the surface of the ovary is not infiltrated or only has a slight surface infiltration. Therefore, it is believed that this type of tumor of the female peritoneum origin is a tumor originating from the "second Müllerian system" and is an independent disease different from ovarian cancer. Because peritoneal serous adenocarcinoma accounts for the vast majority of primary tumors of the peritoneum, so-called female Müllerian tumors mainly refer to serous adenocarcinoma that occurs in the peritoneum, that is, extraovarian peritoneal serous papillary carcinoma.
Prevention
Primary peritoneal cancer prevention
Regular physical examination, early detection and early treatment. Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
Complication
Primary peritoneal cancer complications Complications, abdominal pain, bloating
A small number of patients have pleural effusion, and systemic symptoms such as weight loss and cachexia can occur in the advanced stage.
Symptom
Primary peritoneal cancer symptoms Common symptoms Abdominal pain Abdominal ascites Diffuse abdominal ossification Abdominal mass swelling sensation Nodular abdomen enlargement
The onset is slow and insidious. There are many symptoms in the early stage. When the tumor grows to a certain size or affects other organs, clinical symptoms appear. Abdominal pain, abdominal distension, and abdominal circumference increase are the three most common symptoms. The abdominal pain is not severe and the abdomen is only felt. Suffering or discomfort, the main signs are abdominal mass and ascites, abdominal mass is often large, the boundary is unclear, ascites grows rapidly, mostly bloody.
Examine
Primary peritoneal cancer examination
1. Cytological examination : laparoscopic puncture or retroperitoneal iliac puncture for ascites for cytological examination, malignant tumors are often positive.
2. Peritoneal biopsy : Peritoneal biopsy is of great value in the diagnosis of peritoneal tumors. Laparoscopic direct biopsy can be performed, and peritoneal biopsy can be performed by laparotomy.
3. Immunohistochemistry : immunohistochemical features similar to ovarian serous carcinoma, mucin determination and Schiff's periodic acid staining were positive, no hyaluronic acid was produced, Wick et al. measured immunohistochemical index of peritoneal serous carcinoma, monoclonal angle Protein, epithelial membrane antigen, CA125 antigen, LeuM1, B72.3 antigen, carcinoembryonic antigen, amylase, LN1, LN2, MB2, S-100 protein and placental alkaline phosphatase were positive, Zhou et al reported all cases of EMA Positive for S-100 protein, 75% for CAl25, 88% for CD15, and 38% for placental alkaline phosphatase.
4. B-ultrasound : The main examination relied on diagnosis, which can indicate the location, size, shape and nature of the tumor, and help to identify ovarian cancer and peritoneal cancer.
5. CT examination : can clearly show the mass, ascites, lymph node metastasis.
6. Laparoscopy : You can clearly see the nature, size, location and presence or absence of abdominal cavity dissemination, and can absorb abdominal fluid and biopsy to do the corresponding examination.
Diagnosis
Diagnosis and diagnosis of primary peritoneal cancer
Diagnostic criteria
Because of the non-specific diagnosis method, the preoperative misdiagnosis rate is high, until the intraperitoneal extensive tumor nodules are seen during surgery, and the normal or superficial invaders of the ovary are diagnosed. The diagnosis depends mainly on B-ultrasound, CT, ascites cytology. The diagnosis must be performed by exploratory laparotomy for peritoneal biopsy.
1. American Gynecologic Oncology Group (GOG) Diagnostic criteria for primary peritoneal cancer:
(1) The ovaries on both sides must be of normal physiological size or increased due to benign lesions.
(2) The lesion volume outside the ovary must be larger than the bilateral ovarian involvement lesion.
(3) There must be one of the following findings in the ovarian lesions:
1 ovary has no lesions;
2 The tumor is limited to the surface of the ovary without interstitial infiltration;
3 ovarian surface involvement and interstitial involvement, interstitial involvement must be within 5mm × 5mm;
4 The histological and cytological features of the tumor must be serous, similar or identical to ovarian serous papillary adenocarcinoma, and the degree of differentiation varies.
2. Diagnostic criteria for primary primary peritoneal cancer in China (, 1988)
(1) There are localized tumors in the peritoneum scattered in the nodules and/or in the abdominal cavity, especially in the pelvis.
(2) The bilateral ovaries (including the fallopian tubes) are normal, or have only loose miliary nodules on the surface that are easily stripped.
(3) There is no primary cancer in the internal organs of the gastrointestinal tract, liver, and pancreas.
(4) There is no ectopic ovarian or residual renal cancer in the middle kidney.
Differential diagnosis
1. Abdominal tuberculosis: Serum CA125 is a common antigen derived from various tissues of the body cavity epithelium. Preoperative examination of serum CA125 is helpful in identifying abdominal tuberculosis.
2. Peritoneal metastasis of ovarian cancer: The main difference between the two is that there is no tumor infiltration in the bilateral ovarian parenchyma of PPC. Immunohistochemistry does not help the differentiation of ovarian epithelial cancer.
3. Diffuse peritoneal malignant mesothelioma: Symptoms, signs, and disease levels are similar, mostly in men, with a history of asbestos exposure, mesothelioma cells have an active function of producing hyaluronic acid, measuring serum or ascites The level of hyaluronic acid is helpful for differential diagnosis. The level of CA125 is generally not elevated. Under light microscopy, the tumor cells are polygonal or cubic, the cytoplasm is eosinophilic, no sand, no neutral mucus, D-pas. Negative, ozrin blue staining positive, negative staining after hyaluronidase digestion, carcinoembryonic antigen more negative, S-100, placental alkaline phosphatase, CA125, CD15 also help to identify, such as S-100 protein or concurrent Alkaline phosphatase or B72.3 positive can exclude peritoneal malignant mesothelioma, electron microscopically visible slender, hair-like microvilli.
