-Ο όγκος διασπαράγματος

　　-οι ασθενείς με όγκο διασπαράγματος συχνά έχουν ανωμαλίες των χρωμοσωμάτων: περίπου3/4οι όγκοι παράγουν ανδρογόνα, κλινικά εμφανίζονται μια σειρά από συμπτώματα απώλειας γυναικομαστίας, ανδροποίησης. Υπάρχουν επίσης λίγοι άνθρωποι που μπορεί να μην έχουν αλλαγές ενδοκρινικής λειτουργίας ή να παρουσιάζουν γυναικοποίηση.
　　-Τα όγκοι διασπαράγματος διαφέρουν πολύ σε μέγεθος, η διάμετρος τους είναι συνήθως617cm, με μέση10cm περίπου. Η πλειοψηφία των όγκων είναι μονοπλευροί, με λεία επιφάνεια, και είναι για το πλείστον πυκνές. Μετά από εξωγενή συστατικά ή δίκτυα δομής, οι όγκοι είναι συχνά κελινδροειδείς. Η διατομή είναι γκρίζα, κίτρινη ή κίτρινη-καφέ, μπορεί να υπάρχει κελύφος. Όταν η διάγνωση του όγκου είναι κακή, μπορεί να εμφανιστούν αιμορραγίες, νεκρωτικές περιοχές. Με μικροσκοπική έρευνα μπορεί να δει:
　　1、υψηλή διέγερση Ο όγκος αποτελείται από δομές σωληνάρια που καλύπτονται από υποστηρικτικές細ες, με διάσπαρτα ή συγκεντρωμένα κυττάρα διασπαράγματος στον ιστό, οι Reinke κρυστάλλοι είναι δύσκολο να βρεθούν.
　　2、μέτρια διέγερση To σχισματικό σύστημα αντικαθιστάται από μικροlobular δομή, οι υποστηρικτικές細ες συναρμολογούνται σε σχήμα δοκού, διάσπαρτη και λουλουδωτή, με σπάνιες κεντές ή σφιχτές αδένες. Στην ελεύθερη διαστήματα του ιστών υπάρχουν πολλά κυττάρα διασπαράγματος.
　　3, low differentiation The tumor is composed of a dense cluster of spindle cells, the tumor cells are arranged in broad cell columns, intersecting and matching with each other, and their morphology resembles undifferentiated gonads. Occasionally, poorly differentiated tubules or irregular epithelial strips are seen. The stroma cells are scattered in small clusters.
　　4, reticular subtype Most of them are in the structure of middle and low differentiation supporting mesenchymal tumors, containing varying amounts of similar testicular rete structures. The reticular structure occupies a small part of the tumor, or it can be larger or even the whole structure is of this kind. The reticular area is composed of elongated irregular small tubes or clefts, or it can be dilated or cystic, containing eosinophilic substances resembling thyroid follicles. The cyst wall can be seen with papillary projections, the papillae are short, with a glassy core, and a few papillae are similar to polyps or have complex branches, resembling ovarian serous papillary adenoma. The stroma is often glassy.
　　5, with alien components The microscopic characteristics are that the tumor is composed of components of mesenchymal tumors of different differentiation degrees plus alien components. The most common alien component is gastrointestinal mucinous epithelium, which can form tubules or cysts. The epithelium contains argentaffin cells and argyrophilic cells. The mucinous epithelium is generally benign, and occasionally it can be junctional or malignant. There are also a few mesenchymal tumors containing alien components such as striated muscle or cartilage, but the alien striated muscle or cartilage is often immature.
 

　　May be complicated with acute abdomen due to tumor hemorrhage and necrosis; there have been12There are reports of ovarian supporting mesenchymal tumors in infants of about2About 0% of patients have masculinization symptoms.

　　Supporting mesenchymal tumors mainly manifest as abdominal symptoms and abnormalities in endocrine aspects.
　　1, abdominal symptoms:Supporting mesenchymal tumors vary greatly in size, with an average diameter10cm. The incidence of abdominal masses is much higher than that of supporting cell tumors, reaching32Percent to46Percent. There are reports that a few tumors can undergo torsion or rupture, causing abdominal pain symptoms. The diameter of the tumor is less than5cm, clinically there are no abdominal symptoms, and they are also easily ignored during examination, often discovered by chance or during laparotomy.
　　2, endocrine changes:Due to the function of the tumor cells to secrete androgens, the hormone levels in most patients show changes, the most obvious change being the significant increase in the concentration of testosterone and androstenedione in the serum. Due to the influence of androgens, clinically25Percent to77Percent of patients will experience a series of defeminization and masculinization symptoms. Onset before puberty, there will be precocious puberty with opposite gender. After puberty, the first manifestation will be oligomenorrhea, amenorrhea, breast atrophy, and other defeminization symptoms, followed by the gradual appearance of hirsutism, low voice, acne, Adam's apple, clitoral hypertrophy, and a series of masculinization symptoms.
　　In high and middle differentiation support-In patients with mesenchymal tumors, in addition to containing a high level of testosterone, the tumor cells also contain a certain amount of estradiol, and a few have the phenomenon of estrogen secretion, and the clinical manifestation is abnormal uterine bleeding. In cases with simultaneous endometrial pathological examination, there are various pathological changes stimulated by estrogen, such as polyps, cystic hyperplasia, and well-differentiated adenocarcinoma of the endometrium.
　　The above endocrine manifestations, the detection of hormone levels in the patient's plasma can show significant changes.

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　　106612

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　　15-3

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