Ovarian serous tumors

　　Ovarian serous tumors belong to ovarian epithelial tumors, and it is widely recognized in recent years that ovarian epithelial tumors originate from the surface epithelium-mesenchyme of the ovary. This epithelium and peritoneal mesothelium both come from coelomic epithelium, and they participate in the formation of the Mullerian duct during the embryonic period. The pathogenesis and metastasis pathways are as follows.
　　I. Pathogenesis of Ovarian Serous Tumors
　　1. Serous benign cystadenoma:
　　① Unilocular serous cystadenoma: Due to its appearance as a unilocular thin-walled cyst, it is often called a simple cyst (simplecyst). The tumor surface is smooth, the wall is thin, and the size ranges from several centimeters to tens of centimeters. The section is a single cystic cavity, with a smooth inner wall, and sometimes flat scattered blunt papillae can also be seen. The fluid in the cyst cavity is transparent, pale yellow, serous, and occasionally contains sticky mucus. The epithelium is a single layer of cuboidal or columnar, often containing a small amount of tubal epithelium.
　　② Multilocular serous cystadenoma or serous papillary cystadenoma: The cystic cavities are separated by fibrous tissue into multiple chambers, the surface can be nodular, and the size and texture depend on the size of the cyst and the tension of the cyst fluid. Generally, the capsule is slightly thick, grayish-white, and smooth; papillary growth can be seen within the chambers, and the papillae can be endophytic, exophytic, or both. The epithelium is mostly tubal type, with orderly arrangement of cells, uniform size, and no nuclear division. Sand grains can sometimes be seen between the tumor stroma and the papillae.
　　③ Serous surface papilloma: Less common, characterized by all papillae being exophytic, of unequal size, and under the microscope, ovarian stroma or fibrous tissue can be seen, covered with a single layer of cuboidal or low columnar epithelium, with some cells having cilia. Although these tumors are benign, the epithelial cells can fall off, implant on the surface of the peritoneum or pelvic organs, and even lead to ascites. Clinically, attention should be paid to this.
　　④ Fibrocystic adenoma and adenofibroma: Derived from the ovarian germinal epithelium and its stroma, adenofibroma is mainly fibrous stroma, mostly solid, with a small amount of scattered small cystic cavities; cystic adenofibroma accounts for half or most of the substance, the rest is larger cystic cavities. Both are benign, with an average size of 9 cm, usually unilateral. Occasionally, there are clusters of polygonal large cells in the stroma, which are flavinized follicular membrane cells, and the cystic cavities are covered with a single layer of cuboidal or columnar epithelium.
　　2. Borderline serous tumors:Similar to benign serous cystadenoma, but with more papillary protrusions, larger in size, and more opportunities for bilateral occurrence than benign.
　　Microscopic observation: ① Epithelial hyperplasia does not exceed 3 layers, can also hyperplasia in clusters. There are often papillae formation, with fewer branches, and the surface epithelium does not exceed 3 layers. ② The nuclei are atypical, deeply stained, but limited to below moderate range. ③ Nuclear division is rare, with no more than one in a high-power field. ④ There is no stromal infiltration.
　　3. Serous carcinoma:① Serous adenocarcinoma, serous papillary adenocarcinoma, and serous papillary cystadenocarcinoma: Serous adenocarcinoma is a malignant tumor of the mucosal epithelium of the Mullerian duct, whose cancer cells are often characterized by the formation of cystic cavities and papillae, but still retain the original tissue morphology to some extent. Some tumors form large and irregular small cystic cavities, and sometimes the epithelium protrudes into the cavity to form epithelial clusters or papillae. ② Malignant adenofibroma and cystic adenofibroma: There is no distinction in appearance from benign adenofibroma, and under the microscope, the epithelial components are malignant, with active nuclear division, or irregularly sized cystic cavities, or solid tumors, etc.
　　II. Metastatic Routes of Ovarian Serous Tumors
　　1. Direct Diffusion:Serous papillary cystadenocarcinoma has more opportunities for direct spread and diffusion, such as peritoneum, peritoneal wall peritoneum, and peritoneum of abdominal cavity organs, including diaphragm, omentum, small intestine, rectum, rectouterine pouch, colon, vesicouterine peritoneum, and serous layer of fallopian tube and uterus. About 2/3 of patients have ascites, and the symptoms caused by it have been described as mentioned above. Some patients may have no discomfort at all, just feeling an increase in abdominal circumference. Whether there is ascites is very related to prognosis. Recent reports show that the 5-year survival rate of stage III and IV ovarian cancer without ascites is 5 times higher than that with ascites. The formation of ascites is related to lymphatic obstruction (mainly the right lateral diaphragmatic lymphatic vessels), stimulation of the peritoneum, and unbalanced fluid flow in the abdominal cavity. Cancer cells can not only implant with the flow of fluid, but also the site of abdominal puncture for ascites can appear growth of cancer tumors, forming subcutaneous small nodules or masses. Some patients are misdiagnosed as tuberculous peritonitis and liver cirrhosis due to ascites, and the cancer implantation mass at the puncture site has not yet been able to raise alarm.
　　2. Lymphatic metastasis:Lymphatic metastasis has the highest incidence in serous papillary carcinoma of the ovary, higher than that of mucinous carcinoma. Pathological grading seems to have little effect, while clinical staging with retroperitoneal lymph node metastasis is classified as stage IIIc. The rate of metastasis in pelvic lymph nodes and para-aortic lymph nodes is similar.
　　3. Hematogenous spread:In the past, it was thought that there were not many metastases in the lung and liver parenchyma through hematogenous spread, but recent reports are not rare, and even after surgery and chemotherapy for a certain period of time, there are also cases of recurrence of metastasis.

　　Serous ovarian tumors are prone to complications such as adhesions with surrounding tissues, such as intestinal adhesions, with about 2/3 of patients with ascites. Serous ovarian tumors are a serious gynecological disease, and high-risk groups should regularly pay attention to screening.

　　Serous ovarian tumors show different clinical manifestations according to different classifications.
　　1. Serous Benign Cystadenoma Most cases are unilateral, but serous cystadenomas are more common in both sides than other epithelial tumors. When the tumor is not large, the symptoms may not be obvious, but when it grows, it can cause compressive symptoms, acute abdominal pain may occur due to pedicle torsion or tumor infection. Attention should be paid to pathological diagnosis and differentiation from malignancy, especially for those with papillary growth, especially those with surface papillary exogenous types. Tumor markers such as CA125 can help in differentiation, with an incidence of malignancy of about 35%, but a higher incidence of papillary-type malignancy. Serous adenofibroma is rare, and endocrine disorders are occasionally seen.
　　2. Borderline Serous Tumors In addition to the symptoms of pelvic masses, there are more opportunities for ovarian extrusion, and papillae are prone to bud-like hyperplasia, which is easy to fall off and implant, or cause complications such as ascites and intestinal adhesions.
　　3. Serous Carcinoma Due to the deep location of the ovary in the pelvic cavity, the tumor is not large in the early stage, and it is difficult to appear symptoms when there is no metastasis or complications. Once there is ascites or metastasis, symptoms such as abdominal distension and gastrointestinal symptoms, such as dyspepsia or difficulty in defecation, may occur. Depending on the size and location of the mass, there may be hidden pain or compressive symptoms, manifested as difficulty in urination or discomfort. It is emphasized that women with gynecological tumors must undergo a three-point examination, especially for postmenopausal women, as the vaginal fornix becomes shallow, and it is difficult to find the mass through bimanual examination, especially the posterior fornix with metastatic nodules. It is often easy to find the mass during gynecological three-point examination.
　　

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

　　Ovarian serous tumors can be diagnosed based on the patient's clinical manifestations, symptoms, and the following related examination results.
　　1. Laboratory tests:Tumor marker tests show that 80% of ovarian serous carcinoma patients have positive CAl25 in serum. Due to the possibility of positive results in other tumors and non-tumor diseases, such as endometriosis, it is more meaningful to use it for follow-up monitoring, and other methods should be used in conjunction with differential diagnosis.
　　2. Other auxiliary examinations:Abdominal ultrasound, histopathological examination, laparoscopic examination.

　　The following are the dietary注意事项 for patients with ovarian serous tumors:

　　1. Eat more foods with antitumor effects, such as Dragon pearl tea, hawthorn.

　　2. For hemorrhage, eat goat blood,螺狮, cuttlefish, conch, spinach, lotus root, malan head, mushrooms, Shí ěr, Huǒ zǐ, persimmon cake.

　　3. For infection, eat eels, Wenzhoulab, water snakes, needlefish, carp,麒麟菜, celery, sesame, buckwheat, brassica, toon, red beans, mung beans.

　　4. For abdominal pain and distension, eat pork kidneys, Myrica rubra, hawthorn, citrus cake, walnuts, chestnuts.

　　5. Avoid warm and blood-moving foods such as lamb, dog meat, chives, pepper, and others.

　　6. Avoid greasy, fried, and pickled foods.

　　7. Avoid smoking, drinking, scallions, garlic, chili, and other刺激性 food.

　　The treatment methods for ovarian serous tumors of different classifications should try to adopt surgical resection, supplemented by comprehensive treatment of radiotherapy and chemotherapy.
　　1. Serous Benign Cystadenoma The affected ovary should be removed.
　　2. Borderline Serous Tumors The extent of surgery is determined based on the clinical stage and age of the patient, and all visible tumors should be removed.
　　3. Serous Carcinoma According to the clinical stage of the patient's tumor, which is clearly defined by surgery and pathology (FIGO), the surgical method is determined based on age and the requirements for fertility. Conservative surgery is performed for stage I, while the rest should be operated according to the surgical methods for ovarian cancer, supplemented by chemotherapy.