adenocarcinoma
Introduction
Introduction to adenocarcinoma Adenocarcinoma is a malignant tumor of the parotid epithelium with different structures but no residual pleomorphic adenoma. Adenocarcinoma accounts for 9% of parotid epithelial tumors and belongs to a higher degree of malignancy in parotid malignant tumors. Adenocarcinoma is a glandular epithelial malignancy that can have acinar, nipple, bronchiole alveolar or solid growth. It is often accompanied by mucus production, which requires special staining to detect mucus, especially in poorly differentiated tumors. The detection of mucus can sometimes identify solid adenocarcinomas as large cell carcinomas with other morphological manifestations. Because adenocarcinoma is invasive, it should be extensively removed. The rate of lymph node metastasis of adenocarcinoma is high, which can be as high as 36% to 47%. Radical or selective neck dissection should be performed at the same time as resection of the primary tumor. For the treatment of facial nerves, it is necessary to sacrifice the facial nerve for complete tumor resection, regardless of whether or not facial nerve spasm occurs. Frozen histopathological sections should be used during surgery to check for residual tumor cells at the surgical margin. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: lung cancer
Cause
Adenocarcinoma etiology
Environmental factors (45%):
The body is exposed to environmental pollution, chemical pollution (chemical toxins), ionizing radiation, free radical toxins, microorganisms (bacteria, fungi, viruses, etc.) and their metabolic toxins. It has a direct relationship with the working environment and living environment.
Body factor (35%):
Genetic properties, endocrine imbalance, immune dysfunction, and other carcinogens and carcinogenic factors result in canceration of normal cells in the body.
Often expressed as: a local mass formed by abnormal proliferation of local tissue cells. Cancer is a large class of diseases caused by multiple, multi-stage and multiple mutations in normal cells.
Pathological change
(A) General form: The tumor is round or oval, most of which are non-enveloped but incomplete. The texture is medium hardness and the cut surface is grayish white.
(B) microscopic examination: tumor cells are distinctly shaped and have different structures. Some are solid clumps or small strips, some of which can be seen as glandular cavities, some in a tubular or adenoid structure. It is generally considered that those with a glandular structure have a higher degree of differentiation and a lower degree of malignancy. The connective tissue between the small strips and the small masses is uncertain. Many of them are similar to hard cancers. The interstitial is small and the cancer cells are called soft cancer.
(3) Biological characteristics: Adenocarcinoma has high infiltration and destructive growth characteristics. Adenocarcinoma is easy to invade blood vessels and lymphatic wall, and there are more blood and lymphatic metastasis.
Seen by the naked eye
Adenocarcinoma is mostly located in the periphery of the lungs with clear boundaries. Related fibrosis and pleural shrinkage can also be seen. The tumor can pass through the pleura to reach the chest wall. Whether the tumor penetrates the pleura is important in clinical staging and may require elastic fiber staining to confirm. The tumor was grayish white and showed bleeding and necrosis. If the tumor produces a certain amount of mucus, the exposed area can be seen in the shiny area or the mucus-like area. These peripheral tumors are often unrelated to the bronchus, but malignant pleural effusions often occur. For this reason, the adenocarcinoma in the specimens is significantly less than that of squamous cell carcinoma.
Seen under the microscope
Common bronchial adenocarcinomas form a glandular structure, and tumors can be mixed by well-differentiated and poorly differentiated components. Intracellular mucus needs to be confirmed by special staining of mucus card stain or PAS staining. In addition, papillary or small tubular structures can also be seen, and adenocarcinomas can also have unusual structures: clear cells, signet cells, and spindle cells. Pathological adenocarcinoma must be differentiated from mesothelioma. This is difficult for cytological specimens and requires other complementary methods to help with accurate typing.
Adenocarcinoma cells are more consistent than squamous cell carcinoma or large cell carcinoma. The cells are larger, the nucleus is larger, the ratio of nucleoplasm is higher, and there is obvious eosinophilic nucleoli. A vacuole is visible in the cytoplasm, indicating the presence of mucus. Unlike squamous cell carcinoma, the boundaries of cells are unclear. There are three levels of histological grades: well-differentiated, moderately differentiated, or poorly differentiated, most of which are moderately differentiated. Adenocarcinoma generally does not require immunohistochemistry to confirm the diagnosis, but immunohistochemistry is required to distinguish primary, metastatic or mesothelioma.
Prevention
Adenocarcinoma prevention
There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention.
Complication
Adenocarcinoma complications Complications
Lymph node metastasis occurs and malignant lesions are produced.
Symptom
Adenocarcinoma symptoms common symptoms cough, hemoptysis, bloodshot, chest tightness, ataxia, chest pain, dizziness
The appearance of adenocarcinoma in the morning and evening depends mainly on the location of the tumor. Adenocarcinoma often has intractable, irritating cough, bloody spots or a small amount of bloodshot, chest tingling or chest tightness and other symptoms. If the tumor is large, oppression may occur. Symptoms, ipsilateral diaphragmatic paralysis (oppression of the phrenic nerve), pleural qi dysfunction (invasion of the pleura), edema of the head, venous engorgement (compression of the superior vena cava), limb numbness, no sweat on the face, edema, drooping of the eyelids (branch plexus compression) ).
First, distant metastasis : the most common metastatic sites of adenocarcinoma are brain, bone, liver and adrenal gland. Intracranial hypertension and localization symptoms may occur in patients with brain metastases, including headache, vomiting, blurred vision, dizziness, weakness of one limb, and ataxia. Localized pain, fractures, and hypercalcemia can occur in patients with bone metastases. Patients with liver metastases may have anorexia, liver pain, hepatomegaly, jaundice and ascites. Adrenal metastasis may occur with high blood pressure, and may not have any symptoms. In addition, adenocarcinoma can also be transferred to the surface of the lymph nodes, the most common is bilateral supraclavicular lymph node metastasis, local mass can appear, but not painful, it is unintentionally found.
Second, cough: forty years old, no cause, intractable irritating cough, often an early aura of adenocarcinoma, especially the central type is more important, because the atmospheric tube is stimulated by cancer to cause spasmodic contraction As a result, central lung cancer has a much earlier disclosure of its precursor signals than peripheral lung cancer. Chest pain chest tingling is also an early signal, the nature of sharp tingling, more early in undifferentiated lung cancer.
Third, hemoptysis : for the early stage of central lung cancer, because the tracheal mucosa is rich in blood vessels, but the blood is very small, peripheral lung cancer is far from the trachea, hemoptysis appears generally late. Lung adenocarcinoma may have unexplained hypothermia, especially intermittent heat (reported to account for 70%), and those with the above symptoms should be taken seriously. Reporting symptoms of irritating cough, changes in cough in primary bronchitis, or intractable cough over time (effective for more than three weeks).
Examine
Adenocarcinoma examination
(A) General form: The tumor is round or oval, most of which are non-enveloped but incomplete. The texture is medium hardness and the cut surface is grayish white.
(B) microscopic examination: tumor cells are distinctly shaped and have different structures. Some are solid clumps or small strips, some of which can be seen as glandular cavities, some in a tubular or adenoid structure. It is generally considered that those with a glandular structure have a higher degree of differentiation and a lower degree of malignancy. The connective tissue between the small strips and the small masses is uncertain. Many of them are similar to hard cancers. The interstitial is small and the cancer cells are called soft cancer.
(3) Biological characteristics: Adenocarcinoma has high infiltration and destructive growth characteristics. Adenocarcinoma is easy to invade blood vessels and lymphatic wall, and there are more blood and lymphatic metastasis.
Diagnosis
Diagnosis and diagnosis of adenocarcinoma
diagnosis
Adenocarcinoma is a glandular epithelial malignancy that can have acinar, nipple, bronchiole alveolar or solid growth. It is often accompanied by mucus production, which requires special staining to detect mucus, especially in poorly differentiated tumors. The detection of mucus can sometimes identify solid adenocarcinomas as large cell carcinomas with other morphological manifestations.
Differential diagnosis
Different from other cancers.
