Uterine malignant mesenchymal mixed tumors

　　In recent years, some scholars believe that the tissue origin of malignant mesenchymal mixed tumors comes from the primitive mesenchymal cells of the endometrium, which have the potential for multilineage differentiation of mesenchymal tissue and can differentiate into epithelial and mesenchymal tissues. Therefore, the endometrium can not only develop simple epithelial malignant tumors such as adenocarcinoma and simple mesenchymal malignant tumors such as endometrial stromal sarcoma, fibrosarcoma, etc., but can also develop malignant epithelial components (cancer) and malignant mesenchymal components (sarcoma), which are mixed tumors known as malignant mesenchymal mixed tumors.

　　When malignant mesenchymal mixed tumor of the uterus is transferred to various organs in the pelvic and abdominal cavity in the late stage, accompanied by bloody ascites, abdominal pain, and lumbar pain, it may be complicated with infection. Patients have abnormal vaginal bleeding, with postmenopausal bleeding most common.

　　Malignant mesenchymal mixed tumor of the uterus often occurs in the endometrium, resembling a polyp, often filling the uterine cavity, causing the uterus to enlarge and soften. It can also protrude into the vagina or invade the uterine muscle layer. Patients have abnormal vaginal bleeding, with postmenopausal bleeding most common. There are often lower abdominal or pelvic pain, with vaginal discharge or accompanied by the discharge of tissue-like substances, palpable mass in the lower abdomen. In the late stage, there may be symptoms and signs of ascites or distant metastasis, as well as weight loss, fatigue, fever, etc.

　　Some believe that the origin of the tissue occurrence of malignant mesenchymal mixed tumor is from the primitive mesenchymal cells of the endometrium, which have the potential for multi-directional differentiation of mesenchymal tissue and can differentiate into epithelial and mesenchymal tissues. There is no special preventive method for malignant mesenchymal mixed tumor of the uterus, and early diagnosis, early treatment, and close follow-up are the key.

　　When examining tumor markers for malignant mesenchymal mixed tumor of the uterus, serum CA125, CA199, etc. may increase. Hysteroscopy, ultrasound, CT, and MRI can help understand the condition of the uterus.

　　Patients with malignant mesenchymal mixed tumor of the uterus should regularly consume fresh vegetables and fruits rich in food vitamins, such as tomatoes, cucumbers, carrots, potatoes, cauliflower, eggplants, bananas, etc. The diet should be light, with small and frequent meals, regular and moderate portions, and a mild and warm temperature, easy to digest. Patients should avoid high-cholesterol foods such as animal liver, heart, kidneys, egg yolks, salted duck eggs, and fish roe, crab roe, etc. Avoid greasy and fried foods such as fatty meat, fatty geese, butter, stuffed ducks, cream, cream cakes, oil cakes, cream sweets, oil strips, etc. The following are the therapeutic diets for this disease.

　　1, Silver Ear and Lotus Root Powder Soup

　　25 grams of silver ear, 10 grams of lotus root powder, and appropriate amount of rock sugar. After the silver ear is soaked and softened, add the appropriate amount of rock sugar and simmer until烂. Dissolve the lotus root powder and serve.

　　Effectiveness: Has the effect of clearing heat, moistening dryness, and stopping bleeding.

　　Indications: Menstrual bleeding, with bright red blood.

　　2, Two Fresh Soup

　　Cut 120 grams of fresh lotus root into slices, chop 120 grams of fresh bamboo root, and boil the water to make a decoction for tea.

　　Effectiveness: Nourish Yin, cool blood, remove stasis, and stop bleeding.

　　Indications: Menstrual bleeding, blood heat and stasis type.

　　3, Eliminating Tumor Egg

　　Two eggs, five wall lizards of traditional Chinese medicine, and 9 grams of rhizoma Curcumae, boiled together with 400 grams of water. After the eggs are cooked, peel them and boil again, discard the medicine and eat the eggs. Take once a night.

　　Effectiveness: Dissipate结节, relieve pain, dispel wind, and calm惊.

　　Indications: Qi stagnation and blood stasis type.

　　4. Ivory Jade Juice

　　30 grams of ivory powder, taken with soy milk.

　　5. Aged Walnut

　　6 to 8 walnuts, 30 grams of costus, boiled with honey, discard the medicine and eat the walnuts.

　　6. Mugwort Eggs

　　Two eggs, 10 grams of mugwort, boiled together, discard the mugwort and eat the eggs.

　　The uterine malignant mesenchymal mixed tumor originates from the poorly differentiated endometrial stroma of the Millerian duct derivatives. The clinical treatment of this disease is usually as follows.

　　First, Surgical Treatment

　　Surgical treatment is the first choice. Most advocate for the resection of the whole uterus or subtotal hysterectomy + bilateral adnexa + omentum + pelvic and abdominal lesions + pelvic lymph nodes + paraaortic lymph nodes. If it is not possible to remove all lesions surgically, argon beam coagulation (ABC) can be used to treat residual lesions, and efforts should be made to achieve ideal tumor cell reduction. Because it is often accompanied by pelvic and abdominal lesions or malignant ascites, intraperitoneal chemotherapy or placement of intraperitoneal chemotherapy tubes can be performed simultaneously during surgery.

　　Second, Radiotherapy

　　Pelvic radiotherapy before and after surgery significantly reduces the risk of pelvic recurrence and distant metastasis. The main method of radiation therapy is pelvic irradiation, and intracavitary radiotherapy can be added in some cases. For patients who have lost the possibility of surgery, external and intracavitary whole-body radiotherapy can be performed. The principles of radiotherapy for uterine sarcoma can be referred to from cervical cancer and endometrial cancer.

　　Third, Chemotherapy

　　It plays an important role in patients with stage II and above. Patients with pelvic and abdominal lesions or malignant ascites should undergo combined chemotherapy of systemic and intraperitoneal chemotherapy. Good results can be achieved with ifosfamide and cisplatin for malignant mesenchymal mixed tumors. Common regimens include IEP and cisplatin (DDP) + dacarbazine (DTIC).

　　Fourth, Hormonal Therapy

　　It is suitable for patients with positive ER and PR receptors. Progesterone can be used for the treatment of recurrent tumors and also for adjuvant treatment after surgery. Common drugs include the following.

　　1. Methylprednisolone acetate, oral, long-term maintenance.

　　2. Medroxyprogesterone, oral, long-term maintenance.

　　3. Hydroxyprogesterone caproate, intramuscular injection, once daily, twice a week, maintenance, or change to long-term maintenance with the above oral medication.

　　For patients with negative progesterone receptor, tamoxifen can be used to increase the sensitivity of tumors to progesterone-containing drugs, and then medroxyprogesterone acetate (MPA) or MA can be applied.