Ovarian ring tubal sex cord tumors

　　Ovarian ring tubal sex cord tumors have a familial genetic factor. Clinical symptoms include the syndrome of black spot polyps: most of the tumors are small and can only be found under a microscope, generally with a diameter of 5cm. They are unilateral, round, oval, or nodular, most of which have a capsule. The cross-section is grayish yellow or pink, mostly solid, and can have hemorrhage, necrosis, cystic change, and calcification is rare. In some cases, mucinous cystadenoma or germ cell tumors may be found in the ipsilateral or contralateral ovary.
　　Under microscopic examination, the most characteristic feature is the annular tubular structure. The annular tubules are interspersed with fibrous ovarian stroma, among which florigen cells or cells similar to Leydig cells can be seen. Calcification spots and hyaline change are common.

 

　　Ovarian ring tubal sex cord tumors can cause acute abdominal pain symptoms due to torsion. Ovarian ring tubal sex cord tumors belong to low-grade malignant tumors and should not be neglected. It is necessary to treat them in a timely manner and not to delay the course of the disease.

　　The clinical manifestations of ovarian ring tubal sex cord tumors are mainly divided into the following four aspects.
　　1, Pelvic mass:Because the size of the tumor varies greatly, the small ones are only microscopically visible tiny tumors, and the large ones can reach a diameter of 20cm, so pelvic masses can only be palpated and detected in some patients. The majority of masses are solid, and some can be cystic, with a smooth surface and good mobility. When the tumor has metastasis, most of them are located in retroperitoneum, perinephric area, and the masses formed are inactive and fixed.
　　2, Endocrine changes:Patients with ovarian ring tubal sex cord tumors have menstrual disorders as the most important clinical symptom, which can include irregular vaginal bleeding of varying degrees, amenorrhea, postmenopausal bleeding, precocious puberty in females, and other symptoms. Detection of serum estrogen and progesterone in patients shows that both hormones have明显上升. In cases with endometrial pathological examination, not only some have pathological changes such as endometrial polyps and proliferative lesions under estrogen stimulation, but also some have pathological changes such as atrophy of endometrial glands and interstitial decidualization under the influence of progesterone.
　　3, Familial atypical mole-malignant melanoma syndrome (Peutz-Jeghers syndrome, PJS):About 1/3 of patients may have multiple pigmented spots on the face, lips, oral mucosa, tongue, fingers, and toes, and multiple hamartomatous polyps in the gastrointestinal tract (mainly in the small intestine). Patients may have bleeding or intestinal obstruction due to intestinal polyps, and individual patients may have polyps in the nasopharynx, bladder, and tracheal mucosa. PJS is an autosomal dominant genetic disease. It is noteworthy that only a small number of patients with ring tubular sex cord tumors have PJS.
　　4, Cervical lesions:About 5.4% of patients have concurrent cervical malignant adenocarcinoma. Patients may have symptoms such as irregular vaginal bleeding, contact bleeding, etc., the external os of the cervix can be papillary or nodular, but there may also be no obvious abnormalities in appearance, and the cervical cytology examination may not show malignant cells. The tumor is a mucinous adenocarcinoma, with irregular branching of acini, and rare cell atypia and nuclear division. However, its growth pattern has a highly malignant tendency, often showing extensive infiltrative growth. Although the proportion of ring tubular sex cord tumors combined with cervical mucinous adenocarcinoma is not high, it is very important to perform careful examination of the patient's cervix and necessary biopsy, because the poor prognosis of cervical malignant tumors will have a great impact on the patient from the bottom up.

　　Ovarian ring tubular sex cord tumors are very rare, and there are no effective preventive measures. High-risk groups need to have regular gynecological examinations, achieve early diagnosis, timely treatment, and good follow-up. For young childless women, the normal contralateral ovary can be explored during surgery, and the diagnosis is confirmed as clinical stage I after pelvic exploration, and the affected adnexa can be removed, but long-term follow-up should be done after surgery.

　　Patients with familial atypical mole-malignant melanoma syndrome (PJS) have typical mucosal pigmented spots, multiple intestinal polyps, solid masses in the adnexa, menstrual irregularity, and elevated estrogen and progesterone levels in serum examination, clinical diagnosis is usually not difficult.
　　Most patients without PJS do not have PJS, and only based on the solid mass of the appendages, menstrual irregular symptoms, the patient's serum hormone determination may be helpful at this time. Because the secretion of a large amount of estrogen and progesterone by tumor cells is an outstanding endocrine change in ring tubular sex cord stromal tumors.
　　1, Laboratory examination:Hormone level detection, tumor marker examination.
　　2, Other auxiliary examinations:Histopathological examination.

　　Recommend several food therapy recipes suitable for patients with ovarian tumors.

　　1, Hawthorn, black fungus, and brown sugar soup

　　50 grams of black fungus, 100 grams of hawthorn, and 30 grams of brown sugar.

　　Preparation: Boil hawthorn to about 500 milliliters, remove the residue, add soaked black fungus, cook over low heat until soft, and then add brown sugar. It can be taken 2 to 3 times, finish within 5 days, and take it continuously for 2 to 3 weeks;

　　2, Water chestnut, Job's tears, and fish maw porridge

　　100 grams of Job's tears, 500 grams of water chestnuts, 150 grams of fish maw, half a piece of dried tangerine peel, an appropriate amount of sticky rice, and a little salt.

　　Preparation: Wash all materials with clean water and set aside; remove the shell of the water chestnut and take out the meat, soak the fish maw in clean water to expand and cut it into pieces. Add a sufficient amount of water to the pot, bring it to a boil over high heat, then add the materials when the water boils again, and change to medium heat to continue boiling until the sticky rice blooms into porridge, and season with salt to taste.

　　3. Steamed Chicken Soup with Yam and Walnut Kernel

　　One chicken, 30 grams of walnut kernel, 40 grams of yam, 25 grams of bamboo slices, 25 grams of dried mushrooms, 25 grams of ham, one chicken, appropriate amount of yellow wine and refined salt.

　　Preparation: Peel the yam and cut it into thin slices, wash the walnuts; blanch the whole chicken with boiling water to remove blood and impurities, place it in a soup bowl, add 50 milliliters of yellow wine, appropriate amount of refined salt, and 1000 milliliters of fresh soup; place the yam, walnut kernel, mushrooms, bamboo slices, and ham slices on the chicken, steam for about 2 hours, and remove when the chicken is tender.

　　The characteristics of this group of patients with PJS (familial polyposis syndrome) are small tumor volume, diameter less than 3cm, about 2/3 are bilateral, and the clinical course is benign. Treatment can be unilateral adnexectomy or total hysterectomy with bilateral adnexectomy. However, due to the presence of multiple colonic polyps, attention should be paid to problems such as gastrointestinal bleeding, intestinal obstruction, and even malignant transformation of polyps. It is recommended to follow up and treat with a specialist physician.
　　The characteristics of this group of patients without PJS are large tumor volume (up to 20cm), most with a diameter greater than 5cm, unilateral, about 20% have metastasis and recurrence, but the interval from initial treatment is relatively long, the shortest is 2 years, the longest up to 15 years, with an average of 6.3 years.
　　For patients with clinical stage II and above or recurrence, cytoreductive surgery should be performed. Since the tumor mainly spreads through retroperitoneal lymph nodes, intraperitoneal implantation is rare, and it is also rare to involve the uterus and the opposite ovary. Therefore, it is very important to remove lymph nodes during surgery, including paraaortic and retroperitoneal lymph nodes in the pelvic cavity. Recurrent tumors are generally easy to separate from surrounding tissues, and surgical clearance is not difficult, so the opportunity for reoperation should not be abandoned.
　　Tumors have certain sensitivity to radiotherapy, and radiotherapy can be supplemented after surgery, in distant metastases, and residual lesions. The application reports of chemotherapy are not many.