Ovarian malignant mixed mesenchymal tumors

　　The cause of ovarian malignant mesenchymal mixed tumors is unknown. Most scholars believe that it may originate from the surface epithelium of the ovary and the ovarian stroma or occur in the ectopic endometrium of the ovary. Some scholars have reported that ovarian carcinosarcoma may be related to radiotherapy, and its exact etiology needs to be further explored. In 1988, WHO classified ovarian carcinosarcoma as a subtype of ovarian endometrioid adenocarcinoma, belonging to ovarian epithelial malignant tumors. Recently, Moritani et al. reported a case of ovarian endometrioid adenocarcinoma patient who recurred and then transformed into ovarian carcinosarcoma, suggesting that ovarian carcinosarcoma may originate from endometrioid adenocarcinoma in terms of tissue genesis.

　　Clinical manifestations are often abdominal pain, abdominal distension, discomfort in the stomach, abdominal mass, and symptoms of cancer metastasis. Some patients may have abnormal vaginal bleeding and discharge. At the time of consultation, 80% of patients are in the late stage. Peritoneal surface metastasis and peritoneal implantation.

　　Ovarian malignant mesenchymal mixed tumors have a rapid development. Clinical manifestations are often abdominal pain, abdominal distension, discomfort in the stomach, abdominal mass, and symptoms of cancer metastasis, such as vaginal abnormal bleeding and discharge. At the time of consultation, 80% of patients are in the late stage. Physical examination may reveal a pelvic mass, generally more than 10cm in size, and may have ascites and anemia.

　　1, Vigorously carry out publicity, advocate high-protein, high-vitamin A, C, E diet, avoid high-cholesterol diet. Contraception for high-risk women should use oral contraceptives.

　　2, Women over 30 years old should have a gynecological examination once a year, and high-risk groups should start screening from a young age, and B-ultrasound detection and routine examination of fetal alpha globulin can be performed.

　　3, Early detection and early treatment. Ovarian cystic masses with a diameter greater than 6 cm should be surgically removed and sent for routine pathological examination. Because benign tumors may also have the possibility of malignant transformation if they continue to grow. Solid ovarian masses should be operated on as soon as possible, frozen section examination should be performed during the operation to determine the scope of surgery. For pelvic masses with unclear diagnosis or ineffective conservative treatment, early laparoscopic examination or laparotomy should be performed. Postoperative routine gynecological examination and regular follow-up should be performed for patients with breast cancer or gastrointestinal cancer to detect metastatic cancer early.

　　4, Selenium plays such an important role as an auxiliary means in tumor treatment, and selenium is one of the main components of glutathione peroxidase, which can prevent the formation of peroxides and free radicals in the body, can oxidize lipid peroxides or hydrogen peroxide, thereby protecting cells in the body and inhibiting the occurrence of cancer.

　　One, Histopathological examination

　　1, Gross features

　　Mostly solid or cystic, with irregular surface, grayish-white, with hemorrhagic areas. Cut surface:

　　(1) There is often extensive infiltration in the pelvis and abdomen, with hemorrhagic ascites.

　　(2) It may present as solid yellowish-white areas, with extensive hemorrhage and necrosis.

　　2, Microscopic features

　　(1) Composition: Composed of malignant epithelial components (adenocarcinoma) and sarcoma components.

　　① Main: Poorly differentiated endometrioid adenocarcinoma and serous adenocarcinoma

　　② Other: May have mucinous adenocarcinoma or clear cell carcinoma.

　　(2) Heterologous sarcoma component: May contain immature cartilage tissue and other heterologous components.

　　(3) Homologous sarcoma component: Similar to fibrosarcoma, endometrial stromal sarcoma, or smooth muscle sarcoma.

　　Two, Genetic heterogeneity analysis

　　Homologous allelic deletion phenomenon. Cell culture, immunohistochemistry, and molecular genetic studies have proven it to be of monoclonal origin.

　　Three, Tumor marker detection

　　Four, Laparoscopic examination

　　1, Taoren 3 grams, Gancao 6 grams, Guizhi 10 grams, Mangxiao 10 grams, Xuebi 10 grams, Dahuang 16 grams.

　　Usage: Decocted for oral administration, 1 dose per day, twice a day.

　　2, Gancao 6 grams, Taoren 9, Xingren, Junpi, Danpi, Guizhi each 9 grams, Dahuang 10 grams, Vinegar 30 grams, Honey (for immediate use) 30 grams.

　　Usage: Decocted for oral administration, 1 dose per day, twice a day.

　　3, Guan Gui 3 grams, Aniseed, Dried ginger each 6 grams, Chuanxiong, Chishao, Puhuang, Fried Wulingzi, Wu ye each 10 grams, Xiangfu 12 grams, Yanhusuo 15 grams, Danggui 20 grams.

　　Usage: Take 1 dose daily, decocted into 400ml, taken twice a day, and do not stop taking medicine during the menstrual period.

　　1. Surgical Treatment

　　The main treatment method is surgery, the scope of surgery is the same as that of epithelial ovarian cancer, early stage of bilateral uterus + ovaries + omentum + appendices + pelvic lymph nodes and para-aortic lymph node resection, late stage of tumor cell reduction surgery. However, due to the rapid development and high malignancy of the disease, most patients are in the late stage when they seek medical attention, and it is difficult to achieve ideal surgical treatment effects. Le et al. reported that less than 15% of patients in stage III to IV achieved ideal treatment effects in the first surgery. Yang Yue et al. reported that only 4 cases were satisfactory in 7 cases.

　　In 1994, Prendiville et al. reported the treatment experience of 20 patients with advanced ovarian sarcoma over 10 years at Manchester Saint Mary's Hospital. The patients were divided into three groups and treated with surgery alone, chemotherapy alone, and combined surgery and chemotherapy, respectively. The results showed that 45% of the patients died within one year after surgery, and the average survival period was 14 months, but 2 patients achieved complete clinical remission after 10 cycles of PC (cisplatin and cyclophosphamide) combined chemotherapy, and they were still alive after 103 and 106 months of follow-up.

　　2. Chemotherapy and Radiotherapy

　　The sensitivity of sarcoma to chemotherapy is different from that of adult soft tissue sarcoma. The single use of cisplatin and ifosfamide is more effective than doxorubicin (adriamycin). The combination chemotherapy mainly based on cisplatin and doxorubicin (adriamycin) is expected to improve the effective rate of chemotherapy in patients with sarcoma and prolong the survival period of patients.

　　Mdilli et al. summarized the role of chemotherapy in the treatment of ovarian malignant mesodermal mixed tumors, and the results showed that cisplatin and ifosfamide can improve the survival status of patients. Harris et al. reviewed the treatment experience of the largest number of patients (40 cases) with ovarian sarcoma in recent years and believed that satisfactory tumor cell reduction surgery is the basis for improving the survival rate of patients with ovarian malignant mesodermal mixed tumors. The effective rate of the chemotherapy regimen mainly based on platinum is 42%, while the effective rate of other regimens is only 33%.