Ovarian mucinous tumors

　　The histogenesis originates from the germinal epithelium, divided into endometrioid and intestinal mucinous epithelium, which is now widely used and listed in the International Classification of Ovarian Histology (Scully, 1999). The pathogenesis of ovarian mucinous tumors of different types is as follows.

　　1. Benign mucinous cystadenoma Most are multicystic, generally of moderate size, but can also grow to fill the entire peritoneal cavity, with a diameter up to 50cm. The tumor is gray and shiny, with a slightly thick cyst wall and elasticity. Sometimes several cystic protuberances can be seen on the outer wall, and the surface is slightly pale yellow. The contents of the cyst are mucinous, opaque, and a sticky fluid resembling jelly, slightly pale blue. The solid areas felt during examination are often clusters of many honeycomb-like small compartments, and the tumor can be opened to find that the compartments vary greatly in size and distribution, often with one or more daughter cysts nested within a compartment. The mucin within the tumor is mucoprotein or glycoprotein, so the term 'pseudomucinous cystadenoma' has now been changed to 'mucinous cystadenoma'. The tumor epithelium is a single-layer tall columnar, with the nucleus located at the base and arranged regularly, similar to the cervical canal mucosal epithelium. Sometimes intestinal-type epithelium can also be found, including goblet cells, Paneth cells, and argentaffin cells. Mucinous cystadenomas often occur simultaneously with other ovarian epithelial tumors, such as serous, endometrioid, or sex cord stromal tumors. Peutz-Jeghers syndrome (Chen KT, 1986), which is pigmented melanotic macules of the skin and mucous membranes, accompanied by multiple gastrointestinal polyps, may sometimes occur with this tumor, but attention should be paid to the possibility of malignancy.
　　2. Borderline mucinous cystadenoma More complex than borderline serous tumors, it is multicystic. Thickenings of the cyst wall or papillae may be seen, with most papillae being small and some also polypoid. Microscopic features: ① Epithelial stratification reaches 2～3 layers, but does not exceed 3 layers, with papillae and epithelial clusters forming; ② Cells are slightly to moderately atypical, with reduced mucus secretion and goblet cells visible; ③ Mitotic figures do not exceed 5 per high-power field of vision; ④ Tumor cells do not invade the stroma.
　　3. Peritoneal pseudomucinous cystadenoma Peritoneal mucinous cystadenoma, which is the reaction of peritoneal implantation caused by the presence of mucus in the peritoneal cavity, often combined with appendiceal and ovarian mucinous tumors. The widely accepted view is that peritoneal pseudomucinous cystadenoma originates from mucinous tumors of the ovary and appendix, both of which are often classified as交界性肿瘤 due to atypical epithelial cells and stratification. 10％～29％ of appendiceal mucinous tumors are associated with peritoneal pseudomucinous cystadenoma, and 3.5％～12％ of ovarian mucinous tumors are associated with peritoneal pseudomucinous cystadenoma. One-third of patients with peritoneal pseudomucinous cystadenoma have mucinous tumors in both ovaries and appendices. If both have tumors, the ovary is likely to be metastatic. The ovarian tumors associated with peritoneal pseudomucinous cystadenoma, according to data from Shanghai Medical University, 71.4％ are bilateral, while generally only 10％ of primary mucinous ovarian tumors are bilateral.
　　4. Mucinous cystadenocarcinoma Multilocular is more common, although not much bilateral, but more than benign in ovarian mucinous tumors, accounting for 5% to 40%. The appearance is smooth, round or lobulated, the cross-section is cystic and multilocular, with solid areas. The inner wall of the cyst can see papillae, but less than serous carcinoma, and papillae and solid areas are more than benign or borderline cystadenoma. The cyst cavity contains hemorrhagic gelatinous mucus, and hemorrhage and necrosis are common in solid areas.
　　The microscopic characteristics are: ① Epithelial stratification exceeds 3 layers; ② Severe atypical hyperplasia of the epithelium, accompanied by abnormal mucus secretion; ③ The glands have a back-to-back phenomenon; ④ Active mitosis; ⑤ Stromal infiltration.

　　Ovarian mucinous tumors occasionally occur with appendiceal mucinous cystadenoma and pseudomyxoma peritonei. Benign mucinous cystadenoma should pay attention to whether there is a combined borderline or malignant mucinous carcinoma, and the opportunity to combine pregnancy is 3 to 4 times more than that of serous cystadenoma. Borderline mucinous cystadenoma may appear abdominal pain or distension. The incidence of mucinous cystadenocarcinoma combined with pregnancy is relatively low.

　　The clinical manifestations of ovarian mucinous tumors of different classifications are described as follows.

　　1. Benign mucinous cystadenoma Rarely bilateral. Generally larger, prone to compression symptoms.
　　2. Borderline mucinous cystadenoma Commonly manifested as pelvic mass and ascites, and may also appear abdominal pain or distension.
　　3. Mucinous cystadenocarcinoma The symptoms are similar to serous carcinoma, and there are more unilateral cases than serous carcinoma. Generally, it is manifested as abdominal mass, abdominal distension, abdominal pain, or compression symptoms. In the late stage, there may be cachexia, weight loss, and some patients may also have menstrual changes.

　　Currently, there are no targeted preventive measures for ovarian mucinous tumors. High-risk groups should do regular physical examinations, early detection, and early treatment. After treatment, pay attention to follow-up monitoring of tumor markers to prevent recurrence.

　　Ovarian mucinous tumors can be diagnosed based on the patient's clinical manifestations, symptoms, and the following related examination results.
　　1. Laboratory examination:Tumor marker examination.
　　2. Other auxiliary examinations:Abdominal ultrasound, histopathological examination, laparoscopic examination.

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

　　1. Nourishing Double Ear Soup

　　Black fungus and white fungus each 200g. Soak black fungus and white fungus in water, sauté, add fresh soup and spices, and thicken after cooking to taste.

　　Indications: After surgery and radiotherapy.

　　2. Oyster mushroom egg roll

　　Cut the oyster mushroom into strips, stir-fry with vegetable oil until cooked, then remove and add a little salt; beat the eggs, fry into a skin, put the stir-fried oyster mushroom strips inside, roll them up, and serve.

　　Indications: Poor taste after tumor surgery, radiotherapy, and chemotherapy.

　　3. Carrot, water chestnut, and bamboo sugar pot

　　Carrot 250g, water chestnut 250g, bamboo sugar 1 piece. Put all the ingredients into the pot, add an appropriate amount of water, boil, and then simmer over low heat for 1 hour.

　　Effects: Nourishing yin, generating fluid, and quenching thirst.

　　Indications: For those with heat injury and dryness after radiotherapy, swelling and pain in the throat, and dry mouth and tongue.

　　Not suitable for those with weak spleen and stomach, phlegm, and dampness.

　　4. Bitter Melon Stewed with Mung Bean

　　Bitter Melon 500 grams, mung bean 120 grams, a little salt. Cut the fresh bitter melon open, wash it clean, remove the flesh, and cut it into large pieces. Soak the mung bean in water, wash it clean, and drain the water. Add some water to the pot, bring it to a boil over high heat, add the bitter melon and mung bean, and cook until the mung bean flowers, then season with a little salt and it is ready to drink.

　　Indications: For those with oral cancer, persistent ulcers on the lips that do not heal, or those with tongue pain, swelling, and secondary infection, or with ulcerative taste and smell.

　　Contraindications: People with weak bodies, coldness in the spleen and stomach.

　　5. Stir-fried Beef with Bitter Melon

　　Bitter Melon 1 piece, beef 50 grams, garlic 5 grams, scallion 2 grams, chili 10 grams, sugar, soy sauce, vinegar, cornstarch as needed. Wash the bitter melon clean, cut it in half, remove the inner flesh, and cut it into thin slices. Heat the pan, pour in the bitter melon, and stir-fry for 2 minutes, then pour it into a plate; wash the garlic, scallion, and chili clean, chop them, and heat the pan with oil, then stir-fry until fragrant, then add the stir-fried bitter melon, a little salt, sugar, soy sauce, and vinegar, and stir-fry for 1-2 minutes over high heat, then take it out; wash the beef clean, cut it into strips, soak it in cornstarch and soy sauce for 5 minutes, then quickly stir-fry it in a pan with hot oil until it is cooked, then add it to the bitter melon, stir-fry a few times, and it is ready.

　　Effects: Strengthening the spleen and stomach, clearing heat and detoxifying, strengthening the body and fighting cancer.

　　Indications: Tumor patients with weak spleen and stomach, irritability.

　　The treatment of ovarian mucinous tumors mainly adopts surgical resection, supplemented by comprehensive treatment of radiotherapy and chemotherapy.
　　1. Benign Mucinous Cystadenoma:Surgical resection is effective. When it is difficult to remove the tumor completely due to its size, the fluid inside the cyst can be first aspirated, but care should be taken to prevent the contents from spilling out to avoid the formation of ascitic fluid in the abdominal and pelvic cavity, which may lead to pseudomyxoma peritonei.
　　2. Borderline Mucinous Cystadenoma:主要以手术为主，需根据临床分期来决定手术范围，应尽量切除一切肉眼所见的肿瘤。注意有无合并腹膜黏液瘤或假黏液瘤，最好同时切除阑尾，术后辅以化疗。
　　3. Mucinous Cystadenocarcinoma:Similar to the treatment methods for serous carcinoma.