卵巢未成熟畸胎瘤

　　卵巢未成熟畸胎瘤由来自三胚层的成熟和未成熟胚胎性组织构成，可表现为有1个胚层分化未成熟或分化不完全，亦可表现为(2～3个胚层分化未成熟)。成熟与未成熟组织常混杂。
　　大体肿瘤多为单侧巨大肿物，对侧卵巢可合并良性畸胎瘤。包膜光滑，但常与周围组织有粘连或在手术中撕裂。切面多以实性为主，伴有囊性区；偶见以囊为主者，囊壁有实性区域。实性区质软、细腻，有出血、坏死，呈杂色多彩状，有时见骨、软骨、毛发或脑组织；囊性区通常充以浆液、黏液或胶冻样物。
　　镜下观察为来自三胚层的成熟和未成熟组织构成；外胚层主要是神经组织和皮肤，中胚层以纤维结缔组织、软骨、骨、肌肉和未分化的间叶组织多见，内胚层主要为腺管样结构，有时可见支气管或胃肠上皮。这些组织处于不同的成熟阶段，无器官样排列。未成熟组织主要是指神经上皮组织，可形成菊形团或神经管结构，也可弥漫成片。
　　根据肿瘤中这种神经上皮的含量，有学者提出未成熟畸胎瘤的分级方法。这种分级对治疗和预后的判断均有重要意义。
　　0级：全部为成熟组织。
　　Ⅰ级：存在少量不成熟组织（主要是胶质和原始间充质），可见核分裂。神经上皮较少，每一切片中仅限于1or more/40 times field of view.
　　Ⅱ级：存在较多未成熟组织，但神经上皮在每一切片中不超过3or more/40 times field of view.
　　Stage III: There is a large amount of immature tissue, the amount of neuroepithelium in each section occupies4or more/40 times field of view, and often merges with sarcomatoid stroma.

　　Immature teratoma of the ovary is prone to peritoneal implantation, metastasis, infection, and tissue adhesion. When cancer cells invade the serous membrane, they can fall off to the surface of other organs in the peritoneal cavity, causing peritoneal implantation and spread. Peritoneal implantation and metastasis is a complex biological process, common sites include omentum, mesentery, vesicorectal sinus, uterorectal sinus, etc., and it is more common around the pelvis Douglas space (rectouterine pouch); it can be felt as a hard nodule during vaginal examination, or it can be widely implanted in the peritoneal cavity, forming cancerous peritonitis.

　　Common symptoms of immature teratoma of the ovary are abdominal mass, abdominal pain, etc. Due to the high incidence of peritoneal implantation,6％ have ascites. And due to ascites, the body's physical condition is consumed and weight is reduced. Most patients have normal menstrual and fertility functions.
　　The characteristics of immature teratoma of the ovary are high incidence of metastasis, for32％～58％. The mode of metastasis is often along the peritoneum. Therefore, the most common site of metastasis is the peritoneum and peritoneal cavity of the pelvis and abdomen, omentum, liver surface, diaphragm, serous membrane of the intestines, and mesentery, etc. Most of the metastatic foci are surface implantation. Lymph node metastasis is also not uncommon.

　　The etiology of immature teratoma of the ovary is not yet very clear, therefore there is no effective preventive measure. Young women should try to do regular physical examinations, detect early and treat early, do a good follow-up, and have a better prognosis.

　　According to the age of onset, abdominal mass, rapid progression of the disease, and other symptoms of immature teratoma of the ovary, combined with the following examinations, it is not difficult to make a diagnosis.
　　Firstly, laboratory examination:Mainly for the determination of tumor markers.
　　1、Serum alpha-fetoprotein (AFP)
　　2、Serum chorionic gonadotropin (HCG)
　　3、Neuron-specific Enolase (NSE)
　　Secondly, other auxiliary examinations:Ultrasound examination, abdominal radiography, laparoscopy, and histopathological examination.

　　It is very important to adjust the diet of patients with immature teratoma of the ovary. After surgical treatment, it is common to see deficiency of both Qi and blood, weakness of the spleen and stomach, both lack of nutrients and dysfunction of the body. Therefore, in the adjustment of diet, it is necessary to pay attention to the appropriate supplement of nutrition and calories, to provide high-protein and high-vitamin foods, and to regulate the function of the spleen and stomach, invigorate the stomach Qi, restore the chemical source, and strengthen the foundation of the postnatal. In terms of food selection, in addition to milk and eggs, general patients should eat more fresh vegetables and fruits, supplement proteins and a variety of vitamins. The diet of patients should be light, and high-dose lactose and excessive animal fat should be avoided or eaten in small amounts. Several dietary recipes suitable for patients with immature teratoma of the ovary are recommended.
　　1、Solanum nigrum sugar tea：Solanum nigrum15grams, sedimentary stone30 grams, drink as tea with sugar added to the decoction.
　　2、Sunflower Seed Filling：Sunflower Plate60 grams, decoct the juice and take the liquid, and use the liquid to boil pork60 grams, hawthorn30 grams.
　　3、Xiaoyao mantou crab (Leigong crab):Xiaoyao mantou crab cooked and eaten for meat, and its shell ground into powder, taken daily2grams, daily3times, swallow.
　　4、Sunflower flower:Sunflower flower petals2One, put goji berries on top30 pieces, walnut meat10Pieces, meat slices30 grams, appropriate seasonings steamed and eaten.
　　5、Sausage pig pancreas:Pig pancreas1Clean, add wine, steam and cut to eat. During chemotherapy, patients often have poor appetite and obvious gastrointestinal reactions. The medicine diet should be light and delicious, and have the effect of reversing nausea and vomiting.

　　Ovarian immature teratoma is a highly malignant tumor. If not treated properly, the mortality rate is quite high. If the treatment principles can be correctly mastered, this highly malignant tumor can become a completely curable tumor. The treatment principles of immature teratoma are: ①First, tumor cell reduction surgery should be performed, trying to make the residual tumor ≤2cm in diameter; ②Early and effective combined chemotherapy must be adopted after surgery to reduce tumor recurrence and improve survival rate; ③If the above two points cannot be carried out satisfactorily, tumor recurrence is often inevitable. For recurrent tumors, different specific plans should be formulated according to the different specific situations combined with the law of reversal of malignancy in immature teratoma.
　　一、Surgical treatment
　　1、Surgical scope:During surgery, it should be first carefully explored, especially the diaphragm, the surface of the liver, and the retroperitoneal lymph nodes, to perform correct tumor staging. Since the tumors are mostly unilateral and the patients are usually very young, it is often recommended to perform unilateral adnexectomy to preserve fertility.
　　2、Surgical treatment for recurrent tumors:The recurrent tumors of immature teratoma are mainly treated by surgical resection, supplemented by effective combined chemotherapy. Recurrent tumors are often large and small masses scattered widely in the abdominal and pelvic cavities, large or medium-sized tumors located in the liver or between the liver and diaphragm, which seem very difficult to remove surgically from the appearance. However, do not give up surgery easily. With careful and careful efforts, the removal of the tumor is still feasible. If adhesions are severe and cannot be completely removed, a small amount of tumor tissue can be left, and chemotherapy can be performed after surgery. It can also achieve good results.
　　3、Surgical treatment for residual tumors that have been converted to pathological stage 0 and have not been completely removed:For such tumors, treatment can be adjusted according to different situations.
　　①Large tumor volume and involvement of important organs cause symptoms, such as compression symptoms even affecting respiration and producing a large amount of ascites; or the tumor is located in the mesentery, affecting the peristalsis function of the intestines; or the tumor is close to the pelvic wall, compressing the ureter, etc., in these cases, surgery should be performed as soon as possible to relieve symptoms.
　　②The patient has undergone multiple major surgical traumas in recent days, although there are still some pathological stage 0 tumors in the abdominal cavity, the tumors are not large (diameter ≤6cm around), asymptomatic. It can be observed closely temporarily and surgery can be scheduled after the physical condition improves.
　　③Due to the presence of pathological stage 0 tumors in the abdominal cavity of some cases, there is still a possibility of malignancy after a certain time interval.
　　Obwohl die Wahrscheinlichkeit, dass reife Teratome in Adenokarzinome oder Karzinome wie Karzinome umwandeln, nicht groß ist, ist die Malignität hoch und die Prognose schlecht, wenn sie einmal umgewandelt werden. Daher ist es ratsam, nach einer guten Genesung des Patienten, auch die verbliebenen in Stufe O umgewandelten reifen Teratome zu entfernen.
　　4Zweiterkundung:Für unreife Teratome ist es nicht erforderlich, eine Zweiterkundung in Betracht zu ziehen, da keine Anzeichen einer Tumorrezidivierung bei der klinischen Untersuchung vorliegen. Denn selbst wenn der1Nach der Operation bleiben Tumoren zurück, da dieser Tumor das Merkmal der gutartigen Transformation hat, sich nach einer bestimmten Zeitspanne in ein gutartiges reifes Teratom umwandeln kann, das in der Regel nicht schnell wächst und oft auch durch körperliche Untersuchungen, Ultraschall oder CT-Untersuchungen gemessen werden kann, ohne dass eine Zweiterkundung erforderlich ist. In den letzten Jahren ist durch die Anwendung der kombinierten Chemotherapie fast keine Krebszelle mehr übriggeblieben, daher wird keine Zweiterkundung empfohlen.
　　Zwei, Chemotherapie:Die Chemotherapie ist eine unverzichtbare Behandlungsmethode für unreife Ovarialteratome. Vor der Einführung der kombinierten Chemotherapie war die Überlebensrate unreifer Teratome nur20％～30％. Unmittelbar nach der ersten Operation wird eine kombinierte Chemotherapie frühzeitig eingesetzt, um das Rezidiv zu verhindern und die Überlebensrate zu erhöhen. Nur wenn die Chemotherapie falsch angewendet wird und die Behandlung fehlschlägt, müssen auf die biologischen Eigenschaften der gutartigen Transformation des Tumors zurückgegriffen werden, um wiederkehrende Tumoren durch wiederholte Operationen zu behandeln, um den Patienten vor dem Tod zu retten.
　　Die Auswahl und Anwendung von Chemotherapeutika, die Gesamtdauer der Behandlungszyklen und die Intervalle zwischen den Behandlungszyklen haben bestimmte Anforderungen. Wenn die Medikamente nicht gemäß diesen Anforderungen verabreicht werden, kann die therapeutische Wirkung nicht erreicht werden, was im Wesentlichen mit der Chemotherapie von Ovarialyolk sack Tumoren übereinstimmt. Bei klinischen Stadium I-Fällen kann die chirurgische Staging manchmal nicht genau genug sein, z.B. bei Metastasen der retroperitonealen Lymphknoten, kann eine einfache Palpation oder eine Biopsie von wenigen Lymphknoten nicht unbedingt erklären, ob es kleine Metastasen gibt oder die kleinen Metastasen unter dem Mikroskop sichtbar sind, die Palpation des diaphragmischen Bereichs kann auch einige kleine Metastasenklumpen verpassen, daher ist es angemessen, nach der Operation eine kombinierte Chemotherapie zu verabreichen, aber eine kombinierte Chemotherapie mit weniger schweren Reaktionen und weniger Behandlungszyklen zu wählen. Zum Beispiel VAC6Ein Behandlungszyklus, oder BEP, PVB3Ein Behandlungszyklus, bei Patienten über dem Stadium I sind die folgenden Optionen verfügbar: ①VAC12Ein Behandlungszyklus; ②PVB6Ein Behandlungszyklus oder BEP6Ein Behandlungszyklus; ③PVB3Ein Behandlungszyklus nach VAC6Ein Behandlungszyklus; die Auswahl der Medikamente und die Anzahl der Behandlungszyklen können je nach Krankheitsverlauf angemessen erhöht oder verringert werden. Einige verwenden auch eine Einzeldosis von Doxorubicin (Adriamycin) zur Behandlung unreifer Teratome mit guten Ergebnissen.