Gallbladder smooth muscle sarcoma

　　Most believe that gallbladder smooth muscle sarcoma is related to gallstones, with an incidence rate of 52% to 82.2% in conjunction with gallstones, but their exact relationship is not yet clear. Gallbladder smooth muscle sarcoma mostly occurs in the body and base of the gallbladder, with the tumor generally large, with reports reaching 10cm×9cm×8cm. It often grows infiltratively, has a harder texture, and is significantly adherent to surrounding tissues, showing signs of infiltrative metastasis. Pathological examination reveals thickening of the gallbladder wall, with a few cases showing acute inflammatory changes and varying sizes of stones. The surface of the mass is uneven, dark brown, with a grayish-white and tender section, which may have focal hemorrhage and necrosis. Under the microscope, part of the gallbladder wall is lined with intact epithelium, with inflammatory cell infiltration, tumor cells being fusiform, elliptical, or polygonal, with marked atypicality, frequent nuclear division, and deep staining, visible multinucleated or giant tumor cells. Immunohistochemistry shows α-actin (+), Vimentin (±). RF silver staining reveals abundant reticular fibers surrounding individual tumor cells, and VG staining shows the tumor tissue as yellow.

　　Gallbladder smooth muscle sarcoma can lead to jaundice, pain in the upper right abdomen, gastrointestinal symptoms, and a mass in the upper right abdomen, as follows:

　　1. Pain in the upper right abdomen

　　This symptom accounts for 84% and is often associated with gallbladder cancer, which often coexists with gallstones and inflammation, so the nature of the pain is similar to that of calculous cholecystitis. It starts with discomfort in the upper right abdomen, followed by persistent dull pain or aching, and sometimes intermittent severe pain, which may radiate to the right shoulder.

　　2. Gastrointestinal symptoms

　　The vast majority (90%) experience dyspepsia, aversion to greasy foods, belching, decreased appetite, which is due to the gallbladder's inability to digest fat substances due to its renewal and replacement function.

　　3. Jaundice

　　Jaundice often appears in the late stage of the disease, accounting for 36.5% of cases, which is usually due to malignant obstruction caused by the invasion of cancer tissue into the bile duct, accompanied by weight loss, fatigue, and even cachexia, yellowing of the skin and mucous membranes, and difficult-to-treat skin itching.

　　4. Fever

　　25.9% of patients experience fever.

　　5. Mass in the upper right abdomen

　　In the late stage, the development of the lesion may cause a mass in the upper right abdomen or upper abdomen in 54.5% of cases. This is due to the rapid growth of the tumor blocking the bile duct, causing the gallbladder to enlarge; the second is obstruction caused by invasion of the duodenum, accompanied by obstructive symptoms; in addition, invasion of the liver, stomach, pancreas, and other organs may also cause masses in the corresponding areas.

　　Gallbladder smooth muscle sarcoma is more common in women, with a prevalent age of 50 to 60 years. Early on, there are no clinical symptoms, but in the late stage, patients may experience fatigue, loss of appetite, abdominal distension, nausea, vomiting, weight loss, symptoms that are significantly different from before (if the patient has had cholecystitis or gallstones before), dull pain in the upper right abdomen that radiates to the back, lower abdomen, and lower back, and if obstructive jaundice occurs, it indicates infiltration of the common bile duct or compression of lymph nodes around the extrahepatic bile duct, which may be palpated in the upper right abdomen during physical examination, and sometimes ascites may have already appeared. Most patients are accompanied by gallstones.

　　To prevent gallbladder smooth muscle sarcoma, patients should pay attention to the following in their daily lives:

　　1. Maintain a cheerful mental state, develop good eating habits, avoid spicy foods, eat less rich and greasy foods, and do not drink strong alcohol.

　　2. For people over 40 years old, especially women, regular ultrasound examinations should be conducted. If gallbladder inflammation, gallstones, or polyps are found, more follow-up examinations should be carried out, and early treatment should be sought if there are changes in the condition.

　　Before actively treating the precancerous changes, it is necessary to eliminate potential carcinogenic triggers as soon as possible, such as actively treating cholecystitis, and performing cholecystectomy as soon as possible for symptomatic gallstones or larger stones.

　　Tumor markers such as CEA, CA-50, and CA19-9, combined with clinical manifestations, have certain value in determining the benign or malignant nature of tumors in patients with gallbladder smooth muscle sarcoma.

　　1. Abdominal X-ray film may show a shadow of a gallbladder mass.

　　2. Gallbladder imaging is not visible, if the gallbladder is well imaged but there is a filling defect, it strongly suggests gallbladder tumor.

　　3.Percutaneous liver puncture cholangiography. Can show bile duct stenosis, displacement, or non-filling.

　　4.Endoscopic retrograde cholangiopancreatography. Indicates that the gallbladder is not full and the bile duct is compressed or obstructed.

　　Patients with gallbladder benign tumors should pay attention to dietary adjustments in their daily lives, as follows:

　　1. Tufuling and Yujin Honey Drink

　　Ingredients: 60 grams of Tufuling, 30 grams of Yujin, 30 grams of honey.

　　Preparation: Wash and dry Tufuling (Smilax glabra) and Yujin (Curcuma zedoaria), dry or air-dry, cut into slices, place them in a pot with water, soak for a moment, boil for 30 minutes, filter out the dregs, and mix the filtered juice with honey when warm, stir well, and it is ready.

　　Effect: Promote Qi and blood circulation, anti-tumor pain relief.

　　Administration: Take twice a day, morning and evening.

　　2. Sanqi and Yuanhu Garlic Paste

　　Ingredients: 10 grams of Sanqi powder, 10 grams of Yuanhu powder, 50 grams of garlic.

　　Preparation: Wash and dry Sanqi (Panax notoginseng) and Yuanhu (Corydalis), grind into fine powder, mix thoroughly, and set aside. Wash the purple-skinned garlic, chop it into garlic paste, mix it with the Sanqi and Yuanhu fine powder, add an appropriate amount of warm water as needed, stir into a paste, and it is ready.

　　Effect: Promote blood circulation and Qi, anti-tumor pain relief.

　　Administration: Take twice a day, morning and evening.

　　The treatment of gallbladder smooth muscle sarcoma includes surgical treatment and chemotherapy, as follows:

　　1. Surgical Treatment. Surgical resection is the only option, but most patients cannot undergo surgery to remove the jaundice.

　　2. Chemotherapy (Radiotherapy). Late-stage patients can try chemotherapy.

　　The soft tissue smooth muscle sarcoma can occur locally recurrent and distant metastasis, and rare lymph node metastasis. The most important prognostic factor currently considered is the location and size of the tumor. The ones occurring retroperitoneally and those with large tumors are difficult to resect or cannot be completely resected, and are prone to local recurrence and metastasis. The prognosis of smooth muscle sarcoma of large blood vessels is poor. Local recurrence and metastasis generally occur in the first few years after diagnosis, and can also occur 10 years later. The most common sites of metastasis of retroperitoneal smooth muscle sarcoma are the liver and lung, and non-retroperitoneal tumors mainly metastasize to the lung. Wide or radical surgical methods should be adopted to resect the tumor.