Mesenteric tumors

　　Mesenteric tumors are a rare disease occurring in mesenteric tissues, more common in males, and can occur at any age. The onset is insidious, and early symptoms are often non-specific, with a high rate of misdiagnosis in clinical practice. Approximately 2/3 of patients are misdiagnosed with other diseases or suspected to be abdominal masses that cannot be definitively diagnosed. Mesenteric tumors can originate from any cell component in the mesentery and may have up to 7 sources: lymph tissue, fibrous tissue, fatty tissue, nervous tissue, smooth muscle, vascular tissue, and embryonic remnants. Mesenteric tumors are classified as benign and malignant, with a ratio of about 2:1 between benign and malignant tumors. The most common malignant tumors are fibrosarcoma and leiomyosarcoma. They are mostly located in the mesentery of the small intestine and around it, and can also be found in the sigmoid colon and mesentery.

　　It may cause primary mesenteric tumors and mesenteric artery aneurysms or lead to various complications such as:

　　1. Bleeding or spontaneous rupture of the tumor can cause acute peritonitis and severe pain.

　　2. Malignant tumors have invaded the intestinal tract, causing intestinal bleeding and hematochezia.

　　3. Compression of the inferior vena cava or iliac vein by the tumor can lead to ascites, varicose veins of the abdominal wall, and edema of the lower extremities.

　　The general manifestations of mesenteric tumors are divided into five types:

　　1. Abdominal mass  It is the earliest and most common symptom. The mass can be cystic or solid. If it is hard, the surface is not smooth,呈nodular, and has tenderness, it often suggests malignant tumors.

　　2. Abdominal pain

　　It is usually distension and discomfort. If the tumor bleeds or spontaneously ruptures, it can cause acute peritonitis and severe pain.

　　3. Fever

　　This is more common in malignant tumors. Many patients with lymphosarcoma present with fever of unknown origin as their first symptom. Highly malignant soft tissue sarcomas can have irregular fever or low-grade fever.

　　4. Hematochezia

　　Malignant tumors have invaded the intestinal tract, causing intestinal bleeding.

　　5. Other

　　Some systemic reactions of malignant tumors, such as loss of appetite, weight loss, anemia, and fatigue.

　　In addition, tumors can also compress the bladder and ureter, leading to renal pelvis hydrops, manifested as lumbago, distension, discomfort, or frequent urination. Compression of the inferior vena cava or iliac vein can lead to ascites. A few primary malignant mesenteric tumors present with metastatic lesions as their initial symptoms, such as chest tightness and pain if they metastasize to the lung, or headache and dizziness if they metastasize to the brain. During physical examination, attention should be paid to the location, texture, nodules, and mobility of the mass. It has been reported that the transverse mobility of the mass is a major characteristic of mesenteric tumors.

　　Mesenteric tumors are a rare disease occurring in mesenteric tissue. Limited data in China show that they are more common in males and can occur at any age. This disease has a hidden onset, often without specific symptoms in the early stage, and has a high rate of misdiagnosis in clinical practice, with about 2/3 of patients misdiagnosed with other diseases or suspected to be abdominal masses that cannot be definitively diagnosed. Mesenteric tumors are classified as benign and malignant. Benign tumors have a good prognosis if completely resected, but if not completely resected or resected incompletely, certain tumors such as lipomas, fibromas, and leiomyomas may have a possibility of recurrence. Malignant tumors are often in the late stage of the disease when diagnosed, with a low rate of radical resection and a poor prognosis. The following measures can help prevent mesenteric tumors.

　　1. Generally speaking, various benign tumors, due to injury and consumption of body fluids and yin, are mostly attributed to yin deficiency and internal heat. Therefore, in terms of dietary adjustment, it is advisable to avoid spicy, warm, and dry foods, and to eat less greasy foods; while cold and cool foods should be eaten less or not at all.

　　2. Consuming easily digestible and absorbable protein foods such as milk, eggs, fish, and soy products can enhance the body's immunity.

　　3. It is possible to eat more anti-cancer foods in daily life, such as turtle, mushrooms, black fungus, garlic, seaweed, mustard greens, and royal jelly, etc.

　　4. Regular check-ups, early detection and early treatment.

　　The examination of mesenteric tumors can use X-ray barium meal examination, ultrasound examination, CT examination, and laparoscopic examination.

　　1. X-ray barium meal examination

　　It can show the compression and displacement of the intestinal tract, and if there is calcification, it may be a teratoma. Barium enema造影 can distinguish between intraluminal and extraluminal, showing the size, location, density of the tumor, and the degree of intestinal tract invasion. Sometimes when mesenteric malignant tumors invade the intestinal wall, phenomena such as stiffness of the intestinal wall, thickening or interruption of mucosal folds, and slow passage of barium may occur.

　　2. Ultrasound examination

　　Solid-cystic mesenteric cysts show liquid dark areas, with clear boundary echoes, and have obvious capsule echoes and posterior enhancement effect. Benign tumors have clear and complete capsules, with uniform and sparse hyperechoic areas inside, sometimes or partially silent areas, such as lipomas, fibromas, and neurilemmomas, etc. Malignant tumors may have or not have capsule echo areas, with varying echo intensities inside, uneven distribution, and irregular non-echoic areas.

　　3. CT examination

　　It can directly understand the size, texture, boundary, and adjacent relationship of the mass, and clearly show whether the surrounding tissues and organs are invaded. Especially the relationship between the intestinal tract and the mass is very beneficial for preoperative diagnosis, and can be used to follow up and evaluate the therapeutic effect and understand whether there is recurrence.

　　4. Laparoscopic examination

　　It can not only determine the location of the mass but also take a biopsy for pathological examination to determine the nature of the tumor.

　　1. Composition: 20 grams of portulaca oleracea, 10 grams of mung beans.

　　Usage: Clean the portulaca oleracea and mung beans, place them in a pot, add 1000 milliliters of water, boil over high heat for 5 minutes, then simmer over low heat for 30 minutes, filter the residue and take the juice, drink in portions.

　　Effect: Clearing heat and dampness.

　　2. Composition: 10 grams of ginseng, 20 grams of poria, 50 grams of glutinous rice.

　　Usage: Clean the ginseng, cut into small pieces, clean the poria, place them in a pot, add 500 milliliters of water, boil over high heat for 20 minutes, filter the residue and take the juice, add 500 milliliters of water, add glutinous rice, boil over high heat for 5 minutes, then simmer over low heat for 20 minutes, make porridge, eat while hot.

　　Effect: Greatly tonify the qi, harmonize the stomach and strengthen the spleen.

　　3. Composition: 20 grams of dried ginger, 10 grams of cassia bark.

　　Usage: Clean the dried ginger and cassia bark, place them in a pot, add 500 milliliters of water, boil over high heat for 5 minutes, then simmer over low heat for 30 minutes, filter the residue and take the juice, drink in portions.

　　Effect: Warming and tonifying the spleen and kidneys.

　　The treatment of mesenteric tumors is mainly surgical resection. Whether to add radiotherapy and chemotherapy depends on the pathological type, degree of malignancy, age, and overall condition of the patient.

　　Mesenteric cysts usually have a complete capsule, with clear boundaries. Solitary cysts can generally be removed by cystectomy. If the cyst is closely related to the intestinal tract or tightly adherent to mesenteric vessels, a part of the small intestine can be removed along with it. If it is difficult to remove the cyst, a cyst bag inversion surgery or cystojejunal Roux-Y anastomosis can be performed.

　　Lymphangiomas often contain multiple small cysts of different sizes, and some grow in a branched manner. To achieve radical cure, it is advisable to excise part of the small intestine and mesentery together. As for multiple small lymphangiomas, they can be cut open one by one, and then 3% to 5% iodine alcohol can be applied to the inner wall to destroy the epithelial tissue cells of the tumor wall. It can also be electrocauterized to completely destroy the cyst wall to prevent recurrence.

　　For solid mesenteric tumors, the benign and malignant nature of the tumor should be distinguished during surgery, otherwise adverse consequences may occur, so the excised specimens should be sent for frozen section pathology examination to confirm the diagnosis. Even if it is a benign tumor, the boundaries are often not very clear, and local resection often inevitably injures the mesenteric blood vessels and affects the blood supply of the intestines. Therefore, unless the small tumor resection does not affect the blood supply of the intestines, it is generally necessary to excise the tumor along with the mesentery and a part of the small intestine. Benign tumors have the possibility of malignant transformation or local recurrence, so they should be completely excised when possible to achieve cure. If the excision is not thorough, it often causes postoperative tumor recurrence or malignant transformation. Whether the tumor can be resected by surgery is related to the occurrence site, nature, size, and whether there is infiltration. It is reported that the resection rate of benign tumors is higher than that of malignant tumors, and the reason is that most malignant tumors are located at the root of the mesentery, and they often infiltrate the main blood vessels of the mesentery and have a multicentric nature. The wide-range resection of malignant tumors is the best treatment method to achieve radical cure, and tumors that cannot be resected radically should actively undergo palliative debulking surgery or coloenterostomy to improve the efficacy of postoperative radiotherapy and chemotherapy and delay the occurrence of complications. For recurrent cases, efforts should be made to perform reoperation to resect the tumor, which can effectively extend the patient's survival period and even provide an opportunity for cure. If mesenteric tumor patients have complications such as intestinal obstruction or volvulus, they should be explored as soon as possible under active preoperative preparation. If the twisted or intussuscepted intestine has necrotized and cannot be复位, the necrotic intestine should be excised first, and then explore the tumor to determine the surgical method to reduce the absorption of toxins.

　　In view of the polypotency of mesenteric tumors, appropriate radiotherapy, chemotherapy, hormone therapy, and supportive therapy should be supplemented after surgery according to their pathological and biological characteristics. Traditional Chinese medicine treatment can adopt methods such as soothing the liver and regulating the qi, promoting blood circulation and reducing accumulation, softening hard masses and dispersing nodules, but the efficacy is poor, and it is generally only used for adjuvant treatment of malignant tumors.