Ovarian Small Cell Carcinoma

　　Ovarian small cell cancer is likely to originate from one of the three common types of ovarian tumors: ovarian body cavity epithelium, germ cells, and sex cord stromal tissue. Although ovarian small cell cancer has obvious differences from these three types of tumors, there are also similarities.

　　Undifferentiated cells similar to ovarian small cell cancer can be found in places with poor differentiation of common epithelial tumors, but there are no signs of differentiation into serous, mucinous, endometrioid, or transitional cell types in ovarian small cell cancer. In immunohistochemical studies, all epithelial tumors are positive for epithelial tumor-associated antigens, and one-third of the tumors in small cell cancer are also positive.

　　It was once believed that this tumor was likely to originate from germ cells, in addition to its onset age being similar to that of germ cell tumors, extracellular basement membrane-like substances and intracellular glass bodies were found under light and electron microscopy, which were very similar to the yolk sac structure. However, according to later observations, the so-called basement membrane-like substances can exist in various types of tumors, and the intensity and nature of the glassy bodies are different from those of yolk sac tumors. Serum alpha-fetoprotein (AFP) and chorionic gonadotropin (HCG) are all negative. Clinically, it has also been noted that chemotherapy drugs sensitive to germ cells are ineffective for ovarian small cell cancer.

　　The age distribution of sex cord-stromal tumors is wide, with half occurring after menopause. Juvenile granulosa cell tumors have an earlier onset age than this tumor, with an average age of 13 years, and 44% are under 10 years old. The vast majority of granulosa cell tumors secrete estrogen, have feminizing effects, and can cause precocious puberty, irregular vaginal bleeding, postmenopausal bleeding, without hypercalcemia; while this tumor has no estrogenic effect and is often accompanied by hypercalcemia. Both have similar histological features, and the cells of ovarian small cell cancer can be arranged in a follicular structure similar to that of granulosa cell tumors, which is easy to confuse.

　　Ovarian small cell cancer belongs to small cell cancer, and due to its neuroendocrine function, a series of metabolic abnormalities may occur, such as hypercalcemia, with serum calcium concentration often higher than 2.75mmo1/L. Metastatic tumors may also occur in other parts, most commonly in the liver and lung.

　　Ovarian small cell cancer mainly occurs in young women, with an age distribution of 10-42 years, with an average age of 23 years. Common symptoms include abdominal distension, abdominal pain, lower abdominal mass, ascites, etc., which are non-specific. The vast majority of tumors occur on one side of the ovary, and the incidence on both sides is almost equal. The peritoneum is the best site for metastasis, and there may be pelvic and abdominal lymph node metastasis as well as distant metastasis to the liver, lung, pleura, etc.

　　The prevention of ovarian small cell cancer should try to avoid the following high-risk factors:

　　1. Genetic factors

　　20%-25% of ovarian cancers have a family history, and the risk of developing ovarian cancer for women with a mother or sister who has ovarian cancer is 18 times higher than that for women without a similar history.

　　2. Economic situation

　　The incidence of the disease in developed countries is significantly higher than that in developing countries, and it is more common in the higher social classes and professional women, while it is rare in women with low economic status.

　　3. Reproductive history

　　Infertile women are prone to ovarian cancer, and the risk of developing ovarian cancer decreases gradually with the increase in the number of pregnancies. Some reports show that the risk of ovarian cancer in women who have not given birth is four times higher than that in women who have given birth to 4 or more children, mainly due to the protective effect of non-ovulation during pregnancy on the ovaries.

　　4. Endocrine factors

　　The incidence of ovarian cancer in women who have taken oral contraceptives is lower than that in women who have not taken them. The longer the duration of use, the greater the protective effect on the ovaries. The protective effect remains after the oral contraceptives are stopped, which is due to the cessation of ovulation, reducing the damage to the ovarian epithelium and thus reducing the incidence of ovarian cancer.

　　5. Environmental factors

　　The incidence of ovarian cancer is highest in developed countries, 3-5 times that of developing countries. The incidence of ovarian cancer also increases in women from developing countries who migrate to developed countries, which may be related to the industrialized environment.

　　This disease is highly malignant with extremely poor prognosis.

　　Young women with unilateral adnexal masses and hypercalcemia should consider this disease. At the same time, combined with the results of B-ultrasound, laparoscopy, and other examinations, a diagnosis should be made.
　　1. Laboratory examination:Histochemical and immunohistochemical examination: No argentaffin granules were observed in the cytoplasm by Grimelius staining. The reticular fiber staining showed fibers surrounding larger cell clusters in some tumors and extending into the intercellular spaces of other tumors, irregularly and incompletely surrounding individual cells.
　　2. Other auxiliary examinations:Electron microscopy examination reveals that the diameter of small tumor cells is 6.3～15.0μm [average (10.9±1.8)μm]. Some large tumor cells have a diameter of 12.5～23.8μm [average (15.5±3.5)μm]. The peripheral part of the cell cluster has discontinuous basement membrane (basallamina), and the cells are connected by desmosomelike junctions. The cell nuclei are relatively large, with abundant euchromatin and a small amount of scattered patchy heterochromatin. The most diagnostically valuable feature is the rich cytoplasm containing pools and large sacs formed by the expansion of rough endoplasmic reticulum (RER), which are filled with fine particles of light to moderate electron density. The RER pools or sacs are mostly 0.4～2.4μm in diameter, with a few reaching 10～12μm, and the cell nucleus is twisted and displaced by them. In tumors with or without hypercalcemia, RER pools and sacs are morphologically and quantitatively different, and they can be seen in recurrent and metastatic tumors. This feature can also be clearly distinguished in the ordinary specimens fixed with formalin and ethyl alcohol (formalin) and embedded in paraffin. Other cytoplasmic components include abundant ribosomes, mitochondria, and a small amount of Golgi complex. Some cells contain rich lipid droplets, lysosomes, etc., and some cells have a small amount of microvilli on their free surface. Some tumors have a small amount of dense granules resembling neuroendocrine cells. In some larger cells, there are more free ribosomes and RER sacs, and no components different from small cells have been identified.

　　The diet of patients with ovarian small cell carcinoma should follow the principle of high calories and rich nutrition. The following are the precautions to be followed:

　　1. Eat more foods that cool the blood and activate the blood, soften hard lumps, and disperse nodules: such as sea products like turtle, kelp, nori, and oyster.

　　2. Eat more foods rich in fiber, trace elements, and vitamins.

　　3. Avoid hot, coagulating, and hormone-containing foods such as longan, ejiao, royal jelly, human placenta (Ziheche), jujube, etc.

　　4. Avoid 'inducing' foods such as dog meat, eel, salted fish, goose meat, mutton, shrimp, crab, and blackfish.

　　5. Avoid spicy foods with strong刺激性, such as Sichuan pepper, scallions, chili, garlic, and alcohol.

　　6. Avoid foods that are easy to cause cancer, such as smoked, fried, salted, and moldy foods.

　　The treatment of ovarian small cell carcinoma includes surgery, radiotherapy, and chemotherapy. Surgery is the main treatment, and the scope of surgery is generally hysterectomy plus bilateral salpingectomy. A few patients have undergone retroperitoneal pelvic lymph node dissection, and late-stage patients have undergone tumor cell ablation surgery, followed by pelvic and abdominal radiotherapy or chemotherapy. Chemotherapy regimens include PAC [cisplatin, doxorubicin (adriamycin), cyclophosphamide], VAC (vincristine, actinomycin D, cyclophosphamide), PVB (cisplatin, vincristine, bleomycin), VP-16 + P [etoposide (podophyllotoxin) + cisplatin]. BEP [etoposide (podophyllotoxin), bleomycin, cisplatin]. Regardless of surgery, radiotherapy, chemotherapy, or combined treatment, the treatment effect is generally not ideal, and this is also true for early cases.