fallopian tube tumor
Introduction
Introduction to fallopian tube tumor Tubal cancer (tumoursofthefallopiantube) is rare, and benign and malignant are rare. There are many types of benign tumors of the fallopian tube, and adenomatoid tumors are relatively common. Others such as papilloma, hemangioma, non-slipoma, lipoma, etc. are extremely rare. Because the tumor is small, asymptomatic, difficult to diagnose before surgery, the prognosis is good. There are two kinds of primary and secondary malignant fallopian tubes, most of which are secondary cancers, accounting for 80-90% of oviduct malignant tumors. Most of the primary tumors are located in the ovary and uterus, and can also be contralateral fallopian tubes, cervical cancer, rectal cancer. Breast cancer, transferred. Mainly through lymphatic metastasis. Symptoms, signs, and treatment depend on the primary lesion and poor prognosis. basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious Complications: Tubal pregnancy
Cause
Tubal tumor cause
The cause is unknown. Infertility and less fertility may be the main pathogenic factors. Those with infertility in patients with fallopian tube cancer account for 30% to 60%. Inflammation may be the cause of its disease. Some people think that salpingitis may be only a concomitant lesion of fallopian tube cancer. 2/3 cases are unilateral, which occurs in the ampulla or umbrella. The lesions originate from the endometrium, and the serosal surface is rough. It often adheres to the surrounding tissues. The fallopian tubes swell and form water. The papillary tissue can be seen in the cavity. And turbid liquid, microscopic examination for adenocarcinoma.
pathology
1. Giant examination: The lesion is common in the ampulla, followed by the umbrella end. Most of them occur on one side, and both sides account for 10% to 26%. The early appearance of fallopian tube cancer can be normal, and it is often characterized by thickening of the fallopian tube, which is irregular or sausage-shaped. There is a cauliflower-like tissue or a necrotic mass in the lumen of the fallopian tube. The umbrella end of the fallopian tube is often closed with the surrounding adhesion, and there may be effusion, hemorrhage or empyema in the lumen.
2, microscopic examination: the vast majority of papillary adenocarcinoma, accounting for 90%, of which 50% are serous carcinoma, mostly poorly differentiated, other such as endometrial cancer, clear cell carcinoma, squamous cell carcinoma, acanthoma, squamous Cancer, mucinous cancer, etc. are rare. The histological classification of fallopian tube adenocarcinoma is divided into 3 grades: grade 1 is papillary type, with good differentiation, mainly nipple structure, low degree of malignancy; grade II is papillary acinar type, nipple structure still exists but cell differentiation is poor. The atypical form is obvious and there is a small acinar or glandular cavity formation; the grade III is an acinar medullary type, the cells are poorly differentiated, the degree of malignancy is high, and the mitotic phase is many, forming a solid flaky, nest-like, sometimes visible acinar structure.
Incidence factor
1, age
Benign tumors occur mostly in women at the reproductive stage. Malignant tumors occur mostly in older women. A small number of special types of tumors occur in adolescents and young women.
2. Fertility
The occurrence of some gynecological tumors is related to fertility, and its incidence is related to fertility factors such as premature delivery, close production, and prolificacy.
3. Sexual hygiene
Unclean sexual life can cause female reproductive organs infection, such as: vaginitis, cervicitis, cervical erosion, fallopian tube inflammation. They are an important cause of vulvar cancer, vaginal cancer, cervical cancer and fallopian tube cancer.
4, endocrine
Female reproductive organs are the main target organs of female hormones, and the occurrence of tumors is closely related to endocrine. Some women now use estrogen-free drugs, supplements and some beauty and skin care products without the guidance of a doctor. They deliberately or unknowingly increase the level of estrogen in the body. The long-term high level of estrogen stimulation is one of the pathogenesis factors of fallopian tube cancer and ovarian cancer.
5, bad lifestyle
Smoking, especially large amounts of smoking, may be one of the important causes of cervical cancer and fallopian tube cancer. According to epidemiological surveys, smoking women have a 2-fold higher risk of developing this disease than non-smoking women.
Prevention
Tubal cancer prevention
1, to avoid unclean sexual intercourse and improper sexual relations, active genital sores patients are absolutely prohibited from having sex with anyone.
2. Forbidden sexual intercourse during treatment, and the spouse should also be examined if necessary.
3. Care for local damage should be kept clean and dry to prevent secondary infection.
Complication
Tubal tumor complications Complications Tubal pregnancy
1. Fallopian tube gorge: Tubal tumor symptoms The fallopian tube gorge extends horizontally from the lateral uterine horn to the lower end of the ovary, accounting for about 1/3 of the total length of the fallopian tube. The fallopian tube tumor is connected to the fallopian tube uterus and the external fallopian tube pot. belly. This part is short and straight, and the wall thickness is narrow. Salpingitis is easy to cause occlusion of the isthmus and lead to infertility or ectopic pregnancy, which is a serious hazard of fallopian tube tumors.
2, fallopian tube funnel: fallopian tube tumor symptoms of the fallopian tube funnel first end of the fallopian tube, the tumor symptoms of the fallopian tube expanded into a funnel. In the center of the funnel, there is a mouth of the fallopian tube. When the muscle layer of the funnel is relaxed, the diameter of the mouth is 0.24-0.36 cm. The periphery of the funnel has a number of radially irregular protrusions called the fallopian tube umbrella. The inner surface of the fallopian tube umbrella is covered with mucosa. The longest one of the tumors of the fallopian tube is called the ovarian umbrella, which is connected to the surface of the ovary. The groove on the mucosa of the ovarian umbrella is deeper than that on the fallopian tube umbrella. Therefore, the symptoms of the fallopian tube tumor suggest that the ovarian umbrella may be the pathway that guides the egg into the abdominal cavity of the fallopian tube.
3, the fallopian tube ampulla: the fallopian tube ampulla continues at the outer end of the fallopian tube gorge, the fallopian tube tumor symptoms are the longest fallopian tube, the thickest section of the tube. Its length is 3.47-4.13cm, accounting for about 2/3 of the total length of the fallopian tube, and the diameter is 0.37-0.47cm. The abdomen of the fallopian tube is "S" curved. From the lower end of the ovary to the outer end of the isthmus of the fallopian tube, first outward, then bend upward, along the anterior edge of the ovary, the tumor of the fallopian tube to the upper end of the ovary, then bend backward and move to the funnel. The ampulla is the place where the egg is fertilized. If the fertilized egg is implanted in this part, the tubal pregnancy is formed.
Symptom
Tubal tumor symptoms Common symptoms Lower abdominal mass abdominal pain Vaginal irregular bleeding Vaginal drainage is black watery ascites
Early primary fallopian tube cancer is both "hidden" and "squat", and the symptoms are not typical. The early symptoms of fallopian tube tumors are mainly manifested by vaginal fluid discharge, mild abdominal pain, and when the tumor grows to a certain extent, the abdominal pack can be found to be fast. If the vagina has a large amount of watery excrement, hemorrhage, abdominal pain, the condition has often developed to the middle and late stage; if the cancer cells are widely metastasized, the liquid in the vagina will be cloudy and odorous, and there may be dangers such as poor urination or intestinal obstruction.
Tubal tumor symptoms
More asymptomatic in the early stage, easy to be ignored or delayed diagnosis. With the development of the disease, the clinical manifestations of vaginal discharge, abdominal pain and pelvic mass, called the "triple syndrome" of fallopian tube cancer. However, less than 15% of patients have this typical "triple sign."
(A) vaginal discharge: about 50% of patients have vaginal discharge, a yellow watery liquid, generally no odor, the amount is different, often intermittent. This is the most specific symptom of this disease.
(B) vaginal bleeding: more in the middle of menstruation or after menopause, irregular irregular bleeding, curettage is often negative.
(C) abdominal pain: generally for the affected side of the lower abdomen dull pain, caused by tubal enlargement. Sometimes it is paroxysmal colic, which is caused by spasm contraction of the oviduct. After a large amount of fluid is not discharged from the vagina, the pain is relieved, and a few cases of severe abdominal pain are caused by complications.
(D) lower abdominal mass: gynecological examination can often touch one or both sides of the fallopian tube thickening or mass. The quality is both sexy and has a sausage-like shape or irregular shape. It has light tenderness and activities are often limited. The mass is reduced after drainage. After the liquid is accumulated, it increases again.
(5) Ascites: Less common, the incidence rate is about 10%, showing a pale yellow or bloody.
(6) Others: Increased tumor compression or involvement of surrounding organs can cause abdominal distension, frequent urination, urgency, etc., and late stage dyscrasia.
Tubal tumor classification
First, the benign tumor of the fallopian tube: There are many types of benign tumors of the fallopian tube. The adenoma-like tumor is relatively common. Others include leiomyoma, papilloma and teratoma. Due to the lack of typical symptoms and signs, it is difficult to confirm the diagnosis before surgery, often found in basin and abdominal surgery. The treatment is tumor resection or ipsilateral salpingectomy. The prognosis is good. However, papilloma and teratoma can be malignant, if suspicious, intraoperative frozen section pathological examination.
Second, primary fallopian tube cancer: Primary fallopian tube cancer is a rare gynecological malignant tumor, accounting for about 0.5% of female genital malignant tumors. The peak age of onset is 52 to 57 years old. Vaginal drainage is the most common symptom, often accompanied by pelvic or lower abdominal pain and pelvic mass. The biological characteristics and treatment of fallopian tube cancer are similar to those of ovarian cancer.
Examine
Tubal tumor examination
ordinary inspection
(1) cytological examination: vaginal exfoliative cytology to find atypical glandular epithelial ciliated cells, suggesting the possibility of fallopian tube cancer. Positive patients should be treated with a segmental diagnosis to exclude endometrial cancer and cervical cancer. If the cytology test is positive and the diagnostic curettage is negative, it may be fallopian tube cancer. Malignant cells can be found in ascites or peritoneal washes when the tumor penetrates the serosa layer or has a pelvic cavity.
(2) endometrial examination: endometrial cancer, uterine submucosal fibroids patients often have vaginal fluid, in order to exclude the above diseases need to be diagnosed by segmentation, fallopian tube cancer patients are often negative for diagnostic curettage, accompanied by intrauterine Except for transfer.
(3) imaging examination: B-mode ultrasound, CT, MRl, etc. contribute to preoperative diagnosis and staging, can determine the location, size, nature of the mass and the presence or absence of ascites.
(4) Determination of serum CAl25: can be used as an important reference for the diagnosis and prognosis of fallopian tube cancer, but no specificity.
(5) Laparoscopy: Laparoscopy can directly observe the fallopian tube and ovary, which is helpful for the diagnosis of fallopian tube cancer. At the same time, the peritoneal fluid can be taken for cytological examination.
Pathological diagnostic criteria:
1 The tumor is derived from the endometrium of the fallopian tube; the microscope is mainly affected by the mucosa of the fallopian tube and has a papillary structure;
2 histological type is oviduct mucosal epithelium;
3 visible from benign to malignant metamorphic areas;
4 ovarian and endometrial normal or similar to the pathological morphology of fallopian tube cancer, but the tumor volume must be smaller than the fallopian tube tumor.
Diagnosis
Diagnosis and diagnosis of fallopian tube tumor
diagnosis
The medical history often has a history of primary or secondary infertility. The preoperative diagnosis rate ranged from 2-35%. Therefore, women who experience intermittent vaginal discharge symptoms should have the possibility of exporting ductal carcinoma. A clinical diagnosis can be made when the symptoms of drainage are closely related to abdominal pain and abdominal mass.
Vaginal cytology to assist diagnosis, such as atypical glandular epithelial ciliated cells, suggesting the possibility of ductal carcinoma. If cancer cells are found, cervical cancer and endometrial cancer are excluded by segmental diagnostic curettage, and intrauterine aspiration is performed. Ultrasound and laparoscopy are helpful for diagnosis.
Differential diagnosis
Tubal cancer and ovarian tumors, fallopian tube ovarian cysts are not easy to identify, if suspicious, it should be diagnosed early and early.
