Ovarian mixed germ cell-sex cord stromal tumor

　　Ovarian mixed germ cell-sex cord stromal tumors are currently considered to be benign tumors originating from the vitelline duct. Some scholars propose:
　　The ovarian mixed germ cell-sex cord stromal tumor originating from primordial germ cells and coelomic epithelial cells is composed of germ cells and sex cord stromal cells, derived from the yolk sac. Primordial germ cells have the potential for multilineage differentiation, and differentiation into the embryonic cavity forms teratoma components, while differentiation into the extra-embryonic cavity forms endodermal sinus tumor and choriocarcinoma components. Another type of supporting cells and granulosa cells belong to sex cord stromal components, derived from coelomic components, but some scholars propose that they originate from the mesonephric duct.
　　The ovarian mixed germ cell-sex cord stromal tumor derived from solitary germ cells can originate from germ cells, differentiate into embryonic and extra-embryonic tissues, and also differentiate and transform into precursors of sex cord stromal components.

　　Ovarian mixed germ cell-sex cord stromal tumors can be associated with dysgerminoma, which belongs to malignant mixed germ cell tumors. There are also cases of associated yolk sac tumors (endodermal sinus tumors). If they grow rapidly, they are prone to early metastasis and have a poor prognosis. The lesions can also invade adjacent tissue near the cell membrane, the broad ligament, retroperitoneum, and para-aortic lymph nodes, and can also occur in distant metastasis. Ovarian metastatic tumors are often accompanied by ascites, with a high mortality rate.

　　Ovarian mixed germ cell-sex cord stromal tumors are mainly manifested as irregular vaginal bleeding, abdominal pain, and lower abdominal masses. Young girls may present with endocrine disorders and pseudo-female precocious puberty symptoms, such as breast development, pubic hair growth, and vaginal bleeding.

　　The etiology of ovarian mixed germ cell-sex cord stromal tumors is unknown, and therefore there is no effective preventive measure. However, due to the potential for malignancy, follow-up and prevention of malignant transformation after treatment are particularly important.

　　Diagnosis can be made based on the patient's clinical manifestations, signs, and the results of the following examinations.
　　One, laboratory examination
　　1. Endocrine examination: In patients with pseudo-female precocious puberty symptoms, an increase in urinary estrogen can be detected, and the vaginal cell smear shows estrogenic influence. After tumor resection, urinary estrogen can return to normal, and symptoms can disappear.
　　2. Genetic examination: The karyotype determination of chromosomes is performed in most patients, and their social gender is all female. The karyotype analysis shows 46, XX, and 2 adult women delivered normal full-term infants. All patients have normal ovaries, with no abnormalities in internal and external reproductive organs and body posture.
　　Two, other auxiliary examinations
　　Under electron microscopy, the tissue pathological sections show two types of cells in this tumor:
　　1. The main fusiform cells (cells derived from the sex cord) are aggregated into sheets or loosely dispersed between extracellular collagen fiber bundles or around the collagen fiber bundles. The basement membrane is multilayered and surrounds the outside of single cells or clusters of cells, but lacks the concentric pattern characteristic of germinal cells. Fusiform cells are often connected by desmosomes, with irregular nuclei, dense nuclear material and small nucleoli around the nucleus, and cytoplasm containing monosaccharides or polysaccharides, a few mitochondria, and short segments of rough endoplasmic reticulum. The moderate cytoskeletal system is relatively obvious, consisting of 6-8nm microfilaments, which are often densely packed around the cell, thus related to the thickening of the cell membrane.
　　2. Germ cells are located between fusiform cells, without any connection complex between them. They are occasionally connected by adherens junctions (also known as desmosome bands) and fewer cytoplasmic bridges. The cytoplasmic bridges are a continuous cytoplasm between the local cell membrane and adjacent cells, and they are significantly thickened. Germ cells have a regular ovoid nucleus, with fine and uniformly distributed nucleoplasm, prominent nucleoli, and loosely arranged nucleolar filaments. The cytoplasm is rich and contains a small number of organelles, including monosaccharides, polysaccharides, and mitochondria. Glycogen was not found in some tumor germ cells.

　　Recommend several diet therapy recipes suitable for patients with ovarian mixed germ cell-sertoli-stromal tumors.

　　1, Mugwort Stewed Chicken

　　Mugwort 15 grams, old hen 1 piece, rice wine 60 milliliters.

　　Preparation: First, remove the feathers and internal organs of the chicken, wash it clean, put it in a steaming bowl, add an appropriate amount of boiling water, add wine and mugwort to make soup.

　　2, Safflower Wine

　　Safflower 50 grams, wine 1000 milliliters.

　　Preparation: Add safflower to a container, add wine, and soak for a week.

　　Take 50 milliliters each time, twice a day, for 10 days as one course of treatment.

　　3, Yimucao Shengfu Egg

　　Shengfuzi 15 grams, Yimucao 50 grams, eggs 2 pieces.

　　Preparation: Add all the ingredients to the pot, add an appropriate amount of water, and boil the eggs. After the eggs are cooked, remove the shells and put them back in the pot for a few minutes. Remove the medicine residue. Eat the eggs and drink the soup.

　　4, Hawthorn Congee

　　Glutinous rice 100 grams, hawthorn 30 grams, or fresh hawthorn 60 grams, sugar 10 grams.

　　Preparation: First, boil hawthorn in a pot with water to make a concentrated decoction, then remove the residue. Rinse the glutinous rice clean. Boil the glutinous rice with the medicine juice until the congee is cooked. It can be seasoned with sugar when eating.

　　5, Fresh Stir-fried Enoki Mushrooms

　　Enoki mushrooms 150 grams, vegetable oil 10 grams, shredded ginger and chili strips each 10 grams, vinegar 5 milliliters, sugar 10 grams, salt 5 grams.

　　Preparation: Clean enoki mushrooms, cut into strips. Sauté the shredded ginger in oil, add salt, and quickly stir-fry the mushrooms for about 1 minute. Add sugar and vinegar, stir a few more times and it's ready to eat.

　　For patients before puberty, although the tumor volume is large, the tumor is still active and not adherent to adjacent organs. If the patient is determined to be 46, XX karyotype before surgery and the frozen section during surgery confirms that the tumor does not contain other malignant germ cell components, and the careful examination of the abdominal cavity and wedge biopsy of the opposite ovary confirms normality, the resection of the tumor on the affected side or the resection of the adnexa on the affected side can be performed. Conversely, treatment should be based on the patient's age and the presence of other malignant germ cell components. Total hysterectomy and bilateral adnexectomy should be performed, and radical surgery and pelvic lymphadenectomy should be performed as appropriate. Postoperative adjuvant chemotherapy and (or) radiotherapy should be performed.