Ovarian yolk sac tumor

Introduction to ovarian yolk sac tumor Yolksactumor is the most common type of tumor in ovarian malignant germ cell tumor (OGCT). The yolk sac tumors are almost unilateral, the right side is slightly more common, and the bilateral side is mostly caused by metastasis. Tumors are usually large in size and more than 10 cm in diameter; they are round, oval or lobulated, with a smooth surface and a capsule, sometimes adhering or infiltrating with surrounding tissues. The cut surface is mainly solid, white or grayish white, moist and soft, often accompanied by a cystic sieve-like area containing jelly-like substances, which is common in honeycomb, hemorrhage and necrosis. basic knowledge The proportion of illness: the incidence rate of female patients is about 1-3% Susceptible people: women Mode of infection: non-infectious Complications: ovarian cancer

Ovarian yolk sac tumor cause

Unilateral (30%):

The yolk sac tumors are almost unilateral, the right side is slightly more common; the bilateral side is mostly caused by metastasis, the tumor is usually larger, more than 10cm in diameter; round, oval or lobulated, smooth surface There is a capsule; sometimes it can adhere or infiltrate with surrounding tissues, the cutting surface is mainly solid, white or grayish white, moist and soft; often accompanied by a cystic sieve-like area containing jelly-like substances, in the form of honeycomb; bleeding Necrosis is common.

Yolk sac tumor (30%):

(1) Microcystic structure: also known as reticular structure, most commonly seen, flat or star-shaped tumor cells form loose reticular and small sac or microcapsule structure, low magnification under the shape of a honeycomb, but under high magnification Tumor cells have obvious atypia and nuclear fission is common.

(2) Endodermal sinus-like structure: also known as the Schillei-Duval body, which is arranged in a single layer by cubic or columnar tumor cells, which surrounds the capillaries, thin-walled sinusoids or venular vessels, forming a vascular sleeve-like structure. The cross section is very similar to the glomerulus. Although this special structure is diagnostic, it is not typical in some tumors. Only 54.2% of the materials in Peking Union Medical College Hospital can find the typical Schiller-Duval body.

(3) Solid structure: It is composed of small polygonal epithelioid cells. The cytoplasm of the tumor cells is empty, the nucleus is large, and the nucleoli are prominent; the nuclear fission is active, similar to embryonic cancer.

(4) Alveolar structure: also known as labyrinth-like structure, flat, cubic or astronomical tumor cells constitute a curved or saclike structure.

(5) Polyvesicular yolk sac structure: flat, cubic or low columnar tumor cells form sacs of varying sizes, separated by dense fusiform interstitial or loose mucus-like stroma, this structure and embryo development The structure of the primary yolk sac becomes secondary yolk sac.

A variety of eosinophilic glass-like droplets can be seen in each of the above structures, but it is not unique to yolk sac tumors, as many poorly differentiated malignant tumors can be seen, and this PAS and AFP staining is positive, by tumor cells. Secretion occurs and accumulates in the cytoplasm and then ruptures into the surrounding tissue.

Histological structure (30%):

Sometimes it can constitute the main components of the tumor, including: myxoma-like, papillary, macrocystic, liver-like and primitive endoderm structures. The connective tissue axis of the papillary structure often has obvious glassy changes, and the tumor is extensively necrotic. The surrounding tumor tissue can also form a papillary structure, which is a subtype of solid structure, also known as hepatic yolk sac tumor; it needs to be differentiated from metastatic liver cancer at the time of diagnosis, the age of the patient in clinical, The distribution of tumors has different characteristics. The histologically found bile is a strong basis for the latter. The primitive endoderm structure is formed by primitive endoderm cells forming adenoid and solid masses with connective tissue separation, often contained in the glandular cavity. Concentrated secretions, much like mucin-secreting adenocarcinoma; sometimes glands are similar in morphology to secretory endometrial cancer.

The above various structures are often mixed and migrated to each other, mainly 1-2 species, the most common being microcapsule structures, which contain solid agglomerates or acinar-like structures; polycystic yolk sac liver-like and adenoid or primitive Endoderm-like structures are rare, but mostly form tumors with a single component.

Ovarian yolk sac tumor prevention

1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.

4. Regularly do a good job in screening high-risk populations, so that early detection, early treatment, and good follow-up work.

Ovarian yolk sac tumor complications Complications ovarian cancer

The incidence of ovarian yolk sac tumor metastasis is high. Among the 42 yolk sac tumors admitted to Peking Union Medical College Hospital before 1978, 80% of them have been transferred to the hospital for treatment. Most of them are pelvic or peritoneal peritoneal implantation, the former accounted for 93. %, the latter accounted for 68%, pelvic peritoneum including uterine rectal fossa, bladder reflex, pelvic wall peritoneum, uterine serosa and contralateral ovarian surface, etc., peritoneal peritoneum including omentum, anterior and posterior abdominal peritoneum, liver surface and mesentery, etc. After 1978, in 32 cases of ovarian yolk sac tumors with lymph node dissection or partial resection, there were 7 cases of lymph node metastasis, accounting for 21.9%. Gershenson (1983) reported 15 cases of yolk sac tumor in clinical stage III. Three cases of retroperitoneal lymphatic metastasis occurred, accounting for 20%, and 3 of the 6 cases that had undergone autopsy developed retroperitoneal lymph node metastasis, accounting for 50%. Therefore, in addition to direct infiltration and planting, the path of tumor metastasis was also passed. Lymph node metastasis, liver and lung parenchyma metastasis are less, but in the application of chemotherapy to make the patient's life last longer but ultimately unable to save, sometimes the liver and lung parenchyma metastasis can be seen.

Ovarian yolk sac tumor symptoms Common symptoms Ascites bloating pleural effusion abdominal pain menstrual rare polycystic ovary amenorrhea fever

Due to the rapid growth of ovarian yolk sac tumor, and easy to have rupture of the capsule and intra-abdominal implantation, common symptoms include abdominal mass (76%), abdominal distension, abdominal pain (50%) and ascites (86%), tumor necrosis, bleeding. Increased body temperature, and fever symptoms (50%), a small number of patients still have pleural effusion and gas, but pleural effusion does not mean chest metastasis, and some disappeared 10 to 14 days after surgery, and some Post-mortem autopsy can not find metastasis in the thoracic organs, which seems to be the McGregor. The ovarian function of the patient is generally normal. A few patients have short-term amenorrhea or rare menstruation. The pre-existing reproductive function is generally normal. Most married people have In the case of pregnancy and childbirth, some patients find that the tumor is combined with pregnancy at the same time. Because the tumor is highly malignant and the disease progresses rapidly, the time from the beginning of the symptom to the time of the visit is very short, 45% does not exceed 3 months, and 64% does not exceed half a year.

Examination of ovarian yolk sac tumor

Ovarian yolk sac tumor has some characteristics in clinical manifestations, such as mild age of onset, large tumor, easy to produce ascites, and rapid development of disease course. If you are alert to the possibility of this tumor, it is not difficult to diagnose. In particular, serum alpha-fetoprotein (AFP) detection can play a definitive role in diagnosis. Yolk sac tumors can synthesize AFP and are a very specific tumor marker. Radioimmunoassay methods are extremely sensitive to the determination of AFP in serum. Sometimes the composition of yolk sac tumors in mixed-cell tumors is very small, and it is necessary to make serial sections or repeated sections to find very small tumors. There is an increase in serum AFP.

Diagnosis and differentiation of ovarian yolk sac tumor

diagnosis

Ovarian yolk sac tumor has some characteristics in clinical manifestations, such as mild age of onset, large tumor, easy to produce ascites, rapid development of the disease, if you are alert to the possibility of this tumor, it is not difficult to diagnose, especially serum A Fetal protein (AFP) detection can play a definitive diagnosis. Yolk sac tumor can synthesize AFP, which is a very specific tumor marker. Radioimmunoassay is highly sensitive to the determination of serum AFP, sometimes in mixed type. There are very few components of yolk sac tumor in the tumor of the cell, which must be serially sliced or repeatedly sliced to find a very small tumor, and the serum AFP is elevated. In 100 cases of pure and mixed yolk sac tumor in Peking Union Medical College Hospital, There was an increase in serum AFP before surgery, and there was no false negative. Therefore, serum AFP detection has a clear diagnosis of ovarian endodermal sinus tumor.

Differential diagnosis

Note the differentiation with other ovarian germ cell tumors such as ovarian dysplasia.

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