Ovarian交界性肿瘤

　　The etiology of ovarian交界性肿瘤 is not yet clear. Peritoneal pseudomyxoma associated with交界性肿瘤 was previously believed to be primary in the ovary, but now it is proposed that the most likely source is the appendix. The main pathological type is serous and mucinous, and there are also endometrioid, clear cell, and other classifications, but they are all very rare.

　　Ovarian交界性肿瘤 are prone to adhesions with surrounding tissues and the incidence of lymph node metastasis is 1% to 16%, which is unrelated to clinical stage. Other complications are as follows:

　　1, Tumor rupture

　　It can cause spontaneous rupture due to ischemic necrosis of the cyst wall or tumor erosion through the cyst wall; or due to trauma caused by compression, delivery, gynecological examination, and puncture. After rupture, the cyst fluid flows into the peritoneal cavity, stimulates the peritoneum, and can cause severe abdominal pain, nausea, vomiting, and even shock. During examination, there are signs of peritoneal irritation such as tense abdominal wall, tenderness, and rebound pain. The original mass may shrink or disappear. After diagnosis, immediate laparotomy exploration, cyst resection, and peritoneal lavage should be performed.

　　2, Infection

　　It is relatively rare and often secondary to tumor pedicle torsion or rupture. The main symptoms include fever, abdominal pain, elevated white blood cells, and varying degrees of peritonitis. Active infection control and scheduled surgery exploration should be performed.

　　The clinical symptoms of ovarian交界性tumors are non-specific, mainly abdominal distension, abdominal mass, and lower abdominal pain. Lymph node metastasis also exists, and the involved lymph nodes are mostly pelvic and para-aortic lymph nodes. Whether the tumor is accompanied by implantation or not, the lesions of the involved lymph nodes are similar.

　　The etiology of ovarian交界性tumors is not yet completely clear, so there is currently no effective preventive measures. High-risk groups should be screened regularly to achieve early detection and early treatment, and follow-up after treatment. Vaginal ultrasound, gynecological examination, and serum CA125 are routine follow-up items for patients after surgery, among which vaginal ultrasound examination is currently the most effective means for detecting recurrence, and CA125 is elevated in many serous交界性tumors.

　　Ovarian交界性tumors are diagnosed by histopathology (WHO, 1999): ①The nuclei of交界性tumor cells and the mitotic figures are between the obvious benign and definite malignant of this type; ②Some atypical stratified epithelial cell clusters have detached from their original position; ③There is no obvious stromal infiltration. Other examinations include:
　　First, laboratory examination:Gynecological examination, tumor markers such as serum CA125, CA19-9.
　　Second, other auxiliary examinations:Laparoscopy, vaginal ultrasound, and histopathological examination.

　　Recommend several dietetic recipes suitable for patients with ovarian交界性tumors.

　　1, Phytolacca acinosa Porridge Formula

　　100g of glutinous rice, 10g of phytolacca acinosa, 5 pieces of jujube, and an appropriate amount of clear water.

　　Preparation: Boil phytolacca acinosa in water to make a decoction, remove the dregs, then add glutinous rice and jujube to cook porridge on an empty stomach, take it in small doses, and do not overdo it.

　　Function: Promote bowel movements, relieve constipation, and eliminate edema.

　　Indications: Abdominal hydrothorax caused by urinary difficulty due to ovarian tumors.

　　2, Chenxiang Beef

　　15 grams of rhizoma cyperi, 30 grams of dried tangerine peel, 500 grams of beef, scallions, ginger, and an appropriate amount of salt.

　　Preparation: Boil dried tangerine peel and rhizoma cyperi with 2000 grams of water for half an hour, remove the dregs, add beef with scallions, ginger, salt, and other seasonings, and simmer over low heat until tender, cool, and then slice and eat.

　　Function: Soothe the liver and regulate the qi, and invigorate the spleen and benefit the qi.

　　3, Shenqi Invigorating Spleen Soup

　　10 grams of Korean ginseng, 10 grams of astragalus, 18 grams of codonopsis, 18 grams of yam, 15 grams of goji, 10 grams of angelica, 5 grams of dried tangerine peel, 14 grams of longan meat, 300 grams of pork spareribs or 1 whole chicken, and an appropriate amount of clear water.

　　Preparation: Wash Chinese herbs such as ginseng and astragalus and put them in a cloth bag, tie the mouth, and boil them with spareribs or chicken with water, first with high heat and then with low heat, for 2-3 hours. Remove the cloth bag, add salt, pepper, and other seasonings, and it is ready to eat. Take one small bowl each time, once a day, the above materials can make 5 small bowls, eat the meat and drink the soup. The surplus can be stored in the refrigerator.

　　Function: Invigorate the spleen and lung, and strengthen the stomach and vital energy.

　　The treatment of ovarian交界性肿瘤 is mainly surgical, and except for special cases, it is now generally not recommended to add adjuvant therapy. Unlike the past, the concepts of micro灶性 infiltration and non-invasive implantation have been introduced, providing a basis for the treatment of交界性tumors.
　　1. Conservative Surgery for Ovarian交界性肿瘤 Conservative surgery usually refers to the removal of the affected adnexa and is suitable for young patients with a desire to reproduce. The surgery should meet the following conditions: ① The patient is young and desires to reproduce; ② It is confirmed to be stage I, with the opposite ovary and fallopian tube being normal; ③ There are conditions for long-term follow-up after surgery. For young patients with a tumor in one ovary, it is generally advisable to take abdominal fluid or peritoneal lavage fluid after laparotomy, and then perform a unilateral adnexectomy first, and send a frozen section for examination if there is any suspicion. If the pathological report indicates a交界性 ovarian tumor, a biopsy of the opposite ovary should be performed and sent for pathological examination, and a careful exploration of the pelvis and upper abdomen should be made. If there is no evidence of malignancy, no other surgery is needed. The resected specimen should be cut into slices every 1-2 cm for examination to clarify whether there is invasion. If the paraffin section pathological examination shows cancer, re-staging surgery for ovarian cancer and/or chemotherapy can be performed according to the situation.
　　2. Other Surgical Procedures for Ovarian交界性肿瘤 For adults in clinical stage I who no longer need to reproduce, a hysterectomy, bilateral salpingectomy, omentectomy, and appendectomy can be performed. Since benign,交界性, and malignant components often coexist in the same tumor, if the frozen section pathological examination during surgery cannot determine the交界性 or malignant nature, it is generally advisable to perform lymph node dissection: for stage II, III, and IV, tumor cell reduction surgery can be performed.
　　3. Adjuvant Treatment Regarding the postoperative adjuvant treatment for交界性肿瘤, there are several principles: ① The purpose of the adjuvant treatment for交界性肿瘤 should be to reduce the lesion, and chemotherapy can be given to those with tumor residue to create conditions for the success of a second resection, but it cannot be expected to improve the prognosis through adjuvant treatment. ② Patients with no tumor residue after stage I and other stages of the FIGO postoperative treatment do not need adjuvant treatment, but should be followed up closely. ③ Patients without peritoneal invasion do not need adjuvant treatment, and only those with invasive implantation in serous交界性肿瘤 need chemotherapy. ④ The proliferation rate of tumor cells in交界性肿瘤 is slower than that in epithelial cancer, and chemotherapy should be different from that for ovarian epithelial cancer, and a milder regimen should be chosen, such as the PC regimen is ideal, and the course should not be too intensive. ⑤ It is recommended to conduct tests of tumor cell DNA content, ploidy level, and related cancer genes to clarify the pathological type of the metastatic focus, making the treatment more targeted.