Ovarian endometrioid tumors

　　The tissue origin of ovarian endometrioid tumors may be the metaplasia of ovarian germinal epithelium into endometrioid epithelium, hence, it is common to see endometrioid adenocarcinoma associated with serous or mucinous adenocarcinoma, and it may also originate from endometriotic foci already existing within the ovary. They are classified according to their benign or malignant nature:
　　1. Benign endometrioid tumors Pure endometrioid adenoma and cystadenoma (endometrioid cystadenoma) are extremely rare, with most being adenofibroma (endometrioid adenofibroma) and cystadenofibroma (endometrioid cystadenofibroma). They are generally of moderate size, with a smooth surface, similar to serous adenofibroma and cystadenofibroma. The cut surface is solid fibrous connective tissue, with scattered cystic cavities of varying sizes. The cyst wall is smooth or with nodular protuberances, of varying sizes, and few in number. The glandular epithelium is single-layer cuboidal or short columnar, similar to the proliferative phase of the endometrium. Scattered endometrioid glands of varying sizes are present in the fibrous connective tissue, and sometimes secretions in the glandular cavities can be seen, with positive PAS digest enzyme staining.
　　2. Borderline endometrioid tumors It often occurs in adenofibromas and cystadenofibromas. The appearance is similar to that of benign tumors, and under the microscope, atypical hyperplasia of the glandular epithelium can be seen. It can be divided into three grades (mild, moderate, and severe) based on glandular epithelial hyperplasia and nuclear atypia, but there is no stromal invasion.
　　3. Malignant endometrioid cancer
　　Endometrioid adenocarcinoma:Histologically, it is extremely similar to endometrial adenocarcinoma originating in the uterine corpus, with all types of the latter occurring. It accounts for 16% to 31% of ovarian malignant tumors.
　　Pathological morphology: 55% to 60% are unilateral, cystic and solid or mostly solid, sometimes accompanied by chocolate cysts. The shape is smooth or nodular, or with surface papillary growth. Sizes vary, with diameters of 2 to 35 cm; the cut surface is grayish white,脆, often with large areas of hemorrhage. The papillary morphology is usually short and wide, rarely branching repeatedly, and can be covered with a single layer or a few layers of hyperplastic epithelium. Under the microscope, squamous tissue can sometimes be found, and in some cases, it resembles squamous cell carcinoma, with pure ovarian squamous cell carcinoma being extremely rare. Sand grains can also sometimes be found.
　　The relationship between ovarian endometrioid cancer and endometrial adenocarcinoma: To diagnose primary ovarian endometrioid cancer, it is necessary to exclude metastasis from endometrial adenocarcinoma, as the incidence of endometrial adenocarcinoma is high, and metastasis is common. There is a 5% to 29% chance that both can occur simultaneously, and the criteria for differential diagnosis when both are primary are required.
　　Ovarian mesodermal mixed tumor, also known as malignant mixed Mullerian tumor:
　　Pathology: It can be divided into homologous and heterologous types, with homologous types mainly being carcinosarcoma. The tumor is moderately sized, with an irregular surface, presenting as lobulated or nodular. Under the microscope, adenocarcinoma and sarcoma components can be seen. Heterologous types are mesodermal mixed tumors, with the tumor containing adenocarcinoma and various components derived from the mesoderm, such as cartilage, striated muscle, bone, and various tissues.
　　Ovarian endometrioid stromal sarcoma:
　　Pathology: The size of the tumor varies, round or irregular in shape. The cut surface is mainly solid, but may also be cystic, often accompanied by hemorrhage and necrosis. It is composed of round or oval cells, with tumor cells arranged in a whorl-like pattern around the thin-walled small blood vessels.

　　Ovarian endometrioid tumors often adhere to adjacent organs and tissues. The manifestations are:

　　1. General symptoms are often not prominent, and low fever may occur occasionally, accompanied by fatigue. The course of the disease is long, and some patients may have symptoms of neurasthenia.

　　2. Scars and adhesions formed by chronic inflammation and pelvic congestion can cause lower abdominal distension, pain, and sacral pain, which often worsen during physical exertion, sexual intercourse, and around the menstrual period.

　　3. Due to pelvic congestion, patients may have increased menstrual flow. Menstrual irregularities may occur due to ovarian function damage. Tubal adhesion and obstruction may lead to infertility.

　　Ovarian endometrioid tumors belong to a class of diseases, and the clinical manifestations vary according to the type of tumor the patient has.
　　1. Benign endometrioid tumors Unilateral is more common. Common symptoms include pelvic masses and irregular vaginal bleeding.
　　2. Borderline endometrioid tumors Unilateral is more common. Or asymptomatic, or with masses and vaginal bleeding.
　　3. Malignant endometrioid cancer ① Endometrioid adenocarcinoma may have abdominal and pelvic masses, abdominal distension, and abdominal pain. 10% to 15% of patients may have ascites. Irregular vaginal bleeding or postmenopausal bleeding is more common than in other ovarian epithelial carcinomas. ② Ovarian mesenchymal mixed tumors are more common in postmenopausal women, with rapid tumor growth, often accompanied by abdominal pain. 17% may have ascites, and symptoms of compression are more pronounced. ③ Ovarian endometrioid stromal sarcoma is less common. The age of onset ranges from 10 to 70 years, with an average of 54 years. Symptoms are mostly abdominal masses or abdominal pain. Due to adhesions with adjacent organs or tissues, it can cause gastrointestinal or urinary system symptoms, and irregular uterine bleeding may occur occasionally.

　　At present, there is no effective preventive measure for ovarian endometrioid tumors. High-risk groups should conduct regular physical examinations, early detection, and early treatment, and pay attention to follow-up monitoring of tumor markers and tumor radioimmunology tests after treatment.

　　Ovarian endometrioid tumors can be diagnosed based on clinical manifestations, laboratory tests, and pathological tissue examination.

　　1. Laboratory examinations:Tumor marker examination.

　　2. Other auxiliary examinations:Abdominal ultrasound, CT, histopathological examination, and laparoscopic examination.

　　The optimal dietary plan for patients with ovarian endometrioid tumors includes the following aspects:

　　1. Adequate supply of calories and protein should be ensured.

　　It is recommended to consume more milk, eggs, lean pork, beef, rabbit meat, fish, poultry meat, and soy products; if the patient has a dislike for greasy and strong-smelling foods, options like cheese, egg pancakes, salted duck eggs, etc., can be considered. In daily life, more honey and grain products such as rice and flour should also be consumed.

　　2. Eat more fresh fruits and vegetables

　　Such as rapeseed, spinach, tomatoes, onions, asparagus, hawthorn, fresh jujube, Chinese cabbage, kiwi, kelp, etc. If nausea is severe, you can eat vegetable juice, or eat some fresh cold dishes and fruits;

　　3. Eat more immune-enhancing foods

　　Such as mushrooms, silver ear, black fungus, mushrooms, and animal liver, fish liver oil, carrots, lettuce leaves, etc., which are rich in vitamin A and beta-carotene;

　　4. Reasonable arrangement of three meals

　　Breakfast and dinner should be arranged before 6 a.m. and after 7 p.m. respectively, extending the interval between medication and eating to reduce drug reactions. Avoid using刺激性 spices such as pepper and mustard (spices and food) as well as smoked and roasted foods;

　　5. Other

　　The daily water intake should not be less than 2000 milliliters to alleviate the comfort of the digestive tract mucosa caused by drugs and promote the excretion of toxins. Milk, soy milk, and mung bean soup are helpful in excreting the toxins released by cancer cells.

　　6. Taboos

　　Avoid smoking, alcohol; avoid刺激性食物 such as scallion, garlic, chili, cinnamon, etc.; avoid greasy, fried, moldy, preserved foods; avoid warm and blood-activating foods such as mutton, dog meat, leek, pepper, etc.

　　According to the type of tumor, appropriate treatment measures are taken, and surgical resection is the preferred method.
　　First, benign endometrioid tumor Removal of the affected ovary and fallopian tube.
　　Second, borderline endometrioid tumor Since it often occurs after menopause, it is advisable to perform total hysterectomy with bilateral salpingo-oophorectomy, with a better prognosis.
　　Third, malignant endometrioid carcinoma
　　1. Endometrioid adenocarcinoma:Surgery and adjuvant chemotherapy are determined according to clinical stage and pathological grade.
　　2. Ovarian mesenchymal mixed tumor:Surgery should be performed as soon as possible, including the removal of the entire uterus and bilateral adnexa, whether to remove the lymph nodes is still controversial, but according to the tumor stage and the treatment principles of ovarian epithelial cancer, it is still the majority's preference. Adjuvant chemotherapy or radiotherapy after surgery.
　　3. Ovarian endometrioid stromal sarcoma:Total hysterectomy and bilateral salpingo-oophorectomy, consideration of lymph node dissection according to the situation, low-grade malignancy can be treated with gestagens as adjuvant therapy, and highly malignant cases can be supplemented with chemotherapy or radiotherapy.