Ovarian small cell carcinoma

Introduction to ovarian small cell carcinoma Primary ovarian small cell carcinoma is a very rare highly malignant tumor often associated with hypercalcemia, first reported by Dickersin in 1982. From 1982 to 1991, there were only 36 reports on statistical world literature such as Taraszewi. Very few reports in China, the organization of ovarian small cell carcinoma is still a mystery, because this has relatively small tumor cells and ultrastructural epithelial properties (bridge-like connection, basement membrane), so this non-special The naming of heterosexual small cell carcinoma, accurate histological naming remains to be further explored by pathologists. basic knowledge The proportion of illness: 0.05% - 0.1% Susceptible people: women Mode of infection: non-infectious Complications: nausea and vomiting constipation

Causes of ovarian small cell carcinoma

First, the source

At present, the source of the tissue is unknown, and may include ovarian body cavity epithelium, germ cells, and sex cord interstitial.

Second, high-risk groups

(1) Environmental factors:

The incidence rate in developed countries is significantly higher than in developing countries.

Senior class and professional women are more common than women with low economic status.

(2) Genetic factors:

20%-25% of ovarian cancers have a family history.

(3) Birth history:

The number of pregnancies increases, and the risk of developing ovarian cancer gradually decreases.

(4) Endocrine factors:

The incidence of ovarian cancer in women who take oral contraceptives for a long time is lower than that of women who have not taken it. After taking the pill, it still has a protective effect.

(1) Causes of the disease

Most authors believe that ovarian small cell carcinoma is likely to originate from the ovarian body cavity epithelium, germ cell and sex cord stroma. These three types of common ovarian tumors, although ovarian small cell carcinoma and these three types of tumors are significantly different, but also There are similarities.

In areas where poor epithelial tumors are poorly differentiated, there may be undifferentiated cells resembling ovarian small cell carcinoma, but in ovarian small cell carcinoma there is no evidence of serous, mucinous, endometrioid, and transitional cell differentiation. In immunohistochemical studies, all epithelial tumors were positive for epithelial tumor-associated antigens, and one-third of small cell carcinomas were positive.

Ulbright et al. thought that this tumor is highly likely to originate from germ cells. In addition to its age of onset, it is similar to germ cell tumors. It is also found under light microscopy and electron microscopy. Extracellular basement membrane-like substances and intracellular glass bodies are similar to yolk sac. The structure, but according to Aguirre (1989) and later observed, the so-called basement membrane material can exist in many types of tumors, the intensity and nature of staining of glassy bodies are different from yolk sac tumors, serum alpha-fetoprotein ( Both AFP) and chorionic gonadotropin (HCG) are negative. It is also clinically noted that chemotherapeutic drugs sensitive to germ cells are ineffective against this tumor. A case of ovarian small cell carcinoma in Peking Union Medical College Hospital has been considered to be very effective for germ cell tumors. The 6 courses of PVB regimen have no effect and do not support tumors that originate in germ cells.

The age of onset of sex-interstitial tumors is widely distributed, half of which is seen after menopause. The age of onset of juvenile granulosa cell tumors is earlier than that of this tumor, with an average age of 13 years and 44% less than 10 years old. Most granulosa cell tumors secrete females. Hormone, feminine, can cause precocious puberty, irregular vaginal bleeding, postmenopausal bleeding, without hypercalcemia; and this tumor has no estrogen effect, often accompanied by hypercalcemia, the histology is similar The cells of small cell ovarian cancer can be arranged into a follicular-like structure resembling a granulosa cell tumor, which is easily confused.

(two) pathogenesis

1. The gross tumor is 14-20 cm in diameter and weighs 500-2000 g. It is grayish-white, gray-yellow, solid and nodular. The small cystic cavity can be seen in the cut surface, and mucus-like changes and hemorrhage and necrosis can be seen.

2. The most common light microscopy is a round, oval, fusiform or irregular epithelioid small cell with little cytoplasm, almost entirely composed of nuclei, deep nuclear staining, and relatively small. The nucleolus has many mitotic figures, and the tumor cells can also be arranged in a nest or cord shape. Follicular structures can also be seen in most tumors. In 25% of the tumors, there are large cells rich in eosinophilic cytoplasm. Bubbles, nucleoli are obvious, the two cells can be mixed or clustered, the proportion is different, there are some mucus-rich cells in 9% of tumors.

Ovarian small cell cancer prevention

Try to achieve early detection, early treatment, and regular follow-up. It is very important to maintain a good attitude, to maintain a good mood, to have an optimistic, open-minded spirit, and to be confident in the fight against disease. Don't be afraid, only in this way can you mobilize your subjective initiative and improve your body's immune function.

Ovarian small cell carcinoma complications Complications, nausea and vomiting constipation

Hypercalcemia: serum calcium concentration is higher than 2.75mmo1/L.

Can appear nausea and vomiting, anorexia, constipation, annoying, polyuria, fatigue, muscle fatigue, decreased muscle tone, lethargy, unconsciousness, and even coma, threatening the lives of patients.

Ovarian small cell cancer symptoms Common symptoms Abdominal pain Ascites bloating Lower abdomen mass Hypercalcemia

First, the age of onset

It mainly occurs in young women, with an age distribution of 10 to 42 years, with an average of 23 years.

Second, the symptoms

1, common symptoms:

Mostly unilateral.

Abdominal distension, abdominal pain, lower abdominal mass, ascites, etc.

2, hypercalcemia, normal or lower serum phosphorus levels.

Tumor resection returned to normal within a short period of time, and tumor recurrence and metastasis were again abnormal.

4. Serum AFP and HCG were negative.

Third, transfer

Predilection site: peritoneum

Other: basin, abdominal lymph nodes, liver, lung, pleura and so on.

Examination of small cell ovarian cancer

1, generally

The diameter is 14-20cm, the weight is 500-2000g, grayish white, grayish yellow, solid, nodular.

There are scattered small cysts in the cut surface, which may have mucus-like changes and hemorrhage and necrosis.

2, light microscopy

(1) There are small, oval, fusiform or irregular epithelial-like small cells that are diffuse into pieces, with less cytoplasm, deep nuclear staining, and more mitotic figures.

Tumor cells can be arranged in a nest or cord shape, or a follicular-like structure can be seen.

(2) 25% of tumors are rich in eosinophilic cytoplasmic large cells, the nucleus is vesicular, and the nucleolus is obvious.

(3) A small number of tumors have cells rich in mucus.

3, electron microscopy

(1) Cell cytoplasm:

It is rich in pools and large sacs formed by the expansion of the rough endoplasmic reticulum, which is filled with fine particles of light to moderate electron density, and the nucleus is distorted and displaced.

It also contains polysomes, mitochondria, and a small amount of Golgi complex, or dense lipid droplets, lysosomes, microvilli, and neuroendocrine-like dense particles.

(2) The periphery of the cell mass is a basal lamina, a desmosomelike junction, a large cell nucleus, a rich euchromatin and a small amount of plaque-like heterochromatin.

4, histochemistry and immunohistochemistry

Grimelius staining: cytoplasm without argyrophilic particles.

Reticulated fiber dye: Fiber surrounds a larger cell nest. Or it will protrude into the tumor cells, irregularly and incompletely surrounding a single cell.

Alpha-fetoprotein (AFP) immunohistochemistry: negative.

Diagnosis and diagnosis of ovarian small cell carcinoma

diagnosis

Young women with unilateral accessory masses have hypercalcemia. If there is no hypercalcemia or no hypercalcemia, it is difficult to obtain a definitive diagnosis before surgery. Except for parathyroid gland, bone disease, ovarian vegetative cells This tumor should be highly suspected outside the tumor, although a small number of ovarian serous papillary cystadenocarcinoma, malignant lipocytoma, etc. can also be combined with hypercalcemia, but older.

Differential diagnosis

Histopathologically confusing with this tumor is granulosa cell tumor, metastatic small cell carcinoma and malignant lymphoma.

1. The granulosa cell tumor cells are larger than the tumor, have a nucleus, and have obvious fibroma-like and ovarian tumor-like components. In the comparison of Aguirre immunohistochemical staining of granulosa cell tumor and this tumor, the former EMA is all Negative, the latter positive rate is 1/3; the former of the vementin is all positive, the latter is 1/2, the unique RER sac in the ultrastructure of the tumor, also contributes to the identification of the two, due to small ovarian Cellular and granulosa cell tumors have certain difficulties in the differential diagnosis of pathology. The following clinical and pathological differential diagnosis points (Table 1) are for reference.

2. Metastatic small cell carcinoma of the cervix, endometrial small cell carcinoma histology and small cell lung cancer (oat cell carcinoma), there are silver-stained particles in the cytoplasm under light microscope, and cytoplasmic processes exist in the ultrastructure of electron microscopy. , dense membrane with membrane (neuroendocrine granule), known as neuroendocrine tumor (APUD) tumor) (Ibrahim, 1984; Kunlar, 1984; Young, 1985; Gersell, 1988), and in primary ovarian small cell carcinoma In addition to a small number of dense particles in individual tumors, no features of neuroendocrine tumors were found.

3. Immunohistochemical staining and electron microscopic observation of specific antibodies against lymphocyte markers of malignant lymphoma are different from this tumor.

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