Ovarian Support - Leydig cell tumor
Introduction
Ovarian support - introduction of stromal cell tumor Ovarian support-stromal cell tumor is a rare tumor. Morphology shows that it is an ovarian cord stromal tumor that differentiates into testicular tissue. The tumor cells resemble the testicular interstitial cells (Leydigcell) and the supporting cells (Sertolicell). And growth patterns, reflecting the different developmental stages of testicular tissue, and mixed tumors in different proportions and different degrees of differentiation. basic knowledge The proportion of illness: 0.005%--0.007% Susceptible people: women Mode of infection: non-infectious Complications: precocious puberty
Cause
Ovarian support - the cause of stromal cell tumor
(1) Causes of the disease
Some scholars believe that such patients often have sex chromosome abnormalities: about 3/4 of the tumors produce androgen, clinically de-feminine, masculine series of symptoms, there are still a few people can have no endocrine changes or feminine functions.
(two) pathogenesis
Support cell tumor
(1) General examination: unilateral, round or oval, smooth surface, solid, diameter 0.8 ~ 28cm, most of the volume is small, often limited to the ovary, cut yellow or yellowish white, fish-like, partially visible cyst When the tumor is large, necrotic foci can be seen.
(2) Examination under the microscope:
1 characteristics of tumor cells: tumor cells cubic, columnar or round; cytoplasmic transparent, granules or vacuoles, containing lipid droplets or filled with lipids; nucleus spherical or ovoid, located in the base of tubular cells.
2 Tumor cell tissue arrangement characteristics: The microscopic features of the supporting cell tumor are tubular arrangement structure. The hollow gland tube is a circular or oval tubular structure with uniform morphology, covered with single-layered cubic or low columnar tumor cells, and the cytoplasm is transparent and nucleus. Located in the basal part, the cytoplasm of the tumor cells sometimes falls off into the lumen, forming a microfilament-like structure, the solid glandular duct is elongated, and the tumor cells are not arranged like a hollow gland tube arranged neatly along the basement membrane, irregular, sometimes diffuse, complicated The glandular ducts are inconsistent, or there are few glandular lumens, which are clustered.
2. stromal cell tumor
(1) General examination: the diameter of the tumor is mostly less than 5cm, mostly unilateral, no capsule, clear boundary with surrounding ovarian tissue, solid, soft, cut brown, orange or yellow, fishy, may have bleeding spots Tumor nodules or ovarian ganglia located in the ovarian mesangium, or located in the ovarian medulla, but when the tumor is large, it is difficult to distinguish the above position. Pure stromal cell tumors are mostly caused by ovarian portal cells, and a few are between the ovaries. Quality occurs.
(2) Examination under the microscope: the tumor cells are round or polygonal, the size is the same, the nucleus is large, located in the center, the chromatin is sparse, and there may be one or more basophilic nucleoli, cytoplasm rich, eosinophilic granules or Empty vacuoles, often seen in the cytoplasm of brown lipid pigments, in some of the tumor cells in the pulp, can be found in the nucleus of the long, different size of Reinke crystals, this crystal distribution is uneven, and not all cells Can be found in.
The arrangement of tumor cells is generally tight, nest-like, flaky or strip-like, and some areas are relatively concentrated, forming a nuclear-free cytoplasmic region, rich in interstitial blood vessels, interstitial edema, mucous degeneration or glass. Sample change.
3. Support stromal cell tumor
(1) gross examination: the tumor size varies greatly, the diameter is more than 6 ~ 17cm, the average is about 10cm, the vast majority of tumors are unilateral, smooth surface, mostly solid, with heterologous components or network structure, tumor Mostly cystic, the face is gray, yellow or yellow-brown, can have cystic cavity, bleeding can be seen when the tumor is poorly differentiated, necrotic foci.
(2) Examination under the microscope:
1 Highly differentiated: The tumor consists of a tubular structure that coats the supporting cells. There are scattered or clustered interstitial cells in the fibrous connective tissue between the tubes, and Reinke crystals are difficult to find.
2 moderate differentiation: the tubular structure is replaced by the lobular structure, the supporting cells are arranged in a trabecular shape, diffuse and strip-like, occasionally hollow or solid glandular ducts, and there are a large number of interstitial cells in the loose connective tissue interstitium.
3 poorly differentiated: the tumor consists of a densely integrated group of spindle-shaped cells. The tumor cells are arranged in a wide column of cells, which cross each other. The morphology is similar to the undifferentiated gonads, occasionally poorly differentiated tubules or irregular epithelial cords. The cytoplasmic cells are distributed in small amounts in clusters.
4 reticulated subtypes: most of them are in the middle, poorly differentiated stromal cell tumor structure, containing many different testicular net structures, the network structure accounts for a small part of the tumor, or even larger or even all The structure, the reticular area consists of long irregular tubes or fissures, or expands, or is a cystic cavity containing eosinophils, like thyroid follicles, papillary lobes visible on the wall, short nipples, and glassy changes The core, a small number of nipples like polyps or complex branches, like ovarian serous papilloma, interstitial often have glassy changes.
5 with heterologous components: microscopic features of the tumor is composed of different differentiation of the supporting stromal cell tumor components plus heterologous components, the most common heterogeneous component is gastrointestinal mucus epithelium, can form ducts or sacs, epithelium There are argyrophil cells and pro-silver cells. The mucous epithelium is generally benign. Sometimes there may be borderline or malignant. There are also a few supporting stromal cell tumors containing heterogeneous components of striated muscle or cartilage, but heterologous striated muscle or cartilage is often not Mature.
Prevention
Ovarian support - stromal cell tumor prevention
Prevention: regular physical examination, early detection, early diagnosis, early treatment, and good follow-up.
Complication
Ovarian support - stromal cell tumor complications Complication precocious
Tumor hemorrhagic necrosis complicated with acute abdomen. The ovarian support of mesenchymal cell tumor with precocious puberty was reported in a 12-month-old baby girl.
Symptom
Ovarian support - Symptoms of stromal cell tumor Common symptoms Abdominal mass vaginal irregular bleeding Abdominal pain Postmenopausal bleeding Abnormal uterine bleeding Abdominal ascites Amenorrhea Menopausal precocious
Support cell tumor
(1) Endocrine changes: Most (90%) support cell tumors have endocrine function, mainly as estrogen function, accounting for about 70%, prepubertal patients may have precocious puberty symptoms; women of childbearing age have menorrhagia, Irregular bleeding; elderly women with clinical symptoms such as postmenopausal bleeding, proliferative pathological changes in the endometrium, another 20% of patients have masculine performance, there are cases reported that the tumor can secrete progesterone, aldosterone, kidney Prime.
(2) pelvic mass: Because the size of the tumor varies greatly, it is 0.8~28cm, so small tumors are difficult to reach the mass. Medium-sized or larger tumors can touch the solid mass in the attachment area, most of the surface is smooth. It can be active, and when the tumor is large, it can cause abdominal distension, discomfort and other symptoms of compression.
(3) Peutz-Jeghers syndrome: Ferry et al (1994) reported that two patients with cell tumors have hereditary melanoma polyp syndrome, which has not been reported in previous literature.
2. stromal cell tumor
(1) pelvic symptoms: Although the tumor diameter is 1 ~ 15cm, but the majority is less than 5cm, the average diameter of 2.4cm, clinical pelvic examination is difficult to find, and sometimes even B-ultrasound may not be detected, so there is generally no mass , bloating, discomfort and other symptoms of pelvic compression, Wysocka et al (1999) reported a case of weighing up to 3200g, from the left gonad of patients with androgen insensitivity syndrome.
(2) Endocrine changes: Most patients will have endocrine disorders, about 80% of which are masculine, 10% of which are estrogen-induced, others are non-functional or female, androgen is elevated, and some patients appear Hypertension, diabetes, symptoms of cortisol.
1 masculine performance: unsuccessful girls are characterized by short stature, muscular, hairy, pubic male distribution, clitoris hypertrophy and other pure male changes, women of childbearing age show de-feminization, such as less menstruation, amenorrhea, breast atrophy, facial hairy , clitoris hypertrophy, etc., postmenopausal women's factor palace, breast atrophy and menopause are normal physiological changes, difficult to distinguish from the endocrine effects of the tumor, but if accompanied by clitoris hypertrophy, facial hairiness, low voice and other symptoms, should be considered Tumor endocrine effects may be possible.
2 estrogen effects: endometrial stimulation of estrogen secretion by tumors can occur proliferative lesions, cancer has also been reported, the main clinical manifestations of menorrhagia or postmenopausal bleeding.
3 female, androgen effect: very rare, clinically mild masculinity with irregular vaginal bleeding.
4 pregnancy combined with supporting cell tumor: due to endocrine disorders caused by tumors, generally not easy to pregnancy, so far, foreign literature only reported cases, Horny et al (1995) reported that a case of pregnancy with support cell tumors clinically masculine symptoms, The blood testosterone level was significantly increased. The cesarean section gave birth to a live baby girl, and the tumor of the right ovary with a diameter of 12 cm was removed. The patient was followed up for 20 months after surgery and showed no signs of recurrence.
3. Support stromal cell tumor
(1) Abdominal symptoms: The size of stromal cell tumors is very different, with an average diameter of about 10 cm. The incidence of abdominal masses is much higher than that of supporting cell tumors, reaching 32% to 46%. It is reported that a few tumors can be twisted or broken. Symptoms of abdominal pain, tumor diameter less than 5cm, clinically no abdominal symptoms, easy to be ignored during the examination, often found by chance or laparotomy.
(2) Endocrine changes: Due to the function of tumor cells to secrete androgen, the detection of hormone levels in most patients has changed. The most obvious change is the increase of serum testosterone and androstenedione concentration. Due to the influence of androgen, clinical The upper 25% to 77% of patients will have a series of de-feminization and masculine symptoms. Before the sexual maturity, there will be heterosexual precocity. After sexual maturity, there will be rare menstruation, amenorrhea, breast atrophy and so on. The performance, then gradually appear hairy, low-pitched voice, hemorrhoids, larynx, clitoris hypertrophy and other masculine symptoms.
In patients with high and moderate differentiation support-stromal cell tumors, tumor cells contain a certain amount of estradiol in addition to higher testosterone, and a few have estrogen secretion, and the clinical manifestations are abnormal uterine bleeding. In cases with endometrial pathology, endometrial polyps, cystic hyperplasia, well-differentiated adenocarcinoma and other pathological changes stimulated by estrogen.
The above endocrine performance, the detection of hormone levels in the plasma of patients can have significant changes, Sainz et al (1994) reported similar results, can also be detected in the ascites of patients with poorly differentiated stromal cell tumors, which undoubtedly for the patient's endocrine hormones Testing has provided new tools and methods.
(3) Changes in serum AFP: Not reported in previous literature, Hammad et al (1995) reported a case of 17-year-old patients with stromal cell tumors, preoperative detection of elevated serum AFP, pathological examination found in the tumor stroma There were clusters of hepatocyte-like cells. Immunohistochemical studies confirmed that AFP was derived from hepatocyte-like cells. After surgery, AFP returned to normal. At present, 8 months after surgery, AFP was clinically observed in supporting stromal cell tumors. The exact meaning has yet to be further collected and observed.
(4) Support the classification of stromal cell tumors:
1 Highly differentiated: The tumor consists of two cell components, a supporting cell tumor type and a stromal cell tumor type.
2 moderate differentiation: The tumor is mainly composed of immature support cells. There are a large number of interstitial cells in the loose connective tissue, the tumor cells produce androgen, and the clinical masculinity.
3 poorly differentiated: also known as sarcoma-like type, tumor cells have moderate to severe atypia, more mitotic figures, clinically significant masculinization.
4 Reticulum subtypes: The histological features of these tumors are in the middle, poorly differentiated support of stromal cell tumor tissue containing many different testicular net structures.
5 with heterologous components: refers to the tumor consists of supporting stromal cell tumor components and heterogeneous components, heterogeneous components are commonly gastrointestinal mucus epithelium, generally benign, occasionally borderline or malignant, There are also striated muscle or cartilage components.
Examine
Ovarian support - examination of stromal cell tumor
Hysteroscopy, laparoscopy, and tumor marker examination.
Histopathological examination.
Diagnosis
Ovarian support-diagnosis of stromal cell tumor
Diagnostic criteria
1. Supporting cell tumors are basically benign tumors. Diagnosis can be made based on clinical manifestations, signs and laboratory tests.
2. Interstitial cell tumors are often small in size, but clinical examination can not be found. When menopausal women have symptoms of clinical endocrine disorders and serum testosterone concentrations are significantly elevated, ovarian stromal tumors may be considered, and laparotomy should be considered. .
3. Support - stromal cell tumor is a rare tumor. When the tumor is small and the clinical endocrine symptoms are not obvious, it is difficult to confirm the diagnosis. If the tumor diameter exceeds 5cm, the patient has obvious de-feminization or masculine symptoms, and the testosterone in the blood is obvious. When elevated, the presence of such a tumor should be considered in the diagnosis.
Differential diagnosis
It is clinically difficult to identify stromal cell tumors and support cell tumors or stromal cell tumors. Accurate diagnosis is still confirmed by pathological examination.
