Malignant mixed mesodermal tumor of the uterus

Brief introduction of malignant mesodermal mixed tumor of uterus The malignant mesodermal mixed tumor of the uterus is derived from the poorly differentiated endometrial stroma tissue of the Miller tube derivative, and can differentiate into mucinous tissue, connective tissue, cartilage tissue, striated muscle tissue and smooth muscle tissue, which can also contain malignant Epithelial components and malignant interstitial components, namely cancer and sarcoma components, if the sarcoma and cancer are derived from the original tissue components of the uterus, a homologous malignant Miller tube mixed tumor; if the sarcoma contains a uterus Tissue components such as striated muscle, cartilage, bone, etc., are heterogeneous malignant Miller tube mixed tumors. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: women Mode of infection: non-infectious Complications: ascites, abdominal pain

Uterine malignant mesodermal mixed tumor etiology

(1) Causes of the disease

In recent years, some scholars believe that the tissue origin of malignant mesodermal mixed tumor is derived from the primitive mesenchymal cells of the endometrium. It has the multi-directional differentiation potential of mesodermal tissue and can differentiate into epithelial and mesenchymal tissues. Therefore, intrauterine Membrane can not only produce epithelial malignant tumors such as adenocarcinoma and simple mesenchymal malignancies such as endometrial stromal sarcoma, fibrosarcoma, etc., but also malignant epithelial components (cancer) and malignant mesenchymal components (sarcoma). The mixed tumor is a malignant mesodermal mixed tumor.

(two) pathogenesis

The malignant mesodermal mixed tumor of the uterus comes from the mullerian epithelium and has a tendency to differentiate into pluripotent energy.

General characteristics

(1) The tumor grows from the endometrium, and a polypoid mass that forms a wider base protrudes into the uterine cavity. The surface is smooth or has erosion and ulceration. It is soft and has a smooth surface and may be accompanied by ulcers.

(2) The cut surface is light red, like raw fish, often accompanied by gray-yellow necrotic foci and dark red bleeding area, or a small cyst filled with liquid. If there is a heterologous component, it may have a gritty or hard bone. Area.

(3) The tumor has different degrees of invasive muscle and can invade the deep muscle layer.

2. Microscopic features

(1) Cancer and sarcoma are mixed.

Carcinosarcoma, a homologous composite tumor or combination of tumors, accounts for about 1.2% of uterine cancer, more common in the elderly, can occur after radiation therapy.

Gross: The tumor is large, and the polypoid polyps protrude into the uterine cavity. It can also protrude into the vagina. The tumor is soft and the face is grayish yellow. It involves the muscular layer or lymphatic vessels at an early stage, and quickly involves the tissues and organs of the small pelvis. And mediastinal lymph node metastasis is early, prone to lung, liver metastasis, poor prognosis, but the homology is better than the heterogeneous Mullerian tube mixed tumor.

Histology: homologous carcinosarcoma, containing tubular or cord-shaped cancer cells, surrounded by sarcomatoid mesenchymal cells of varying degrees of differentiation, cancerous glands or alveolar, papillary, sometimes accompanied by scales The sarcoma component is similar to interstitial sarcoma, mainly fusiform cells, and some cells may be pleomorphic and may be characterized by differentiation into myoblasts.

(2) The main components of cancer are adenocarcinoma and squamous cell carcinoma, and the vast majority are adenocarcinoma (95%), and mainly endometrial adenocarcinoma, a small part is clear cell carcinoma, serous or mucinous adenocarcinoma, A small number of squamous cell carcinomas (5%) are mixed with adenocarcinoma.

Malignant mesoderm mixed tumor.

(3) The sarcoma components are homologous and heterologous. The homologous sarcoma is typically spindle cell sarcoma. In addition to spindle cell sarcoma, heterologous sarcoma also contains rhabdomyosarcoma (striated muscle cells), osteogenic meat. Tumor (tumor bone), chondrosarcoma (tumor cartilage) or liposarcoma, may also have glial components, the above various components may be mixed; because the amount of various tissues contained in the tumor varies, the degree of differentiation is different The formed tissue images are complex and diverse, and multiple sections need to be taken to avoid correct diagnosis.

Malignant mesoderm mixed tumor is a heterogeneous composite tumor. The sarcoma component is heterogeneous, similar to poorly differentiated mesenchymal cells, heterogeneous chondroblasts, osteoblasts, rhabdomyoblasts, and fat cells. There are ganglion cells, mucus degeneration is common, EM can be confirmed as different differentiation stages of primitive mesenchymal tissue, Mullerian epithelium from pluripotency, immunohistochemistry shows that mesenchymal tissue components contain epithelial-labeled antigens, supporting mesenchymal tissue Epithelioid differentiation characteristics, epithelial differentiation in various forms, such as papillary, adenoid or oviduct epithelial, and even contain grit.

Occasionally, various components of malignant mixed tumors can be seen in polypoid masses and papillary adenomas. Patients after radiotherapy are mostly heterogeneous malignant mesodermal mixed tumors with rapid tumor metastasis and metastasis of cancer. There are many, and there are also two or more components that transfer at the same time.

(4) The tumor can invade the muscular layer, and the paraventricular and pelvic vessels can have tumor thrombus.

(5) ER (estrogen receptor), PR (progesterone receptor): ER and PR positive rate were 25% to 51%.

3. Metastatic malignant mesodermal mixed tumor metastasis is characterized by lymphatic or direct spread to the pelvic and abdominal organs. It has been reported that the pelvic lymph node metastasis accounts for about 1/3 of the primary operation of the malignant mesodermal mixed tumor. The transfer accounted for about 1/6. In some cases, there was a metastasis of the pelvic and abdominal organs, which often invaded the greater omentum, peritoneum, intestinal surface, rectum and bladder, similar to endometrial serous papillary adenocarcinoma.

US GOG analysis of 301 clinical I/II uterine malignant mesodermal mixed tumors found that 167 cases were homologous, of which lymph node metastasis rate was 15%, 134 cases were heterogeneous, and lymph node metastasis rate was 21%. Membrane transfer rate 5%, attachment transfer 5% ~ 12%, abdominal cytology positive rate 15% ~ 27%, intraoperative observation of the tumor is confined to the uterus, and postoperative pathology can be found 19% pelvic or abdominal Para-arterial lymph node metastasis.

4. Clinical Staging Most scholars advocate the staging of FIGO on endometrial cancer as a staging of uterine sarcoma. The International Federation of Obstetrics and Gynecology (FIGO) stipulates that 194 years of endometrial cancer should be prescribed before October 1989. For clinical staging, the 1971 clinical stage was used for those who were unable to undergo surgery alone or after radiotherapy (Table 1).

Surgical pathological staging FIGO was recommended in October 1988 for the use of endometrial cancer surgery-pathological staging.

(1) Provisions concerning the phased period:

1 Because endometrial cancer has been surgically staged, the previously used segmental diagnosis to distinguish between stage I or phase II methods is no longer applied.

2 A small number of patients began to choose radiotherapy, still using the clinical staging of the 1971 FIGO, but should be noted.

3 The thickness of the muscle layer should be measured together with the depth of cancer invasion.

Histopathological grade:

G1: Non-squamous or mulberry-like solid growth type 5%.

G2: Non-squamous or non-mulberry-like solid growth types account for 6% to 50%.

G3: Non-squamous or non-mulberry-like solid growth type >50%.

(2) Notes on pathological grading:

1 Pay attention to nuclear atypicality. If it is not consistent with the structural classification, G1 or G2 should be upgraded by one level.

2 For the classification of serous adenocarcinoma, clear cell adenocarcinoma and squamous cell carcinoma, nuclear grading should be considered first.

3 Adenocarcinoma with squamous components should be graded according to the nuclear fraction of glandular components.

Clinically, it is often found that the clinical stage of many patients does not match the extent of tumor spread and metastasis at the time of surgery. The clinical stage is often earlier than the actual stage. Among the clinical stage I patients, about 32.0% to 64.0% underestimate the stage, and may even have Distant metastasis, significantly affecting the prognosis, foreign scholars on 35 patients with malignant Miller tube mixed tumor according to clinical stage, surgical pathological staging (FIGO pathological staging) and proposed pathological staging (based on the pathological stage of FIGO, such as myometrial blood vessels Or there was tumor infiltration in the lymphatics, and the stage was increased in stage 1 or 1 stage. 21 cases with stage I stage were found, and the pathological stage of FIGO was reduced to 9 cases. The tumor spread of the remaining 12 cases exceeded the range of stage I, according to proposed Pathological staging, the reduction of stage I was 4 cases, compared with the three stages, the 2-year survival rate of stage I was 33.0% (clinical stage), 56.0% (FIGO pathological stage) and 75.0% (proposed pathological stage), respectively. The improvement of stage I survival rate indicates that the stage is more accurate. The difference between the early and late mortality of uterine sarcoma within 2 years is 73.0% according to the clinical stage I and II, and the stage III and IV are 100%. P>0.05 The difference was not significant. According to the pathological stage of surgery, the mortality rate in stage I and II was 57.0% in 2 years, and that in stage III and IV was 100% (P<0.01). The difference was significant, indicating that the surgical pathological stage can be compared. Correctly reflect the difference in prognosis between early and late stages. Therefore, it is emphasized that surgical pathological staging should be performed to facilitate adjuvant therapy and prognosis.

Malignant mesodermal mixed tumor prevention of uterus

Early diagnosis, early treatment, close follow-up.

Uterine malignant mesodermal mixed tumor complications Complications, abdominal pain, abdominal pain

Late metastasis to the organs of the pelvic and abdominal cavity, accompanied by bloody ascites, abdominal pain and low back pain.

Uterine malignant mesodermal mixed tumor symptoms Common symptoms Vaginal discharge fragment tissue vaginal bleeding fatigue lower abdominal mass abdominal pain weight loss

1. Often associated with obesity (40%), diabetes (15%), infertility (25%).

2. The most common symptoms are abnormal vaginal bleeding, which accounts for the most postmenopausal bleeding, accounting for 80% to 90%; often accompanied by lower abdomen or pelvic pain (25%), may have vaginal discharge or accompanied by tissue-like discharge.

3. It can reach the lower abdomen mass (10%), and the mass can be hard or soft.

In the advanced stage, there may be symptoms and signs of ascites or distant metastasis, as well as systemic symptoms such as weight loss, fatigue, and fever.

4. Signs of tumors occur in the endometrium, shaped like polyps, often filled with uterine cavity, which makes the uterus enlarge and soften. The tumor can protrude into the vagina or invade the myometrium.

5. High degree of malignancy, rapid development of the disease, about 1/3 of patients have extrauterine metastasis during surgery, including 40% of ovaries, 33% of fallopian tubes, 33% of lymph nodes, 13% of peritoneum, poor prognosis, average 5-year survival rate 18 %~42%.

Examination of malignant mesodermal mixed tumor of uterus

Tumor markers serum CA125, CA199, etc. can be elevated.

Hysteroscopy, B-ultrasound, CT, and MRI all help to understand the uterine condition.

Diagnosis and diagnosis of malignant mesodermal mixed tumor of uterus

1. History of uterus malignant mesodermal mixed tumor symptoms are not specific, similar to the general female reproductive system tumor symptoms, so preoperative diagnosis is quite difficult, it is generally believed that postmenopausal vaginal bleeding, abdominal pain and other symptoms should consider the possibility of uterine sarcoma Sex, when the pelvic examination see polypoid-like protrusions in the cervix, in the diagnosis of cervical polyps, endometrial polyps and submucosal fibroids, should be alert to the possibility of mixed Miller tube mixed tumor.

2. Gynecological examination

(1) All elderly women and adolescent girls have gynecological symptoms accompanied by enlarged uterus.

(2) In the vaginal examination, see the opening of the cervix, the presence of polypoids, the presence of uterine cavity exudates, the presence of massive masses and the presence of a large number of necrotic tissues.

(3) Patients who have received pelvic radiation therapy in the past have increased uterus, especially those who have been treated for many years.

3. Pre-surgical scraping is of great value to the malignant mesodermal mixed tumor of the uterus. The literature reports that the positive rate of the diagnosis is 80%-90%, and it is reported that it is only 30%-40%. Microscopic examination of the biopsy, sometimes the malignant mesodermal mixed tumor is not enough, only the adenocarcinoma component is taken, and the sarcoma component is not taken and misdiagnosed as endometrial adenocarcinoma.

It is differentiated from uterine leiomyosarcoma, endometrial stromal sarcoma, malignant lymphoma, and malignant hemangioendothelioma.

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