OVERVIEW
Mesenteric malignant teratoma is derived from germ cells and consists of three germ layers, outer, middle and inner, mainly composed of immature tissues, the tumor body is mostly solid, cystic is rare. The tumor is often large in size, mostly round or ovoid, or nodular, with smooth surface, incomplete envelope, and variable hardness. Common cartilage, bone or calcification foci, can be complicated by hemorrhage, necrosis, rapid growth can penetrate the peritoneum to the surrounding infiltration, dissemination.
Etiology
During human embryonic development, certain totipotent stem cells are separated or detached from the whole body, forming abnormally differentiated tissues with three embryonic layers, namely, endoderm, mesoderm and ectoderm, to form teratoma. A mature teratoma is composed of mature differentiated tissues, while an immature teratoma is composed of immature differentiated tissues.
Symptoms
Depending on the location, size, composition, and degree of malignancy of the tumor, the clinical manifestations are complex and varied. Painless mass is the most common symptom, and it can also cause compression symptoms, such as intestinal obstruction, pyelonephrosis, lower limb edema and so on. In the advanced stage, lymphatic and hematogenous metastasis may occur, with symptoms of compression of enlarged lymph nodes and pulmonary and bone metastasis, and significant weight loss. On examination, abdominal mass can be palpated, with soft and hard uneven texture, and even bony nodules can be detected.
Examination
1. X-ray: abnormal calcified shadow is often seen.
2. Ultrasound, CT scan and MRI: mixed signals can be seen, and there may be strong echoes or bony density shadows, with unclear boundary and no complete envelope. It can clarify the tumor site, size, infiltration range, degree of lymph node metastasis and the relationship with important blood vessels.
Diagnosis
According to clinical manifestations and physical examination of the abdomen, most of them can be clearly localized and diagnosed; X-ray, ultrasound, CT, MRI, gastrointestinal barium enema, pyelography, blood alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and other tests are helpful for qualitative diagnosis and judgment of the condition; abnormal calcification can often be seen in X-ray film. Ultrasound, CT, MRI examination can see mixed signal shadow, there may be strong echogenic or bony density shadow, the border is not clear, no complete envelope, and can clarify the tumor site, size, infiltration range, the degree of lymph node metastasis and the relationship with important blood vessels. Gastrointestinal barium enema and renal pelvic secretography can be used to understand the corresponding organ pressure and push. This disease is often accompanied by increased blood AFP and HCG levels.
Treatment
Once diagnosed, malignant teratoma of mesentery should be treated by surgery as soon as possible. Malignant teratoma often secretes digestive enzymes and sebaceous material, which can lead to inflammatory reaction and close adhesion with the surrounding tissues, therefore, it often needs combined multi-organ resection, with high surgical risk, relatively low radical resection rate and high surgical mortality. For those with huge tumors and serious adhesion with large blood vessels, interventional chemotherapy plus embolization of trophoblastic vessels can be carried out first, and then surgical resection can be carried out when the tumor is shrunken, and part of the tumor wall can be preserved during the operation, and postoperative radiotherapy and chemotherapy can also have a certain degree of efficacy.