majority of sexually transmitted diseases have fear, anxiety neurosis, anxiety or depression, readme first dizzy, headache, insomnia, nightmares, palpitations, loss of appetite, tinnitus, and fatigue. poor often feel dribbling urine or urethral itching, pain and discomfort, urethra "discharge." Scrotum, lower abdominal pain fall discomfort, back pain, and nocturnal emission, premature ejaculation, irregular menstruation, decreased libido and so on. In severe cases, can feel a sense of the urethra or vagina in insect crawling insects such as feeling a sense of allergic symptoms.[Cause]
mediastinal mesenchymal tumors and other tumors are caused by what the?
mediastinal mesenchymal tumors of similar causes soft tissue tumors in the body, although the domestic and foreign scholars in genetics, environment, immunology virology and has done a lot of work, but the exact cause is still not confirmed.
1. trauma is the first to notice some of the tumor surface and the relationship between trauma, there are few reports that surgery, burns or chemical burns, scar tissue and nearby tissue foreign body high incidence of soft tissue tumors, the incubation period of 2 to 50 years.
2. animal experiments confirmed that subcutaneous injection of chemical substances polycyclic hydrocarbons can produce a variety of sarcomas, but research in humans is still not confirmed. Herbicides or defoliants may be given in benzene dioxide into the body and accumulate in fat and other tissues, can not rapidly metabolized, it may induce soft tissue sarcoma, but the soldiers from the Vietnam War and investigative reporting of local residents could not confirm this .
3. ionizing radiation in the radiation field in patients undergoing radiotherapy appear sarcoma, generally have an incubation period of 2 to 25 years, the most common type of malignant fibrous histiocytoma and angiosarcoma.
4. the vast majority of benign soft tissue sarcoma is a malignant primary, but not by malignant from benign tumors, such as a general criterion for many years with a history of benign tumor to grow rapidly, and in the light microscope to find the positive residual benign lesions, considered to be malignant. The authors have observed several cases of malignant transformation of benign tumors found in the malignant from the start.
5. viral factors have been in experimental animals and in human soft tissue sarcoma isolated C-type virus, leukemia virus, EB virus, and noted that patients with hiv infection often accompanied by Kaposi West sarcoma.
6. lymphatic immune factors in the incidence of sarcoma is always with chronic lymphedema after radical mastectomy related to long-term use of immunosuppressive agents such as cyclosporine can cause soft tissue sarcoma .
8. p53 gene mutations in sporadic mutation in soft tissue tumors are not common, but known to the abnormal expression of p53 gene mutations in Rb soft tissue tumors more aggressive than those without mutations .
(B) the pathogenesis
benign mediastinal soft tissue morphology and broadly similar to the originating organization, essentially the same as normal tissue , the number or structure is arranged only a slight difference. mediastinal malignant soft tissue tumor morphology and a larger difference between the normal tissue of origin, and different degrees of cell differentiation. High degree of differentiation, often find in the tumor tissue origin see certain morphological characteristics similar to the two sometimes difficult to identify, to be with immunohistochemistry, electron microscopy and clinical tools to identify.[Sign]
mediastinal mesenchymal tumors can be asymptomatic for years, more than half is due to accidental discovery, it can be in the physical examination or autopsy report. The most common complaint was chest pain, coughing, shortness of breath, difficulty swallowing, hoarseness, Horner syndrome, superior vena cava syndrome and trachea, heart pressure, etc., there are some non-specific symptoms such as fever, night sweats, general malaise, anorexia, weight loss, etc., these same tumor location, size, nature and growth of the way, less benign symptoms of cystic solid tumors produce symptoms than less, expansive growth will produce compression symptoms, invasive growth often appear involved organs corresponding symptoms. Clinical common mesenchymal tumors are:
1. mediastinal fatty tumors benign and malignant sub-two categories, benign tumors in the majority. Which mediastinum rare, can occur in any part of the mediastinum, mostly in the anterior mediastinum, Xinyuan phrenic angle side or the heart. etiology is unknown, it was believed to have originated in the mediastinal pleura or chest wall subcutaneous adipose tissue, but also that originated in the degradation of the thymus.
(1) mediastinal lipoma: is the more common mediastinal mesenchymal tumors. Can occur at any age, adult males slightly more. Tumors are usually encapsulated, mostly spherical, nodular-shaped or irregular in shape, cut surface light yellow or yellow, oily-like, fibrous tissue is often divided into different sizes of the lobular structure, softer texture, size is usually larger, may be associated with hemorrhage, necrosis, liquefaction, cystic degeneration and ossification. Histologically, mainly composed of mature adipose tissue, often extending into the neck, intercostal or spinal canal, slow growth, sometimes malignant. Generally no obvious clinical symptoms, such as large tumor volume can compress surrounding tissue, can produce symptoms. CT diagnosis of fatty tumors important value, in the mediastinum with good contrast, showing a circular retrosternal mediastinal mass, CT values are lower, for-100HU, no clear outer edge of the tumor invasion. Diagnosis of mediastinal lipoma should be noted in the mediastinal lipoma to find the composition of the thymus, the thymus to exclude the diagnosis of lipoma. It should also identify with lipomatosis, because there is complete tumor capsule, surgical resection is not difficult, the general prognosis is good.
(2) mediastinal liposarcoma: its etiology is unknown. Occurred in the mediastinum are rare men slightly more than women, more common in 40 to 60 years, rare in young people, the vast majority of primary tumors, there are malignant from benign fatty tumor from the report. liposarcoma is usually larger, nodular or lobulated, fibrous capsule may have meager, those facets of well-differentiated lipoma like, such as the proliferation of fibrous tissue associated with the white cord is visible during interludes. Mucoid lipoma was jelly. Round cell and pleomorphic were fish-like or brain-like, may have hemorrhage and necrosis, microscopic morphology and diverse. Now often develops into well-differentiated type, mucinous type, round cell and pleomorphic and dedifferentiated type 5 types, plus five kinds of cancer exist hybrid components. liposarcoma were located in the posterior mediastinum. Longer course of preoperative duration ranging from weeks to years, often obvious chest pain, pressure symptoms can produce a huge mass, CT is important for diagnosis, mri and CT scans compared to multi-level, the tumor extended in scope superior to CT. Wide local excision, including sarcoma envelope, radiation therapy for mucin-type liposarcoma effective, and mucus, the more the better. liposarcoma of the mediastinum were worse prognosis than superficial. surgical removal of the envelope only when the prognosis is poor. liposarcoma of the 5-year survival 40% to 64%, recurrence rate, reported by 24%, for relapsed patients should be re-operation.
2. mediastinal tumor of fibrous tissue fibrous tissue tumors derived from the fiber cells, fibroblasts and collagen fibers formed. according to the degree of differentiation and maturation into benign and malignant mediastinal tumor immunogenicity is very rare fiber, the domestic shanghai chest Hospital 1990 1796 cases of mediastinal tumors were treated, of which only 17 cases of fibrous tumor immunogenicity, only sporadic cases reported in other . At present, the habit of such tumors are classified as fibromatosis, fibrosarcoma and malignant fibrous histiocytoma.
(1) mediastinal fibromatosis: a disease fibrosis by collagen fibers and mature fiber cells. Of unknown etiology may be related to inflammation or tumor of some active substances produced, but also may be an allergy and autoimmune diseases. Between the biological behavior between benign and malignant. No significant edge in general morphology, showed diffuse nodular hyperplasia and nodular hyperplasia. Mostly middle-aged patients, clinical symptoms due to thoracic mediastinal organs by the proliferation of fibrous tissue wrapped and oppression caused to surrounding the aortic arch, trachea, bronchi, heart, etc., often because of the superior vena cava obstruction is noted, There are other chest pain, fever, difficulty swallowing, hoarseness, esr and other performance. cancer does not occur, treatment should be taken to complete resection, incomplete resection of local recurrence will be.
(2) mediastinal fibrosarcoma: the cause is unknown. In the mediastinum are rare, and more in the posterior mediastinum. Tumors were round or oval, larger, generally pseudocapsule, differentiation as well, cut surface white, hard and tough, with swirling structure. Poorly differentiated facets such as fish-like, soft, showing hemorrhage and necrosis. Microscope, mainly by the spindle fibroblast cells, and contains reticular fibers and collagen fibers, some areas show myxoid change, showing that mitotic cells showed varying degrees of heteromorphism, according to the number of cells, differentiation, collagen the number of fibers and the number of mitotic figures can be broadly divided into three: the person is a well differentiated, worse, as the two worst were the three, guidance on the prognosis. Rapid tumor growth, local infiltration was extended, few distant metastasis, generally found in larger, usually produce symptoms, complained of cough, chest pain, difficulty breathing and swallowing difficulties. Some of the large tumor secrete insulin-like factor, causing low blood sugar. chest x-ray fibrosarcoma and fibroma were not characteristic, not a good site, usually outline a clear, prominent side of the mediastinum, without calcification, may be complicated by pleural effusion. Invasion by mass grave, ill-defined, complete resection difficult. according to the lesion incision design appropriate for the smooth operation is very important. Surgery for these tumors is still the main treatment, radiotherapy or chemotherapy uncertain. Patients with poor prognosis, most patients died a few years after the discovery of tumor spread within the chest.
(3) mediastinal malignant fibrous histiocytoma: malignant fibrous histiocytoma of the elderly the most common soft tissue sarcoma, only a very small number of lesions is primary in the mediastinum. No difference in incidence between men and women. posterior mediastinum common, followed by the mediastinum. Usually malignant fibrous histiocytoma showed invasive growth, no capsule, but some statistics that domestic primary in the mediastinum of malignant fibrous histiocytoma enveloped more. Tumors can grow large, usually nodular, gray cut surface fish-like, can also be yellow or brown, often accompanied by hemorrhagic tumor necrosis and large cystic change, such as fiber ingredients, hard texture. Containing more mucus, the mucus-like translucent. Microscopic morphology shows the main components of fibroblast cells and tissue cells, can be associated with varying amounts of mononuclear and multinucleated giant cells, foam cells and undifferentiated primitive mesenchymal cells and a variety of inflammatory cells, during which there various forms of transitional cell. fibroblasts were slender spindle or obese, and more seats arranged in a special pattern-like structure. Cells were round or polygonal, abundant cytoplasm, the number of mitotic figures within the tumor ranging from common abnormal mitotic figures were evident. Early often asymptomatic and difficult to find, only when the tumor growth suppression surrounding organs or large blood vessels when the symptoms. chest x-ray may suggest the presence of tumor, more common in the posterior mediastinum, usually round or irregular lumps, prominent side of the mediastinum, size, density is generally more uniform, a few uneven density may be associated with calcification . CT can clearly understand the tumor and surrounding tissue, especially vascular relationship, there is help for surgical planning, the lesion is small, edge finishing, homogeneous density. Larger, irregular, often accompanied by necrosis (55%) and calcification (7% ~ 20%) and invasion of adjacent organs and tissues, diagnosis is generally required with biopsy. Preferred surgical treatment, surgical removal of the principle as complete as possible. Preoperative or postoperative adjuvant therapy such as radiotherapy and chemotherapy has not yet been confirmed. malignant fibrous histiocytoma of the higher degree of malignancy, local recurrence rate of 40% to 55%, the transfer rate of 14% to 55%, the most common lung metastases. 5-year survival rate of 36%.
3. Solitary fibrous tumor in the mediastinum are very rare, nearly half are malignant, the tumor originated in the skin between the undifferentiated mesenchymal cells, the incidence of asbestos contact history has nothing to do. Tumors isolated, confined, generally thin pedicle and broad-based, often complete capsule, and the surface with the pleura, the ultrastructure suggesting that tumor cells are essentially fibroblasts, immunohistochemical staining shows vimentin-positive, and sometimes keratin was negative. More common in adult males, often chest pain, coughing, breathing difficulties and fever and other symptoms, may have bone and joint disease, clubbing and hypoglycemia performance. May have transferred, the more common is the liver, lymph node metastasis can also be found. treatment with surgical resection, postoperative radiotherapy and chemotherapy. Generally good prognosis of benign and rarely recur. malignant long-term survival of patients is very low, easy to relapse, the majority of recurrence survival time of less than 5 years.
4. mediastinal vascular tumor vascular tumors mediastinum is rare. Statistics that the incidence rate of cases of mediastinal tumors 0.5% to 1.5%, its 10% to 30% are malignant, etiology and pathogenesis is unknown, can occur in any part of the mediastinum, the majority of the previous upper mediastinum.
(1) mediastinal hemangioma: cavernous hemangioma in common, some as capillary hemangioma, a benign vascular tumor of the two accounted for 90% of vein-type has also been reported. Mainly in the splanchnic area or paravertebral sulcus, and occasionally can be extended to the chest wall, neck and spinal canal. tumor may have thin capsule, mostly purple, soft, uncertain form, a small number of hemorrhage, microscopic tumor endothelium by a thin layer lining the lumen of the expansion of the composition, between the lumen separated by a thin fibrous tissue, seen spotty thrombosis, calcification, cholesterol granuloma. More common in young adults, gender differences do not, patients are asymptomatic, the occurrence of symptoms and tumor size, location and pressure of the surrounding tissue or assault, can have chest pain, chest tightness, coughing and other symptoms. CT can help diagnose hemangioma, showing isolated mediastinal soft tissue mass, medium density, size, border clearance, but also vague, compared with x-ray is easy to show the presence of vein stone. treatment to surgical excision is preferred.
(2) vascular endothelial cell tumor: histological features ranging between benign and malignant, derived from vascular endothelial cells. Invasive growth can be presented, and with regional lymph node metastasis and the transfer of vital organs, including lung and liver are common sites of metastases, a low-grade malignant tumor, microscopic little atypia, mitotic figures rarely, surgical resection should be widely There is a certain recurrence rate.
(3) vascular endothelial sarcoma: occurred in the mediastinum are very rare, of unknown etiology, usually non-encapsulated tumor, with extensive hemorrhage and necrosis within the tumor cell density, shaped significantly, easy to see mitotic cells generally have been around the reticular fiber sheath, in solid sheets, lacunar obvious. Highly malignant disease progressed rapidly, showing invasive growth, lymph node and lung metastasis may have sometimes found to have unresectable surgery, patients in relapse after short-term, short-lived.
(4) vascular smooth muscle tumors: primary subcutaneous tissue in the distal extremities, rare in the mediastinum. Can occur at any age, any part of the mediastinum, including the anterior mediastinum common. Addition to the pathological expression of smooth muscle tumors, while it has its own characteristics: tumor boundaries clear, thick-walled blood vessels surrounded by the smooth muscle bundles arranged in concentric circles, the outer cells gradually merging with the wall outside the smooth muscle cells together, the same type, but also No mitotic figures, vascular wall thickness, lumen was a narrow slit-like, wall plates and no elastic membrane. Large tumors may have compression symptoms, preoperative diagnosis depends on biopsy, the preferred surgery, prognosis is good.
(5) vascular smooth muscle sarcoma: incidence of the following parts of the superior vena cava, pulmonary artery common vascular lesions in the small blood vessels when the primary is not easy to find, controversial diagnosis, tumor size to be combined , disease location, metastasis and endoscopic findings to determine the number of mitosis, the preferred surgical treatment, extent of surgery, including blood vessels throughout the tumor and nearby tissue and adhesions, has been reported recurrence rate of 75% was given to relapsed patients had radiotherapy, but without success, only a few cases of chemotherapy benefit.
(6) vascular sheath cell tumor: hemangiopericytoma originated in benign and malignant cells have divided, but difficult to distinguish between pathology, tumors can occur in any part of the body to lower extremities , retroperitoneal, and the most common head and neck area, occurred in the mediastinum is rare. No age and gender differences. course of varying lengths, from years to decades, slow growth, hematogenous spread is the main way to transfer to the lung and bone common, most patients are asymptomatic, or the late great because tumor infiltration compression symptoms, which are more specific The symptoms of low blood sugar, causes may be related to tumor secretion of renin, blood glucose was a lot of use and consumption related, once to remove the tumor, blood sugar back to normal. Diagnosis depends on pathology determined. mri and angiography can show the tumor-rich vascular network, and clear boundaries, while the tumor feeding artery and its branches of radiation. Preoperative embolization to reduce tumor blood supply, or due to general tumor boundaries clear with thin capsule, easy-to-surgery, postoperative recurrence possible, radiation therapy can be used as adjuvant therapy, chemotherapy is not very useful.
(1) mediastinal lymphangioma: lymphangioma is a malformation not true tumors. lymphatic system and venous system causes traffic failure, is congenital. May also be secondary to surgery, trauma. mediastinal tumors account for 0.7% to 4.5%, the neck is most common, occur within the mediastinum is rare, and mostly an extension of the neck to the mediastinum. Clinical lymphangioma into the neck type, neck type mediastinum, mediastinal type. according to the size of abnormal lymphatic vessels, divided into three types. ① capillary-type: from the small lymphatic vessels form; ② cavernous type: the expansion of the lymphatic lumen tubes, the cavity containing lymph, often an increase in interstitial connective tissue, and scattered lymphocytes and lymphoid follicles, often grow along the tissue space, easy to excision; ③ cystic lymphangioma: The most common type,
(2) lymphangioleiomyomatosis: all occurred in healthy women tumor, originally known as lymphatic skin cell tumor, its limitations can be located in the mediastinal lesions, often with the thoracic duct and its branches are closely related, leading to chylothorax. Diffuse type is called lymphangioleiomyomatosis, can affect the lungs, some cases of tuberous sclerosis syndrome in the background, suggesting that in the pathogenesis of contact, the incidence may be related to female hormones. The idea that a kind of hamartoma. Surgery is better.
6. mediastinal muscle-derived tumors
(1) mediastinal rhabdomyoma: This cancer can occur at any site, even non-skeletal parts, rarely primary in the mediastinum, Miller (1978) have reported one case of this occurred in the anterior mediastinal tumors, and speculated that it originated in the thymus, the domestic periodicals rarely reported, this pre-cancer surgery is good.
(2) mediastinal Rhabdomyosarcoma: rhabdomyosarcoma by different degrees of skeletal muscle differentiation of malignant cells, cell morphology varied. Clinically, according to the tumor cell differentiation, a special form of organizational structure and the giant body, will be divided into embryonal (including grape family type), spindle cell type, alveolar and pleomorphic type 4, in which the most common type embryos . Can occur at any age, the incidence of different pathological types of differences in age, alveolar occur in young people, mostly occurs in infants embryonal, pleomorphic mostly occur in the elderly. More common in men than women disease. mediastinal rhabdomyosarcoma often asymptomatic, even as the first symptom of metastatic sites, find the primary tumor was discovered, a large mass surrounding organs can occur when pressure symptoms, due to a higher degree of tumor malignancy, rapid growth, early and difficult to find, and discovered that a lymph node or hematogenous metastasis, no major organ for the transfer of mass and limited to the mediastinum should be complete surgical excision. At the same time should be combined with radiotherapy and chemotherapy, the pathological classification of rhabdomyosarcoma can determine the prognosis, especially evident in children and adolescents, the prognosis is the best type grape rhabdomyosarcoma, 5-year survival rate was 95%; followed by the fusiform cell rhabdomyosarcoma, 88%; embryonal 66%; alveolar and pleomorphic poor, 54% ~ 62%.
7. other rare mesenchymal tumors occur in other mesenchymal mediastinal tumors have mesenchymal tumors, meningeal tumors, synovial sarcoma, bone of osteosarcoma, chondrosarcoma, etc., and xanthogranulomatous inflammatory mass, which is the lymph nodes of non-tuberculous granulomatous lesions formed in the mediastinum tumor, chest x-ray showed round or lobulated shadow broke into the lungs, smooth edges. mass may produce large compression symptoms, and could therefore be surgery.
due to occur in the mediastinum mesenchymal tumors from different sources, fewer symptoms, no specific preoperative diagnosis depends on pathology support, of course, combined with clinical history and physical check, select the appropriate auxiliary means of inspection, will help improve the preoperative diagnostic accuracy.
soft tissue sarcoma of the stage and grade of their diagnosis, treatment, prognosis, evaluation and research is very important. Because sarcoma less lymph node metastasis, TNM staging is difficult to accurately classic description, and classification is too complex, difficult to master. Many clinicians prefer simpler and helpful clinical classification system, such as transfer possibilities <15%, were designated as low-grade list, the opposite is highly malignant, the two systems, enabling them to make treatment more choice. However, this approach is too simple, not a more comprehensive response sarcoma morphology and biological behavior of the degree of change, here is a ENNEKING staging system (Table 1).
based on cell structure, shape, mitosis and cell necrosis determined grading criteria, which show graded G1 low-grade, G2 show a high degree; anatomic site within the region T1, T2 are outside the region.[Aftertreat]
mediastinal mesenchymal tumors and other tumors ate?[Prevent]
(b) the description of patients with a positive attitude towards the prevalence of nature, and should patiently and repeatedly to the scientific knowledge to explain. Guiding the patient properly treat the disease.
(c) to gradually guide the patient's attention from their own transfer to the outside world. Through participation in various social and recreational activities, so that gradually got rid of the concept of hypochondriasis.
(E) is the lifting of the main drug treatment in patients with concomitant anxiety and depression. Available benzodiazepines hua Zhuo, tricyclic antidepressants, SSRIs and symptomatic treatment of analgesics, sedatives, etc.[Treat]
a) surgery for the treatment of choice, surgical approach and surgical technical issues should be the principle of mediastinal tumor surgery, for complete resection. For malignant mesenchymal tumors sometimes have combined with radiotherapy or chemotherapy, but the results are often unsatisfactory.
(b) the prognosis
2. limitations of the most important factor is the tumor classification of tumors of soft tissue sarcoma U.S. MSKCC will be divided into two, namely, the low degree of differentiation and a high degree of differentiation, according to this standard , prospective study of 2058 cases of soft tissue sarcoma significant difference in survival prognosis. In addition to fat-derived mediastinal sarcoma, the rest are poor prognosis.
3. surgical margin was positively correlated with tumor recurrence, local recurrence, but to note the impact on survival is controversial, in addition, the formation of local recurrence in the sense of distant metastasis small.
4. cell proliferation, such as ki-67 and p105 belong to the proliferation markers, and some studies suggest that prognosis, remains to be further explored.
5.DNA flow cytometry to determine ploidy with prognosis of patients with solid tumors, determination of cellular dna content, estimated cell cycle distribution and ploidy, diploid has been reported and aneuploid tumors in 10-year survival, the former significantly larger than the latter.
No correlation Information
urethra itch: common of gonococcal urethritis (acute gonorrhea), incubation period of 1-14 days, often 2-5 days . Beginning, for the acute anterior urethritis, urethral irritation, itching and mild irritation, followed by a thin mucus flow, causing urinary discomfort.
urethra pain: common in prostatitis patients showed symptoms include: dysuria, urinary urgency, urinary frequency, urinary wait, interrupted the urine, urinary weakness, urinary dribbling, urinary bifurcation, urinary retention, urethra drops of white, hematuria, waist and knee pain, groin and thigh pain on both sides of radioactivity, abdominal and perineal pain or heavy feeling discomfort, anal pain, dizziness, fatigue, itching urethra burning, testicular bulge pain, scrotal wet, wet dream. Decreased libido and sexual function, infertility and so on.
urethral itching, burning sensation during urination is a symptom of fungal diagnosis of urethritis. Mycotic urethritis is caused by urethritis fungal disease. Diagnosis based on: 1. urethral symptoms of itching, burning sensation when urinating. 2 Check the urethra with a small amount of overflow discharge, watery or mucus-like, a few red or black. 3 laboratory tests take Urine, urethral discharge, or urethral swab check mold or training. Especially in the indwelling catheter should be regularly checked.
itching urethra: urethral slight burning sensation when urinating, itching feeling are common symptoms of urethritis. urethritis is a common disease, common in women, clinically divided into acute and chronic, non-specific urethritis and gonococcal urethritis, the latter two similar clinical manifestations, must be distinguished history and bacteriology.
more pelvic symptoms
β-amino acids, amino acids, urinary cancer, ureteral stricture aciduria white mucus-like urine, urine white blood cell in urine white asphalt will increase the amount of residual urine bladder irritation bladder tuberculosis, bladder dysfunction, bladder spasm incomplete bladder emptying the bladder bulging bladder diverticulum bladder fibrosis and bladder capacity, reduced bladder detrusor instability forced vaginal fistula urine muscle hyperreflexia
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