Ovarian granulosa cell tumors

　　To date, the etiology of granulosa cell tumors is not clear. However, research has found that 58% have gene defects with DNA replication errors. The pathogenesis is as follows:
　　1. Adult granulosa cell tumor
　　Most tumors are unilateral, with bilateral tumors accounting for 5% to 10%. There is a great difference in tumor volume, with small ones only visible under a microscope and large ones that can fill the abdominal cavity. Most tumors are of medium size, with an average diameter of 12 cm. Tumors are round, oval, or lobulated, with a smooth surface and a complete capsule, but 10% to 15% may spontaneously rupture. The texture is hard, tough, or soft, and can be cystic, solid, or both.
　　Microscopic examination shows: ① Characteristics of tumor cells: tumor cells are small, round, oval, spindle-shaped, or polygonal. The cytoplasm is scarce, eosinophilic or neutral, and the cell boundary is unclear. The nucleus is oval or round, the chromatin is reticulate, and there is a typical longitudinal groove in the nucleus, forming a coffee bean-like appearance, which is helpful for differential diagnosis and diagnosis. There is no reticular fiber surrounding the tumor cells. The atypicality of tumor cells is small, the mitosis is few, and it is generally less than 3/10 HPFs. ② Morphology of tumor cell arrangement: tumor cells can be arranged in various forms, such as microfollicular, macroleaflet, trabecular, ribbon-like, and diffuse types. Some tumors are mainly of one form, while others exist in a mixed form of several types.
　　Some scholars have reported the presence of focal liver cell differentiation in granulosa cell tumors and AFP positivity.
　　2, Juvenile granulosa cell tumor
　　Most tumors are unilateral, with bilateral tumors accounting for about 2%. The tumor volume is large, with a diameter of 3-32 cm, with an average diameter of 12.5 cm. Most are solid or cystic and solid, occasionally thin-walled unilocular or multilocular cysts containing serous or gelatinous fluid, and may also contain bloody fluid. The cut surface of the solid area is gray, cream yellow, or yellow, and in highly malignant cases, hemorrhage and necrotic foci can be seen.
　　Microscopic examination shows: ① Characteristics of tumor cells: tumor cells are relatively uniform in size and volume. The cytoplasm is rich, eosinophilic or vacuolated. The nucleus is deeply stained and lacks the longitudinal groove of the nuclear of adult granulosa cell tumors. Mitosis is common, often exceeding 5/10 HPFs. Tumor cells can have a certain degree of atypicality, with severe atypicality reaching 10% to 15%. Flavination is obvious. ② Morphology of tumor cell arrangement: tumors can form atypical follicular shapes, nodules, and solid areas.
　　The typical morphology is solid sheet-like tumor cells, accompanied by follicles of different sizes and shapes, clear boundaries, round or irregular shapes. These follicles resemble normal developing follicles, covered with one to several layers of granulosa cells, containing eosinophilic or alkalophilic fluid in the lumen, and most are positive for mucin carmine staining. The surrounding structure of the follicle is theca cells.
　　The tumor cells in the solid area are arranged diffusely or in multiple nodules, with the surrounding stroma containing theca cells, and these two types of cells can also be mixed. Theca cells often undergo flavinization.

　　If the tumor grows rapidly, the capsule breaks, or the tumor twists, there may be acute abdominal pain symptoms. Late-stage recurrence is common. There are reports of recurrence at the diaphragm 15 years after the excision of the primary tumor and radiotherapy. There are also reports of multiple lung metastases and recurrence 15 years after the excision of the primary adnexa. In addition to intraperitoneal and retroperitoneal metastases, there are reports of vertebral bone metastases and liver parenchymal metastases.

　　About 3% of granulosa cell tumor patients have no obvious symptoms and are discovered by chance. The clinical symptoms of the vast majority of patients are mainly caused by endocrine disorders and abdominal masses.
　　1. Estrogen stimulation symptoms Since tumor cells can secrete estrogen, if the tumor occurs in children before puberty, most of them show precocious puberty. This type of precocious puberty is caused by tumor stimulation and is not true precocious puberty, also known as pseudo-prococious puberty. Clinical manifestations may include breast enlargement, development of the mons pubis, growth of pubic and axillary hair, abnormal development of internal and external genitalia, and even anovulatory menstruation. Some may also show excessive growth in height and bone age, with symptoms of asynchrony in the development of spirit and thought.
　　When the tumor occurs in women of childbearing age, due to the proliferative pathological changes of the endometrium caused by the estrogen secreted by the tumor, the endometrium may show irregular shedding with the fluctuation of estrogen levels in the body, so about 2/3 of the patients may have abnormal vaginal bleeding symptoms such as menorrhagia and prolonged menstrual periods. A small number of patients may also experience continuous amenorrhea or irregular bleeding. The chance of endometrial cancer in granulosa cell tumor patients is 10 times that of normal people. Granulosa cell tumors are also prone to be associated with uterine fibroids, which further aggravates the symptoms of irregular vaginal bleeding. There is also a possibility of breast cancer in about 6% of patients.
　　When the tumor occurs in postmenopausal women, postmenopausal bleeding is a typical clinical symptom, and other manifestations may include breast tenderness, breast enlargement, and vaginal smear showing a right shift in the maturation index of squamous epithelium. In this age group of patients, the incidence of endometrial hyperplastic diseases, precancerous lesions, and cancer is higher than that in women of childbearing age. Patients with endometrial cancer are often over 50 years old.
　　2. Androgenic signs Due to the occurrence of luteinization of ovarian stroma and theca interna cells, a few patients may experience oligomenorrhea, amenorrhea, hirsutism, enlargement of the clitoris, facial acne, and hoarse voice, among other androgenic symptoms. These symptoms often occur in patients with cystic granulosa cell tumors.
　　3. Abdominal mass The average diameter of ovarian granulosa cell tumors is about 12cm, generally of moderate size, and can be palpated during gynecological pelvic examination, but not easily palpable in the abdomen. If a patient feels a mass in the lower abdomen and presents with this as the main complaint, the tumor is often quite large.
　　If accompanied by ascites, symptoms such as abdominal distension, fullness, and difficulty in urination may occur. Ovarian granulosa cell tumors can be palpated as solid and cystic masses through abdominal examination and gynecological pelvic examination, which are generally of moderate size, smooth surface, and movable. The uterus of women of childbearing age can enlarge or have uterine fibroids, while postmenopausal women can have smooth and rosy vaginal mucosa and an uterus that does not atrophy due to tumor hormone stimulation. When the tumor or ascites is present, there can be significant abdominal enlargement and distension. Patients may occasionally have pleural effusion.

　　The etiology of ovarian granulosa cell tumors is not yet fully understood, therefore, there are no targeted preventive measures at present. High-risk populations should undergo regular physical examinations, early detection, and early treatment. After treatment, follow-up care should be taken, and B-ultrasound examinations should be performed regularly to prevent recurrence.

　　Ovarian granulosa cell tumors are tumors with obvious clinical characteristics. Patients may find masses in the adnexa, accompanied by obvious endocrine disorders caused by estrogen stimulation, and diagnosis is usually not difficult. For patients with atypical clinical symptoms, a comprehensive analysis and differentiation should be made based on their age, tumor size, texture, and auxiliary examinations, in order to make a more accurate diagnosis. A few patients may need frozen section pathological examination during surgery to confirm the diagnosis. Routine examination methods include the following:
　　First, laboratory examination
　　Hormone level examination It can assist clinical analysis and diagnosis by detecting the levels of estrogen, progesterone, testosterone, and gonadotropin in the blood of patients, as well as the levels of estrogen in urine. For postmenopausal women, the examination of hormone levels in vaginal cytology smears is simple and easy to perform, which can be of great help in diagnosis.
　　Second, other auxiliary examinations
　　1, Imaging examination MRI, CT, ultrasound, and other examination methods can generally determine the location, source, and relationship with the uterus and surrounding organs of pelvic masses, as well as changes in cystic and solid nature. However, they cannot confirm the histological type of the tumor and are also difficult to estimate its benign or malignant nature.
　　2, Diagnostic curettage It can accurately understand the endometrial hyperplasia, precancerous or cancerous changes under tumor stimulation, clearly define the tumor stage before surgery, which is conducive to formulating appropriate and appropriate treatment plans and achieving satisfactory prognostic effects.

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

　　After chemotherapy, patients may experience significant damage to gastrointestinal function, leading to symptoms such as decreased appetite, loose stools, abdominal distension, pale tongue with white coating, and thin, weak pulse. Choose foods that tonify the spleen and Qi, and transform dampness: such as tangerines, oranges, corn, Coix seed, soybeans, Chinese yam, Astragalus, and Codonopsis.

　　1, Goji Berry Turtle Lean Pork Soup

　　Ingredients: 1 turtle, 30 grams of goji berries, 150 grams of lean pork.

　　Preparation: Kill the turtle, remove the internal organs, wash, cut into small pieces, add water, and stew with goji berries and lean pork until tender. Season with salt and serve.

　　Indications: Weakness after chemotherapy.

　　2, Compound Astragalus Porridge

　　Ingredients: 30 grams of raw Astragalus, 15 grams of red bean, 30 grams of raw Coix seed, 9 grams of chicken gizzard, 2 golden pomelo cakes, 30 grams of glutinous rice.

　　Preparation: Wash raw Astragalus, raw Coix seed, red bean, and glutinous rice, and wash the chicken gizzard. Dry and grind into fine powder. Put the raw Astragalus in a pot, add 1000 milliliters of water, and simmer over low heat for 20 minutes. Remove the Astragalus, add Coix seed and red bean, and boil for 30 minutes. Then add glutinous rice and chicken gizzard powder, and cook into porridge.

　　Take twice a day, chew 1 golden pomelo cake after eating porridge.

　　Indications: After chemotherapy, the stomach is damaged, with weak Qi and poor appetite.

　　3, American ginseng and Chinese yam pigeon soup

　　Ingredients: 1 pigeon, 30 grams of Chinese yam, 15 grams of American ginseng slices, 4 dried red dates, 1 slice of ginger.

　　Preparation: Wash American ginseng, Chinese yam, dried red dates (with seeds removed), and ginger. Remove feathers and internal organs from the pigeon, wash, and cut into small pieces. Place all the ingredients in a steaming bowl, add an appropriate amount of boiling water, cover the bowl, and simmer over low heat for 2 hours. Season with salt to taste. Drink the soup and eat the meat as desired.

　　Indications: Symptoms such as damage to Qi and Yin after chemotherapy, weakness, poor appetite, dry mouth, etc.

　　Traditional Chinese medicine therapy has certain auxiliary effects on tumor treatment, and it mainly has the following categories:
　　1. Chinese Medicine with Direct Antitumor Effects
　　Functions: ① Used alone to treat all stages of tumors. ② Control tumor growth before surgery. ③ Prevent tumor recurrence after surgery. ④ Used in radiotherapy and chemotherapy to correct anemia, leukopenia, gastrointestinal reactions, etc.
　　2. Internal Administration Decoction
　　Leonurus japonicus, Prunella vulgaris, Ligusticum chuanxiong, Ophiopogon japonicus, Scolopendra, Hemerocallis, Semen Nelumbinis, Lonicera japonica, Melia azedarach, Adenophora, Cinnamomum cassia, bamboo shavings, Bubalus bubalis pearl, Osteolepis, Trionyx sinensis, Asiasaraca, etc.
　　Adjustments: Nausea, add Pinellia ternata, Scutellaria baicalensis, ginger. Thrombocytopenia, add Rehmannia glutinosa, Polygonum multiflorum, Lycium barbarum, Cistanche deserticola. Poor appetite and abdominal distension, add hawthorn, Massa medicata, Hordeum vulgare; Nausea and vomiting, add bamboo shavings, Perilla frutescens, Coptis chinensis, Perilla frutescens, Amomum villosum. Excessive leukorrhea, add Poria cocos, Atractylodes macrocephala, Aplysia, Lotus node; Red and white leukorrhea add Aplysia, Rubia cordifolia, Poria cocos, Gardenia jasminoides. Leukopenia, add Cornus officinalis, Psoralea corylifolia, Curculigo orchioides, Polygonum multiflorum, Epimedium sagittatum, or Panax ginseng, Schisandra chinensis, Ophiopogon japonicus, Eclipta prostrata, Moutan Cortex, or Trichosanthes kirilowii, Cinnamomum cassia, Glycyrrhiza uralensis.
　　The above prescription is decocted with water and taken once a day, 30 doses as one course of treatment.
　　3. Internal Administration Powder
　　Narula, Aloe vera, American ginseng, Pearl, Hippocampus, Scolopendra, Cordyceps sinensis, etc.
　　Grind the prepared medicine into fine powder, take 3 times a day, 1 to 2 grams each time. If it is difficult to swallow the powder, the medicine powder can be filled into capsules, 0.5 grams per capsule, 2 to 4 capsules each time.
　　4. External Application Lotion
　　Stephania tetrandra, Frankincense, Corydalis Yanhusuo, Rana catesbeiana skin, Myrrha, Borneol, Gallus gallus domesticus, etc.
　　Refined into external application agent, used for local application on the painful area. Apply 2 to 3 times a day.
　　5. External Application Paste
　　Rhizoma Coptidis, Rhizoma Anemarrhenae, Corydalis Yanhusuo, Bupleurum, Curcuma, Evodia, Cornu Antelopis, Buthus Martensii, Scolopendra, Borneol, etc.
　　Boil the medicine in water, apply locally with damp敷剂, for 20 to 30 minutes each time, 1 to 3 times a day.