What Is a Mucinous Adenoma?

Peritoneal myxoma, ovarian myxoid cystadenoma patients have 2 to 5% of patients with peritoneal myxoma, mostly secondary to cyst rupture, tumor cells are planted in the peritoneum and form tumor nodules, producing a large number of mucus, and generally no organs occur Substantial infiltration. It is not easy to completely remove the operation, and it is easy to relapse after surgery. The 5-year survival rate is only 45%. The tumor epithelium is highly differentiated and is not sensitive to radiotherapy or chemotherapy.

Myxoid tumor

Myxoid cystadenomas account for 20% of benign ovarian tumors. 95% of tumors are unilateral, with a grayish-white surface, large or huge volume, often with multiple chambers on the section, and different cyst sizes. The cyst interval consists of connective tissue, the cyst fluid is jelly-like, contains mucin or glycoprotein, the tumor surface is smooth, there is little growth of nipples, and the cyst cavity is covered with a single layer of high columnar epithelium, which can produce mucus. The malignant change rate is 5-10%.

Overview of Mucinous Tumors

Mucinous cystadenocarcinoma accounts for about 10% of ovarian malignancies. Most of them are unilateral and the tumor is larger. The papilla wall or papillary area can be seen on the cyst wall. The half cyst is semi-solid on the cut surface, and the cyst fluid is cloudy or bloody. The prognosis is significantly better than serous cancer. The 5-year survival rate is 40-50%.

Mucinous Tumor Recipes

Prescription: Dioscorea toad soup: 15g each of ground beetle, toad, columbine, columbine, codonopsis, 18g each of Hedyotis diffusa, coix seed, barberry, 10g each of Triangle and Atractylodes, 12g of Rhizoma Curcuma and 3g of Licorice Decoction 3 times, take 3 times. If there is no obvious response, you can even take it for more than 2-3 months.

Efficacy: Pan Mingji et al. Achieved a certain effect with this formula in treating ovarian cancer.

Recipe: 30g of walnut branches, 30g of comfrey root, decoction.

Overview of Mucinous Tumor Diseases

The contents of such tumors were previously known as pseudomucinous cystic tumors because they were soluble in acetic acid and were different from gastric mucus. In recent years, histochemical tests have confirmed that it is a mucin, such as acetylglucosamine and other protein-containing carbohydrate complexes. Because the contents of this tumor cyst cavity are characterized by rich albumin and glycoproteins (belonging to mucopolysaccharides), they are now commonly referred to as mucinous cystadenomas. The epithelium that covers the walls of the glands and cysts is similar to the endometrium or intestinal mucosa.

Such tumors are quite common, accounting for about 15 to 25% of all ovarian tumors, and mucinous cancers account for 6 to 10% of all ovarian cancers. About 85% of all ovarian mucinous tumors are benign (mucinous cystadenomas), borderline malignancies (junctional mucinous cystadenocarcinomas) account for about 6%, and invasive carcinomas (mucinous cystadenocarcinoma) are about 9% (Bemnigto, etc.). Myxoid cystadenomas are most common between the ages of 30 and 50 years, and borderline tumors and invasive carcinomas are most common between the ages of 40 and 70 years. Among them, mucinous borderline cystadenocarcinoma accounts for 17 to 52% of ovarian mucinous carcinoma.

Mucinous tumor tissue

At present, it is believed that myxoid tumors originate from metaplasia of ovarian surface epithelium or body cavity epithelial cysts. Much evidence suggests that mucinous tumors may contain other Mullerian-type epithelium such as fallopian tube type, endometrioid epithelium. Body cavity epithelial cysts and transitional areas between mucous epithelium can also be seen. However, in some mucinous tumors, goblet cells (approximately 1/4 cases), argentaffin cells (approximately 1/5 cases), and Paneth's cells (see A small number of cases); and mucinous glands and cysts are often components of teratomas. About 5% of mucinous tumors are associated with benign cystic teratomas, so it is believed that mucinous tumors may originate from germ cells, much like a single Germ tumor. However, mesoderm-derived organs such as the kidney and cervix can also show intestinal metaplasia and appear the above cells (Anopardi et al.). Similar metaplasia of ovarian surface epithelium can explain the origin of intestinal mucinous tumors (Fenegli et al.). Occasionally the cervical endometrium and intestinal epithelium coexist in the same tumor and even within the same gland.

Some scholars believe that the occurrence of this disease seems to have a genetic tendency. For example, Peut-JeGHres syndrome in genetic diseases is characterized by skin and mucosal pigmentation and gastrointestinal polyps. About 14% of patients have ovarian tumors or granulosa cell tumors. , Or cystadenoma.

Myxoid tumor laboratory test

[Visual inspection] Mucinous cystadenoma is mostly unilateral, and about 5-10% is bilateral. About 10 to 20% of borderline tumors and erosive cancers are bilateral. Tumors are usually large, most of which are 15-30 cm in diameter. The average weight is 2,000 to 4,000 g, and it has been reported in the literature that it weighs 149 kg (328 lbs) (Spohn, 1922). The surface of the tumor is smooth, the cyst wall is thin, transparent or translucent. The section is mostly multi-chambered, and the liquid inside the capsule is thick or viscous, such as jelly, or thin like water. Borderline tumors and erosive cancers can have nipples and solid thickened areas. Hemorrhagic and necrotic lesions are common, and the fluid in the capsule becomes brown or bloody.

[Light microscopy] Mucinous cystadenoma is covered with highly differentiated monolayer and high columnar epithelium, rich in cytoplasm, containing mucin, and the nucleus is located at the base. Goblet cells can be seen between the mucinous epithelial cells. Approximately 20% of tumors contain argyrophils and occasionally Parnett's cells. If there is obvious stratified epithelial hyperplasia (no more than three layers of borderline tumor cells), budding and bypassing, nuclear atypia, and mitotic phases, it may indicate borderline tumors or erosive cancer. Highly differentiated mucinous cystadenocarcinoma is covered with highly columnar mucinous epithelium, mildly atypical, with cancer cells invading the stroma, and the glandular ducts are regular; moderately differentiated, tumor cells are significantly heterotypic, invading the stroma, invading the stroma, irregular, Epithelial protrusion structure; poorly differentiated type, cancer cells secrete mucus, are pleomorphic, cells are obviously irregular, and glandular duct-like structures are visible.

[Electromicroscopy] Most of the mucous cystadenoma-coated epithelium resembles the endometrium of the cervix, with small, thick microvilli visible at the top of the cells, which protrude toward the cavity surface in an irregular manner. The apical cell membrane between the microvilli is smooth and lacks the phenomenon of cell drinking. The upper part of the side wall of the cell is smooth, and it is closely connected with adjacent cells. Occasionally, desmosomes are present; there are complex villous protrusions at the base of the cell membrane, which intersect with adjacent cells in fingers, and often do not contain desmosomes. The basal cell membrane is mostly smooth or slightly bent. The nucleus is located at the base and often contains a nucleoli. The core is filled with round or oval mucus droplets. Mitochondria are small and located in the body of the cell. The Golgi apparatus was well-developed, with a matte endoplasmic reticulum without matt surface, varying numbers of rough endoplasmic reticulum and free ribosomes, lacking glycogen, and no lysosomal-like structure.

The ultrastructure of a mucinous adenocarcinoma or cystadenocarcinoma is basically like a myxoid cystadenomas. Electron microscopy showed that the lower the cancer cell differentiation, the worse the secretion of mucus. In poorly differentiated cells, the nucleus of cancer cells is obviously deformed, which can be deep grooves, pseudolobules, irregular folds or deformities, curled or even cave-shaped, and is characterized by secreted mucus droplets and intestinal villi.

[Peritoneal myxoma] The peritoneal pseudomyxoma (pseudomucinous peritonei) has been used abroad, but this situation originates from ovarian myxoid cystoma or appendix mucinous cyst, and the content of the two has been confirmed as mucus, so it should be renamed as peritoneal myxoma (myxoma peritonei); in fact, Long et al. (1969) suggested long ago that it was called myxoma tous peritonitis or mucinous ascites. It is a serious complication of ovarian myxoma (about 2 to 5%). Silverberg (1971) reported that the incidence of peritoneal myxoma in myxoid cystadenomas is as high as 16%. Its characteristic is that the jelly-like substance fills the entire abdominal cavity, and the mucus-like mass can be deposited in the wall and viscera of the peritoneum. It can cause organ adhesions, block lymphatic vessels, and cause foreign body peritonitis.

There is no satisfactory explanation for the mechanism of peritoneal implantation in benign mucous epithelium. The two most common origins of the disease are myxoid ovarian tumors and appendix mucinous cysts. Implantation can be caused by the rupture of these tumors and the overflow of mucus into the abdominal cavity. However, in many cases of peritoneal myxoma, the tumor has neither evidence of rupture nor penetration. It is thought that due to the slow leakage of mucus material into the abdominal cavity, it can cause peritoneal hyperplasia and metaplasia to produce mucus-producing epithelium, thereby forming a peritoneal pseudomyxoma. Although repeated surgery, the prognosis is often poor because the epithelial remnants of the implant cannot be removed.