Ovarian supporting-stromal cell tumors

　　Patients with ovarian supporting-stromal cell tumors often have chromosomal abnormalities: about 3/4 of the tumors produce androgens, and clinical symptoms such as defeminization and masculinization occur. A few people can have no endocrine changes or present feminizing function.
　　The size of the supporting-stromal cell tumor varies greatly, with a diameter of 6-17 cm, averaging about 10 cm. The majority of tumors are unilateral, smooth in surface, and mostly solid. Accompanied by heterologous components or reticular structures, the tumors are mostly cystic. The cut surface is grayish-white, yellow, or yellow-brown, and may have cystic cavities. When the tumor is poorly differentiated, hemorrhage and necrotic foci may be seen. Under microscopic examination, it can be seen that:
　　1, High differentiation The tumor is composed of tubular structures covered by supporting cells, with scattered or clustered stromal cells in the intertubular fibrous connective tissue, Reinke crystals are not easily found.
　　2, Moderate differentiation The tubular structures are replaced by lobular structures, the supporting cells arranged in trabecular, diffuse, and striated patterns, occasionally hollow or solid gland ducts. There are a large number of stromal cells in the loose connective tissue stroma.
　　3, Low differentiation The tumor is composed of a dense cluster of spindle-shaped cells, the tumor cells arranged in broad cellular columns, intersecting and fitting together, with a morphology similar to undifferentiated gonads. Occasionally, poorly differentiated tubules or irregular epithelial strips are seen. A small number of stromal cells are distributed in clusters.
　　4, Reticulated subtype Most of them are in the structure of mesenchymal tumors with medium and low differentiation, containing an amount of similar to the rete testis, and the reticular structure occupies a small part of the tumor, or even a larger part or all of it is this kind of structure. The reticular area is composed of long, irregular small tubes or clefts, or is dilated, or cystic, containing eosinophilic substances, resembling thyroid follicles. The cyst wall can be seen with papillary projections, with short papillae and a glassy degenerative core, a few papillae are like polyps or have complex branches, resembling ovarian serous papillary adenoma. The stroma is often glassy degenerated.
　　5, Accompanied by heterologous components The microscopic characteristics are that the tumor is composed of components of mesenchymal tumors of different differentiation degrees plus heterologous components. The most common heterologous component is gastrointestinal-type mucinous epithelium, which can form glands or cysts, with argentaffin cells and argentaffin cells in the epithelium. The mucinous epithelium is generally benign, with occasional交界性 or malignant. There are also a few mesenchymal tumors containing heterologous components such as striated muscle or cartilage, but the heterologous striated muscle or cartilage is often immature.
 

　　Complications may occur due to tumor hemorrhage and necrosis, leading to acute abdomen; there have been reports of a 12-month-old female infant with ovarian mesenchymal cell tumor complicated with precocious puberty; in addition, about 20% of patients have masculinization manifestations.

　　Mesenchymal tumors mainly manifest as abdominal symptoms and endocrine abnormalities.
　　1, Abdominal symptoms:The size of mesenchymal tumors varies greatly, with an average diameter of about 10cm. The incidence of abdominal masses is much higher than that of Sertoli cell tumors, reaching 32% to 46%. There have been reports of a few tumors that can twist or rupture, causing abdominal pain symptoms. Tumors with a diameter less than 5cm generally have no abdominal symptoms in clinical practice, and are also easily ignored during examination, often discovered accidentally or during laparotomy.
　　2, Endocrine changes:Due to the function of tumor cells to secrete androgens, the hormone levels in most patients have changed, with the most obvious change being a significant increase in the concentration of testosterone and androstenedione in the serum. Due to the influence of androgens, 25% to 77% of patients may appear a series of defeminization and masculinization symptoms. The onset of the disease before puberty may lead to precocious puberty. After puberty, the first manifestation is oligomenorrhea, amenorrhea, breast atrophy, and other defeminization symptoms, followed by the gradual appearance of hirsutism, deep voice, acne, Adam's apple, clitoral hypertrophy, and a series of masculinization symptoms.
　　In patients with high and medium differentiated mesenchymal tumors, in addition to containing a high amount of testosterone, the tumor cells also contain a certain amount of estradiol, and a few cases show estrogen secretion, with clinical manifestations of abnormal uterine bleeding. In cases with simultaneous endometrial pathological examination, there may be various pathological changes stimulated by estrogen, such as polyps, cystic hyperplasia, and well-differentiated adenocarcinoma of the endometrium.
　　Above endocrine manifestations, there can be significant changes in hormone levels in the patient's plasma.

　　Due to the unknown etiology, there is currently no special preventive method for mesenchymal tumors. The only thing we can do is to regularly conduct physical examinations on high-risk populations, discover early, diagnose early, treat early, and follow up well.

　　It is difficult to make a diagnosis when the tumor is small and the clinical endocrine symptoms are not obvious. If the tumor diameter is more than 5 cm, the patient has obvious androgenic or androgenic symptoms, and the level of testosterone in the blood is significantly increased, the diagnosis is not difficult when combined with the following examination results.
　　1, Laboratory examination:Tumor marker examination.
　　2, Other auxiliary examinations:Abdominal ultrasound, laparoscopy, and tissue pathology examination.

　　Recommend several food therapy formulas suitable for patients with supportive-stromal cell tumors of the ovary.

　　1,枸杞子黄花饮

　　Pig bladder 1, Chinese wolfberry 20 grams, chrysanthemum 100 grams, hawthorn 50 grams. Clean and cut the pig bladder into fine pieces; the latter three are separately wrapped in fine gauze. Boil the medicine package with the pig bladder, add salt, ginger, scallion, and monosodium glutamate for seasoning. Take it.

　　2,葵盘凤尾水杨梅汤

　　Sunflower seed head 100 grams, Suaeda salsa 60 grams, and Salix myricoides (whole grass) 60 grams. Clean the above ingredients and put them into a pot, add an appropriate amount of water to boil for 1-2 hours to become semi-gelatinous. Take orally.

　　3, Other

　　In terms of diet, attention should be paid to nutritional balance. In addition to adequate protein intake, fats and sugars should be taken in moderation, and vitamins E, D, and minerals such as iron and calcium should be supplemented with special attention. Among them, appropriate vitamin E supplementation can clear free radicals, improve skin elasticity, delay the process of ovarian atrophy, and play an anti-aging role, and can also regulate immune function. It takes 150-300 milligrams a day.

　　Considerations for the treatment of supportive-stromal cell tumors: ①Highly differentiated supportive stromal cell tumors are benign tumors, and the treatment principle is to perform unilateral adnexectomy. ②Other types of supportive stromal cell tumors: For young women who have not given birth, after careful exploration during surgery and clinical staging as stage I, unilateral adnexectomy can be performed, followed by postoperative follow-up. For middle-aged and elderly women without the need for childbearing, bilateral hysterectomy with bilateral adnexectomy should be performed.
　　For patients with tumor metastasis, recurrence, or dissemination found during surgery, tumor cell ablation surgery should be performed, followed by chemotherapy or radiotherapy.