Uterine smooth muscle sarcoma

　　The exact etiology of uterine smooth muscle sarcoma is unknown. Some believe it is related to embryonic cell residue and stromal cell differentiation from the perspective of histogenesis. A history of pelvic radiotherapy and long-term stimulation by estrogen may be risk factors for the disease, but there is no clear evidence to prove these assumptions. Primary smooth muscle sarcoma originates from the smooth muscle tissue of the uterine muscular wall or the vascular wall between the muscular walls. This type of sarcoma grows diffusely, with no obvious boundary between it and the uterine wall, and without a capsule. Secondary smooth muscle sarcoma is the malignant transformation of an existing smooth muscle tumor. Statistics show that about 0.5% of uterine fibroids can undergo malignant transformation into sarcoma, and in cases of multiple fibroids, only a few may undergo malignant transformation. Malignant transformation of fibroids often starts from the center of the tumor and spreads outward until the entire fibroid develops into a sarcoma, at which point it often invades the capsule. There are reports that some patients have a history of receiving radiotherapy for benign diseases or malignant tumors, and most of these occur more than 10 years after radiotherapy.

　　Uterine smooth muscle sarcoma generally has no special symptoms and can present with symptoms similar to those of uterine fibroids. Two-thirds of patients with uterine smooth muscle sarcoma develop anemia after experiencing heavy bleeding. This disease can lead to secondary infection, recurrence, and distant metastasis.

　　Uterine smooth muscle sarcoma generally has no special symptoms and can present with symptoms similar to those of uterine fibroids.

　　1. Abnormal vaginal bleeding

　　The most common symptom is abnormal menstruation or vaginal bleeding after menopause, accounting for 65.5% to 78.2%.

　　2. Abdominal mass

　　It is more common in patients with myoma sarcomatous transformation; the mass increases rapidly, and if the sarcoma grows into the vagina, there is often a feeling of a mass protruding into the vagina. The uterus is often enlarged, irregular in shape, and soft in texture.

　　3. Abdominal pain

　　It is also a common symptom due to the rapid growth of the myoma, causing abdominal distension or hidden pain for the patient.

　　4. Increased vaginal discharge

　　It can be serous, bloody, or white, and when infection occurs, it is manifested as purulent and malodorous.

　　5. Compression symptoms

　　If the tumor is large, it can compress the bladder or rectum, causing irritation symptoms, and compressing the veins can cause lower limb edema.

　　6. Advanced patients

　　May have weight loss, anemia, fever, systemic failure, pelvic mass infiltration into the pelvic wall, fixed and cannot move.

　　Uterine smooth muscle sarcoma is believed to be related to embryonic cell residue and stromal cell differentiation. The prevention of uterine smooth muscle sarcoma lies in regular physical examinations, early detection, early treatment, and good follow-up.

　　Gynecological examination of uterine smooth muscle sarcoma shows significant enlargement of the uterus,呈多个结节状, soft in texture. If the sarcoma protrudes from the uterine cavity through the cervical os or into the vagina, a purple-red mass can be seen, and when infection occurs, there is purulent discharge on the surface. If it is a grape-like sarcoma, soft,脆, and easily bleeding tumors can be found in the cervical os or vagina. The specific clinical examination of this disease is as follows.

　　1. Histopathological Examination: Accurate pathological diagnosis is very important for determining the prognosis of patients and for proper treatment. The diagnosis of typical uterine smooth muscle sarcoma is not difficult. If the tumor grows diffusely without capsule, has no obvious boundary with surrounding tissues, and has a grayish-yellow or fishy texture in cross-section, it is soft and brittle. The mitotic figure in the mirror examination is 10 or more per 10 high-power fields, and the cells have obvious atypicality and coagulative necrosis.

　　2. Vaginal Color Doppler Ultrasound Examination:Tumor tissue is affected by the action of vascular endothelial growth factors, the new blood vessels are mainly endothelial cells, lack smooth muscle, and the blood flow resistance decreases, which is shown as high diastolic blood flow and low resistance in Doppler ultrasound.

　　3. Diagnostic Curettage: Diagnostic curettage is one of the methods for early diagnosis of uterine sarcoma. Curettage has great value for the diagnosis of endometrial stromal sarcoma and malignant müllerian duct mixed tumor, but has less diagnostic value for uterine smooth muscle sarcoma because the lesions of uterine smooth muscle sarcoma are often located between the muscular wall, and it is difficult to scrape out sarcoma tissue with curettage.

　　Patients with uterine smooth muscle sarcoma should eat dandelion greens, melon, black plum, oyster, turtle, sea horse, etc. Patients should avoid smoking, drinking, and spicy刺激性 food. Avoid inducing factors, such as roosters. Avoid greasy, fried, moldy, and salted food. The following is the therapeutic diet 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 the rock sugar is cooked until soft, add the lotus root powder and serve.

　　Effects: Has the effects of clearing heat, moisturizing dryness, and stopping bleeding.

　　Indications: Menstrual blood in large amounts, with bright red blood color.

　　2. Two Fresh Soup

　　120 grams of fresh lotus root sliced, 120 grams of fresh mung bean sprout root chopped, boil the water into juice and drink as tea.

　　Effects: Nourish yin and cool blood, remove blood stasis and stop bleeding.

　　Indications: Menstrual blood in large amounts, blood-heat and blood stasis type.

　　3. Eliminating Tumor Eggs

　　Boil 2 eggs, 5 wall lizards of traditional Chinese medicine, and 9 grams of Ophiopogon japonicus in 400 grams of water together, remove the shell after the eggs are cooked, discard the medicine and eat the eggs, take once a day at night.

　　Effects: Dispersing nodules, relieving pain, expelling wind and calming惊fright.

　　Indications: Qi stagnation and blood stasis type.

　　The treatment principle for uterine smooth muscle sarcoma focuses on activating blood circulation and removing blood stasis, softening hardness and removing masses. The treatment mainly focuses on activating blood circulation and removing blood stasis to resolve phlegm. According to the physical condition, those with solid physique should remove pathogenic factors first, and then reinforce the healthy Qi; those with weak physique should reinforce the healthy Qi and remove pathogenic factors, taking both symptoms and root into consideration.

　　First,辨证选方Selection of Prescriptions Based on Syndrome Differentiation

　　1. Blood Stasis and Phlegm Congestion

　　Therapeutic Method: Resolving phlegm, activating blood circulation and removing masses.

　　Herbal Medicine: Modified Guizhi Fu Ling Wan. 15g of Guizhi, 20g of Fu Ling, 15g of Dan Pi, 15g of Chi Shao, 15g of Tao Ren, 30g of Bie Jia, 30g of Gu Lou, 30g of Mu Li, 20g of Xian He Cao, 15g of Shan Ci Gu. Add 15g of Huai Shi Shi, 10g of San Qi if there is a lot of bleeding; add 15g of Zhizi, 15g of Hou Po if there is abdominal distension.

　　2. Exuberant Damp Toxin

　　Therapeutic Method: Clear heat and drain dampness, activate blood circulation and stop bleeding.

　　Herbal Medicine:Modified Huang Lian Jie Du Decoction. 15g of Huang Lian, 15g of Huang Qin, 15g of Huang Bai, 15g of Shan Zhi, 20g of Tu Fu Ling, 20g of Gong Ying, 50g of Yi Mi, 20g of Ban Gui Lian, 15g of Long Kui, 10g of San Qi. Add 15g of Da Fu Pi, 15g of Hou Po, 15g of Yang Pie if there is abdominal distension like a drum; add 20g of Yuan Hu, 20g of Mo Yao if the pain is severe.

　　3. Deficiency of both Qi and blood

　　Therapeutic Method: Tonify Qi and nourish blood, soften hardness and remove masses.

　　Herbal Medicine: Modified Baizhen Decoction. 20g of Angelica sinensis, 15g of Bai Shao, 20g of Shu Di, 20g of Dangshen, 30g of Huang Qi, 15g of Bai Zhu, 20g of Fu Ling, 30g of Bie Jia, 20g of Gu Lou, 15g of Shan Ci Gu, 20g of Xian He Cao. Add 20g of Ejiao, 10g of San Qi, 15g of Huai Shi Shi if there is a lot of vaginal bleeding; add 15g of Zao Ren, 15g of Ye Jiao Teng if there is restlessness at night.

　　Second, Special Prescription

　　1. 60g of radix scutellaria powder, add 500ml of distilled water, soak for three minutes, then boil and filter with a sand pot, take 100ml daily, divided into 4 times. Suitable for uterine cancer.

　　2. 15g of Yuanhu, 15g of Wulingzhi, roasted into charcoal with vinegar, take all at once, drink with boiling water, can be taken for 3 doses, suitable for abdominal pain and bleeding in uterine cancer.