Types and treatment of serous cystadenomas. Cystadenoma – what is it like? Computed tomography CT

Ovarian tumors are a very common disease of the female reproductive system. Serous cystadenoma and are identical concepts in medicine. Serous ovarian cyst is one of the most common ovarian tumors, the proportion of which is approximately 70%. It quite fits the definition of a “cyst” since it is a bubble called serous. Cystadenoma is formed from the epidermis, therefore it belongs to epithelial tumors; its cavity is lined with epithelium.

Education is classified as benign, and has a number of features in its structure and development:

It does not grow into neighboring tissues, it only pushes them apart or squeezes them.
Her cells are growing slowly.
Does not metastasize.

Depending on the nature of the formation, serous cystadenoma can be:

Smooth-walled (simple). Simple ovarian cystadenoma mainly affects only one ovary and has a single chamber. But there are also multi-chambered ones with watery contents yellowish color. The size of the tumor varies from 4 to 15 cm. Simple serous cystadenoma is most often diagnosed in patients over the age of 50 years. It does not interfere with normal childbearing if it does not exceed 3 cm.
Papillary (papillary) or, as doctors sometimes call it, rough-papillary cystadenoma. Cystadenoma, a papillary or papillary cyst, is considered next stage diseases, since the papillae appear only several years after the development of the tumor. A borderline papillary cyst is characterized by abundant and frequent papillary formations with fields of extensive dislocation. Papillary cystadenoma can be chambered and develops in both ovaries. With everting papillary cystadenoma, the growths are located outside the capsule. Inverting is characterized by the presence of papillae in the middle of the cyst. At mixed form the papillae are located internally and externally.
Serous papillary cystadenomas develop into malignant form with a probability of 50%. There are single-chamber and. Inside they are filled with a transparent liquid of a brownish or dirty yellow hue. Papillary ovarian cystadenoma is one of the most hazardous formations, since it tends to grow into nearby organs. As a result of this process, work is disrupted urinary tract and intestines, diarrhea and problems with urination occur.
very similar in nature to serous, but unlike the latter, it contains a mucous substance in the cavity. The tumor is covered with cells similar to the mucus-secreting cells of the uterus. The structure of the tumor is a cavity with chambers and partitions and is easily diagnosed using ultrasound. As a rule, this formation occurs simultaneously on both the right and left ovaries. The tumor can reach large sizes(up to 30 cm), therefore subject to surgical removal.

Smooth walled cystadenoma

Serous cystadenoma

Causes and symptoms

Until now, the causes of the cyst have not yet been fully elucidated. Most probable cause development is considered a temporary disturbance in the level of hormones in the body. According to one assumption, serous ovarian cystadenoma develops from functional cysts. Typically, such tumors disappear a few months after their appearance. However, after a year, the functional tumor loses its ability to resolve and papillary cystadenoma develops.

Provoking factors include:

Lack of regular sex life.
Genetic predisposition.
The presence of papilloma virus, sexually transmitted diseases.
Abortion.
Ectopic pregnancy.
Previous operations on the ovaries.

Symptoms of a tumor are directly related to its size. First, nagging pain appears in the lower abdomen and lower back on the side where the cyst has developed. With its significant increase, a significant increase in the abdomen is observed, a presence is felt inside foreign body. Papillary ovarian tumor is characterized by the appearance of ascites (accumulation of fluid in the abdominal cavity).

Diagnostic methods

Diagnosing the disease is quite easy.

For this purpose they prescribe:

Gynecological examination.
Ultrasound. On an ultrasound screen, a serous ovarian cyst looks like a spot round shape with clearly defined contours. After ultrasound examination surgical treatment can be prescribed.
Blood test for tumor markers. Feature papillary cystadenoma is its malignant change, which happens quite often. Therefore, patients diagnosed with this formation are recommended to donate blood for the presence of tumor markers before removing the tumor. Their meaning allows the doctor to choose the right operation.
CT or MRI. These studies are necessary to clarify the location and nature of the formation.
Blood analysis. To detect either an inflammatory process or blood loss.
Pregnancy test. This method is necessary to exclude ectopic pregnancy.

Treatment of the disease

In the absence of urgent indications for surgical intervention, the tumor is monitored for several months, drug treatment. A functional cyst will disappear or significantly decrease in size in 1 to 3 months. If it is confirmed that the formation is not functional, has signs of progression in other special indications surgery is prescribed.

They try to treat simple serous cystadenoma with a diameter of less than 3 cm by enucleation.

If the size of the cyst exceeds 3 cm, then a dense capsule is formed from the surrounding tissues due to their compression. In this case, you will most likely have to remove the entire ovary.

Laparoscopy.

Papillary serous cystadenoma is particularly dangerous due to the fact that it can degenerate into serous carcinoma ovary (cancer). It all depends on the results histological examination cysts. If the tumor is malignant, then the issue of removing the ovaries and sometimes even the uterus is decided.

Get rid of the tumor using the following types surgical intervention:

. Through several small incisions, the cystadenoma is removed.
Laparotomy. The tumor is removed through one large incision.

Laparotomy. Increase.

The main task when removing a cyst at a young age is to preserve the ovary. If the presence of simple serous cystadenoma is confirmed, then operational tactics is not justified, since malignant tumor it rarely outgrows. However, the absence of a risk of a tumor becoming malignant is not a reason to relax, since, as it grows, it can cause numerous other complications.

Possible forecast

In patients childbearing age who have a cyst or cystadenoma of the left ovary or a cyst of the right ovary are interested in the question of the possibility future pregnancy after the operation. In the presence of a benign tumor, the ovary is not affected at all, and the ability to have children is completely preserved.

If one ovary was removed, then the possibility of becoming pregnant also remains.

It is important to note that there are cases where, when exposed to certain factors, a borderline or malignant tumor can form. Ovarian cystadenocarcinoma is a malignant tumor that belongs to the category of secondary cancer. Often such a tumor develops in serous cystadenomas. Mucinous cystadenoma, according to medical statistics, less often leads to the formation of such tumors.

When a cyst is detected big size, having a bilateral location, or if serous cystadenocarcinoma is diagnosed, both ovaries are removed, the woman loses her ability to bear children. In general, with early diagnosis and with properly selected treatment, the prognosis for this disease is favorable.

Cystadenoma (cystoma) of the ovary is a benign pathological process in the uterine appendages, which leads to the formation of a tumor with a dense capsule.

Since the main cause of the disease is hormonal changes, it is more often diagnosed in patients in premenopausal period. However, it is possible that cystomas may develop in younger women.

The danger of the pathology lies in its tendency to easily malignize, that is, turn into an oncological formation. After identifying a cystadenoma, doctors recommend getting rid of the problem surgically as soon as possible.

Previously, surgeons removed the ovary immediately, but modern techniques The operations allow preserving the organ and providing the woman with the opportunity to have children in the future.

What is ovarian cystadenoma

The formation can occur in the structure of the left or right ovary. It consists of one or more chambers filled with liquid, the volume of which is constantly increasing.

Due to this, the size of the tumor grows, and after a while it begins to put pressure on the surrounding organs, preventing them from functioning normally. In addition, the cells of the cystadenoma walls are actively dividing, helping the formation to develop.

Important! Do not confuse a cyst with a cyst, because clinical picture diseases are almost the same, but the first type tumor often turns into cancer, and the cyst is not capable of malignancy.

Pathology is borderline state ovary between a benign process and oncology, therefore it requires compulsory treatment and follow-up.

It most often occurs in women 45-50 years old, since at this age the functioning of the appendages is most unstable - they either stop working or, on the contrary, synthesize excessive amounts of hormones. Such jumps provoke the appearance of cysts.

It is interesting to know that cystadenoma of the left ovary develops much less frequently than the right one. This is due to the fact that the right-sided appendages are better saturated with blood and, as a result, work more actively. Due to this, more favorable conditions for the appearance of pathology.

At first the disease does not make itself felt, the woman may long time not to guess that there is a problem.

Symptoms appear when the cyst reaches a certain size and begins to irritate surrounding organs and interfere with the functioning of the ovary itself. In advanced cases, you can visually see an enlargement of the abdomen due to tumor growth.

Causes

The main cause of cystadenoma is inadequate reaction body on the influence of hormones or pathological concentrations biologically active substances in a woman's blood. In addition, there are a number of factors that increase the risk of cysts:

onset of puberty in early age(up to 12 years old);
late menopause (continuation of menstruation after 50 years);
gynecological problems (inflammation of the appendages, endometriosis, etc.).

Read also: Is it necessary to remove an ovarian cyst along with teeth and hair?

There is also a certain role to play genetic factor and influence external environment. Negatively affect women Health smoking, stress, intrauterine operations (curettage, abortion), lifting unbearable weights.

Kinds

Ovarian cystadenomas may differ in their structure, appearance, the nature of the contents, growth activity. They can be single- or multi-chamber, affect one or both appendages, and have varying degrees of risk of degeneration into oncology. Taking these factors into account, several types of cystomas are distinguished.

Serous

Serous ovarian cystadenoma is a cilioepithelial tumor that can quickly reach significant sizes; cases of cystoma development up to more than 15 kg are known.

It usually consists of one large chamber and affects only the right or left appendage, and practically does not occur simultaneously on both sides. Inside the formation there is a straw-yellow serous fluid, which is produced by the epithelium of the cystadenoma.

There are several types of serous cystomas:

simple serous - a smooth-walled tumor, grows slower than others, rarely develops to a large size;
papillary – often considered as separate species cyst, characterized by the presence of growths on the internal or external surface;
rough papillary cystadenoma – dense papillae appear on the walls of the formation, the tumor rarely becomes malignant.

Mucinous

It is observed in women of different age categories, in advanced cases reaches significant sizes. The cystoma has a round or oval shape, consists of several cameras.

Inside it is filled with mucous contents, which have a thick, viscous consistency (pseudomucin). During gynecological examination the formation can be felt in the form of an elastic seal with a knotty surface.

This type, unlike the bulk of other cysts, does not lead to ascites (outflow of fluid into abdominal cavity) and remains asymptomatic for a long time.

Border

Borderline ovarian cystadenoma is special condition, which is classified as a specific type cancerous tumor.

This cystoma, unlike typical oncology, does not require the use of chemotherapy drugs after removal of the formation. This is due to the fact that borderline cystadenomas do not metastasize and almost never recur, that is, they do not recur.

Papillary

Papillary ovarian cystadenoma is one of the most severe types of cystomas. The disease progresses rapidly, affects both appendages, provokes the appearance of ascites, inflammation in the pelvis, and often succumbs to cancerous degeneration.

In addition, it is diagnosed in girls of childbearing age. Depending on the location of the papillae, there are three types of papillary cystadenomas:

inverting - papillae grow inside the capsule;
everting - the papillae are located on the outer surface of the capsule, while the cyst looks like a cauliflower;
mixed - the presence of papillae on both surfaces of the formation.

Read also: Symptoms, causes and diagnosis of ovarian apoplexy: treatment without surgery

Symptoms

The clinical manifestations of cystadenoma depend on the size of the tumor and how it affects the functioning of neighboring organs. Characteristic are aching painful sensations from the localization of the formation, which can also radiate to the lower back.

As the cystoma grows, patients develop new complaints - foreign body sensation, bladder dysfunction, bloating.

Analyzes and examinations

To diagnose cystadenoma, additional examination methods are used that allow you to see the condition internal organs patients – ultrasound, computed tomography.

You can also resort to laboratory research, namely, the determination of a special tumor marker protein in the blood, the presence of which will indicate a problem.

Ultrasound examination, ultrasound examination of the ovaries

Fast and affordable way, which makes it possible to clarify the location of the tumor, its size, nature and density of the walls.

It is best to undergo an ultrasound in the middle of the menstrual cycle, approximately 14-15 days after the start of menstruation. At this time, the results will be most informative.

Computed tomography CT

Using CT, you can obtain layer-by-layer images of the formation, this allows you to study the pathology in detail and accurately determine its type.

The advantage of the method is that its information content does not depend on the day of the menstrual cycle, but it is less accessible than ultrasound.

Blood test for ca125

CA-125 is a specific protein that appears in bloodstream in the presence of a purulent, oncological and, in rare cases, a benign process in the body.

It is determined by analyzing blood taken from a vein by adding special reagents to it. If the protein concentration is high or increased compared to past results, this should be a reason to contact a specialist.

Treatment of cystadenoma: types of operations

Regardless of the type of cystadenoma, doctors recommend removing the tumor surgically. The operation can be performed using two methods - laparotomy and laparoscopy.

The decisive factors when choosing an intervention method are the size of the cystoma, the patient’s condition and the clinic’s equipment.

Laparoscopy

A relatively new technique for removing tumors that does not require a long incision on the abdomen. All manipulations are carried out through three small holes: light is supplied through one, the camera is supplied through the second, and the necessary tool is supplied through the third.

After such an operation, patients recover quickly; the very next day they are allowed to get out of bed and move independently around the department.

The downside is limited access to the abdominal cavity, so large tumors cannot be operated on by laparoscopy.

Laparotomy

A long incision is made in the abdomen to allow access to the insides. Through it, the entire tumor is easily removed, and the surrounding tissues are examined.

After laparotomy, patients recover somewhat longer than after laparoscopic surgery; in addition, the risk of developing postoperative complications is higher.

Neoplasms in the area of the uterine appendages are diverse - in most cases, only after surgery, based on the results of histological examination, can malignant degeneration be excluded. Ovarian cystadenoma is an epithelial tumor, some of which can cause oncological pathology with an unfavorable prognosis, therefore, at the stage of preparation for surgery, the doctor always approaches the examination from the standpoint of oncological alertness.

Options for benign neoplasms

Depending on the structure and cellular structure, epithelial tumors are divided into the following main types:

Serous cystadenoma;
Mucinous cystoma;
Endometrioid ovarian disease;
Clear cell tumor;
Brenner's tumor;
Mixed variant of the neoplasm.

Not always at the stage preoperative preparation it is possible to accurately determine the type of neoplasm: most often, during surgery during an express biopsy, the doctor will be able to accurately determine the histological variant of the cystoma.

Serous tumors

The most common type is serous ovarian cystadenoma. The inner surface of the cystoma is lined with normal ovarian epithelium, which produces a liquid secretion. Main diagnostic criteria that suggest the histotype of a benign neoplasm are:

smooth-walled;
one-sided;
single-chamber;
small in size (no more than 30 cm in diameter);
liquid contents without dense inclusions.

Having received the result of the ultrasound scan, and based on the clinical manifestations, the doctor will suggest a surgical treatment option - only by removing the tumor can we confidently say that the process is benign. The scope of the operation in the absence of suspicion of cancer is always organ-preserving: it is quite enough to remove the cyst or perform a partial resection of the organ.

Mucinous neoplasms

The second most common epithelial cystadenoma of the ovary is mucinous cystoma. The inner surface of the tumor is lined with columnar cells, which are similar to the cervical epithelium of the cervix, which produces thick mucus. The main features of mucinous ovarian cystadenoma are:

lumpy surface;
multi-chamber;
medium and large in size (can reach 50 cm in diameter);
thick mucus-like contents.
smooth walls inner surface.

The old name of the tumor is pseudomucinous cystadenoma of the ovary. The benign quality of the neoplasm is confirmed histologically, which allows the doctor to use low-traumatic types of operations.

Endometriosis, Brenner fibroma, clear cell and mixed cystomas are much less common. The main task of the doctor at the stage of examination and preparation for surgery to predict the tumor histotype as accurately as possible in order to choose the optimal treatment tactics.

Borderline cystomas

Frequent option tumor growth– a precancerous condition in which the first signs of obligatory malignant degeneration appear. Borderline cystomas include:

Serous papillary cystadenoma;
Superficial papillary tumor of the ovary;
Borderline papillary cystadenoma.

The earlier any of the precancerous histotypes are detected, the better prognosis for the treatment of ovarian cystadenoma: given the huge risk of ovarian cancer, any papillary cystadenoma must be treated surgical intervention with the obligatory use of the principles of oncological vigilance.

Serous papillary tumor

The most prognostically favorable variant of precancer, serous papillary cystadenoma of the ovary is much less likely to degenerate compared to other types of borderline papillary neoplasms. The likelihood of this histotype of cystoma can be assumed based on the following characteristics:

single-chamber (less often – double-chamber);
medium size (up to 30 cm);
the presence of a small number of papillae on the inner surface of the cyst.

With transvaginal ultrasound scanning the doctor will see single rough papillae inside the cystoma, which is the first and important sign of a borderline cancer condition. The risk of degeneration is not great, but the approach to treatment tactics is clear - the tumor must be removed taking into account the expected malignant growth.

Papillary cystadenoma of the ovary

Much more serious and more dangerous situation when, as a result of examination, multiple papillary growths are revealed on the surface of the cystoma. This is a sign active growth with proliferation of cellular elements. To the signs precancerous condition relate:

a large number of small papillae that tend to merge and form cauliflower-like structures;
wide distribution over the surface of the cystoma;
rapid increase in the size of the cystic neoplasm;
multilocular tumor.

The worst option is the detection of papillary growths on neighboring organs and the abdominal covering of the abdomen. This indicates the metastatic spread of precancer, which sharply worsens the prognosis for curing papillary ovarian cystadenoma.

Borderline tumor

It is often impossible to identify the moment of malignant degeneration - borderline papillary cystadenoma may short period time to become ovarian cancer. A borderline precancerous condition is characterized by:

extensive size of papillary growths;
rapid growth of cystoma;
the appearance of fluid in the abdomen (ascites).

Important as much as possible short time prepare and perform radical surgery to reduce the risk of malignancy. However, even with histological confirmation of a pre-tumor condition, the doctor will carry out postoperative treatment using methods of therapy for ovarian oncology.

Malignant neoplasms

Ovarian cancer has many histological types. The classification of epithelial tumors includes the following main options:

Serous cystadenocarcinoma;
Superficial papillary adenocarcinoma;
Mucinous malignant tumor.

Rarely occurring types (endometrioid, clear cell, transitional cell, squamous and mixed) are usually a surgical finding - after surgery for ovarian cystadenocarcinoma, the histologist finds specific cancer cells and issues a conclusion to the attending physician about the presence of an atypical histotype of cancer.

Serous type ovarian adenocarcinoma

As is the case with benign cyst, this type of tumor is the most common (up to 60% of all types of epithelial ovarian cancer). Serous ovarian cystadenocarcinoma may be no different from an ordinary cystoma serous type Therefore, in each specific case, it is necessary to perform a rapid tissue biopsy during surgery to remove a cystic neoplasm in the ovary. Often, only histology can distinguish cystadenoma from adenocarcinoma. An assessment of cell differentiation is mandatory - there are 3 options:

highly differentiated;
moderately differentiated;
low differentiated.

The best prognosis for cystadenocarcinoma with highly differentiated tumor cellular structures.

Superficial papillary adenocarcinoma

The presence of growths on outer surface cystomas are always a high risk for papillary ovarian cystadenocarcinoma. It is extremely important not to delay surgery for ovarian cystadenoma, even if examination does not reveal papillae on the surface of the cyst: sometimes papillary growths can only be detected during surgery. Risk papillary cancer very high if the following symptoms are present:

a large number of papillary structures;
extensive growth;
the presence of metastases in the second ovary;
metastatic damage to neighboring tissues and organs.

It is necessary to undergo surgery to radically remove the cyst with mandatory combination antitumor therapy.

Mucinous malignant cystoma

Malignancy based on pseudomucinous cystadenoma of the ovary occurs in 15% of women, so the presence of a multilocular cyst filled with mucus is a risk factor for oncology. TO important features Possible malignant degeneration include:

the appearance of pain syndrome;
dysfunction pelvic organs;
formation of ascites.

During examination, it is not always possible to distinguish cancer from mucinous cystadenoma of the ovary, so the doctor will assume oncology when performing surgery for a pseudomucinous neoplasm.

Treatment tactics

Any variant of ovarian cystadenoma requires surgical intervention. You cannot postpone or refuse surgery in order to create conditions for the progression of the cystoma. Transition from benign to borderline and malignant condition may take a short period of time (from several weeks to 2-3 months), so the main and most effective treatment ovarian cystadenoma – surgery to remove the tumor. Great value for choice therapeutic tactics V postoperative period has a histological result - depending on the type of tumor, the doctor will offer the following options:

medical supervision for up to 2 years with periodic examinations;
a single course of chemotherapy;
combination therapy with drugs and radiation exposure.

It is necessary to accurately and accurately follow the specialist's instructions in order to prevent recurrence of the ovarian tumor and improve the prognosis for life, especially against the background of detection of ovarian cancer.

Ovarian cystadenoma is a benign tumor and is called in some sources a true ovarian cyst. Anatomically, this formation is a bubble of epithelial tissue, filled with liquid or mucous substance, capable of reaching 50 cm in diameter in the most advanced cases.

In addition, the tumor may be smooth or covered with tissue projections called papillae. Benign tumor implies:

The inability of cystadenoma to penetrate adjacent tissues; it can only compress or displace them.
Slow, stable and non-jumping growth of tumor tissue.
The neoplasm is not capable of forming metastases, and therefore does not spread to other systems, organs, and so on.

Reasons for appearance of this disease have not yet been established, as well as the causes of the appearance of many other neoplasms. But there is a list of risk factors that increase the likelihood of this formation:

hormonal disorders;
menstrual irregularities;
infectious and inflammatory diseases;
frequent stressful situations and etc.

In addition to the above risk factors, there are a large number of other factors that can also trigger the appearance of ovarian cystadenoma, albeit with a much lower probability. Among them are:

long-term sexual abstinence;
ectopic pregnancies, unprofessional abortions and childbirth;
sexually transmitted diseases, disorder normal functions ovarian and genital diseases;
a sharp increase in physical activity;
hereditary predisposition.

Although some researchers are inclined to believe that main reason the appearance of ovarian cystadenoma is a hormonal imbalance, this hypothesis has not been confirmed by statistics.

Note. Hormonal disbalance Usually, if it does not cause the development of a tumor, it appears after dangerous tissue has to be removed.

The image clearly shows why ovarian cystadenoma is easy to diagnose using ultrasound - the difference in the size of the ovaries in the presence of a neoplasm is obvious

Types of ovarian cystadenomas

There are several types of cystadenomas, which differ in the mechanics of formation, size, morphological and histological features, as well as health hazards. These varieties are:

Serous ovarian cystadenoma (its special subtype - papillary ovarian cystadenoma - differs in appearance and functionality).
Mucinous cystadenoma of the ovary.

Treatment for these types of cysts varies, which is why it is so important correct positioning diagnosis and accurate results laboratory tests.

In addition to belonging to one of the varieties, the lesion can be left-sided or right-sided, or bilateral. The clinical manifestations of cystadenoma of the right or left ovary are identical.

Serous cystadenoma of the ovary

Note. This type is more common than all others: 70% of women with ovarian cystadenoma are affected by this type of disease. Serous ovarian cystadenoma often occurs in women after 50 years of age; it is very rare in women under 30.

This type of disease best fits the most common description of ovarian cystadenoma - the neoplasm is a bubble of smooth epithelial tissue filled with a clear yellowish liquid. The shape of the cyst is round and consists of one chamber. The dynamics of development are poorly predictable, sizes vary from 5 mm to 35 cm in diameter. With all this, this variety very rarely it turns out to be malignant and does not interfere with bearing or conceiving children. Sometimes serous ovarian cystadenoma is called a smooth-walled cilioepithelial cyst, or serous cyst.

This is what serous ovarian cystadenoma looks like under a microscope. The black line is dense epithelial tissue that is not capable of unpredictable growth, due to which serous ovarian cystadenoma very rarely turns into cancer.

Note. Main theory The occurrence of serous cystadenomas is as follows: they develop from functional cysts if the latter do not resolve on their own. Functional cysts disappear due to a special layer of cells, which becomes thinner over time or even disappears in some places. And it is in these places that new growths appear.

Rough papillary serous cystadenoma of the ovary

Rough papillary cystadenoma of the ovary in some cases develops from serous cyst after a few years of its existence. Its key differences are the presence of growths (papillae) inside and outside the capsule, as well as consistency and color.

Rough papillary cystadenoma of the ovary is much more often bilateral and usually has several chambers. The symptoms of the disease are similar to those of cancer and teratoma. However, it is very easy to distinguish rough-papillary cystadenoma from serous one - just do an ultrasound. Due to the small, but still present, likelihood of malignant degeneration, you should be tested for tumor markers.

Some experts distinguish rough-papillary cystadenoma as a separate type of cyst, while others consider it a subtype of papillary cystadenoma.

Note. Despite the fact that this type is less common than serous cystadenomas, rough papillary cystadenomas of the ovary account for more than a third of all cases of cystadenomas and about 10% of all ovarian tumors.

Papillary serous cystadenoma of the ovary

This variety has a 50% chance of developing into a malignant tumor. The difference from rough papillary cystadenoma is the ability of the epithelial tissue of papillary cystadenoma not only to grow, but also to form stable structures and metastasize. In the most advanced clinical cases, multiple papillae cover the internal and outer surface capsules, forming nodes and changing the shape of the bubble. There are everting and inverting types of overgrowth of papillae; in the first, the papillae grow outside, and in the second, inside.

Note. Formations with everting papillae are much more likely to be bilateral, and are also twice as likely to cause ascites.

Mucinous cystadenoma of the ovary

Mucinous cystadenoma of the ovary is almost always multilocular, occurs after menopause, and is filled with mucus called mucin.

The image illustrates perfectly main feature mucinous cystadenoma of the ovaries - a multilocular tumor, the cavities of which are filled with a substance of jelly-like or mucous consistency, which can have different shades

The shell of the neoplasm is smooth, elastic, can slowly stretch and, at particularly large sizes, even be translucent. The sizes can reach 30-50 cm in diameter, and on average, tumors of this subtype have a significant volume, which is why they are easy to detect using ultrasound. The mucus inside the tumor can vary in consistency (from mucus to a jelly-like substance) and color (from light yellow to brown), and may also contain blood.

Note. Mucinous ovarian cystadenoma differs from a real cancer tumor primarily in the inability of the epithelium to invade adjacent tissues, that is, the absence of metastases.

Diagnosis and treatment of cystadenomas

Diagnosis is carried out using ultrasound, histological examination and laboratory tests for tumor markers - substances that help determine the ability of unwanted tissues to metastasize.

Once the presence of oncology has been established, histological examination will help determine the exact subtype of the formation, and malignancy or benignity is determined using tumor markers.

Treatment combines surgical and medical approaches: the cystadenoma must be removed, and medications can compensate hormonal imbalance after operation.

Previously, the ovary was often removed with a cyst, which significantly reduced the patient’s ability to become pregnant. Now doctors have learned to perform laparoscopy - a minimally invasive operation that does not require large incisions and sometimes even completely avoids injury to the patient’s ovaries and other genital organs. Thus, after removal of an ovarian cystadenoma, pregnancy is quite likely.

A true benign tumor originating from the epithelial tissue of an organ. With small sizes (up to 3 cm), the disease is asymptomatic. As the tumor grows, the patient experiences dull, aching or cramping pain in the lower abdomen and lower back, as well as signs of compression of neighboring organs (frequent urination, constipation, swelling of the legs, etc.). For diagnosis, bimanual examination, ultrasound, CT and MRI of the pelvic organs, and blood tests for tumor markers are used. The only one effective method Treatment of serous cystadenoma is surgery to remove the tumor, ovary, appendages or uterus with appendages.

General information

Serous cystadenoma (serous cystoma, simple, cilioepithelial or smooth-walled cystadenoma) is a tight-elastic benign ovarian neoplasm located lateral or posterior to the uterus. Typically, the tumor develops between the ages of 30 and 50 years. In more than 80% of patients, the tumor diameter is from 5 to 16 cm, but in some late diagnosed cases its size reached 30-32 cm. The frequency of simple cystadenoma is 11% of all ovarian tumors and 45% of serous (cilioepithelial) tumors. As a rule, the tumor occurs on one side. In 72% of cases it is single-chamber, in 10% of patients it is two-chamber and in 18% it is multi-chamber.

Causes of serous cystadenoma

To date, there is no scientifically proven theory of the occurrence of simple cystoma. According to some gynecologists, such a neoplasm is formed from functional ovarian cysts - follicular and corpus luteum, which have not completely resolved and have begun to fill with serous contents. Predisposing factors to the development of simple ovarian cystadenoma are:

Hormonal disorders, preventing the normal maturation of the egg. Imbalance in women's hormonal sphere may be observed during extinction reproductive function, accompanying somatic and endocrine diseases, stress, significant physical and emotional overload, extreme diets, long-term sexual abstinence.
Early puberty with the appearance of the first menstruation at the age of 10-12 years.
Inflammatory diseases of women(endometritis, adnexitis, etc.). Diseases caused by STI pathogens during disordered sexual life without barrier contraception are especially dangerous.
Surgeries on the pelvic organs. Simple serous cystadenomas are somewhat more often observed in patients who have had an ectopic pregnancy, abortion, or surgical treatment of gynecological diseases.
Burdened heredity. According to some observations, in women whose mothers suffered from serous ovarian tumors, cystadenoma is detected more often.

Pathogenesis

A serous cystoma usually forms in one of the ovaries. At first it is a small smooth-walled single-chamber (less often multi-chamber) neoplasm. Its dense connective tissue walls are lined on the inside with single-layer cubic or cylindrical ciliated epithelium, which has secretory activity. As the cystadenoma grows, serous contents accumulate inside it—watery clear liquid light yellow color. As a result, the growing tumor-like formation compresses surrounding organs and nerve fibers, which leads to pain. When an inflammatory process occurs, the smooth shiny surface of the cystoma becomes dull and covered with adhesions.

Symptoms of serous cystadenoma

Clinical symptoms for small (up to 3 cm) smooth-walled cystomas are usually not observed; they become an accidental finding during a gynecological examination or ultrasound of the pelvic organs. As the tumor grows, the patient experiences symptoms associated with the pressure of the cyst on neighboring organs. The most typical pain syndrome. Usually it is in the nature of dull, aching, less often cramping pain that occurs in the groin area, behind the pubis or in the lower back. In addition, a woman may experience pressure on bladder, rectum, feel the presence of a foreign body.

With large cystomas, the functions of adjacent organs may be impaired due to their compression, which manifests itself frequent urination, discomfort in the intestines, constipation, nausea, swelling lower limbs. In cases where the tumor reaches a size of 6-10 cm or more, it can lead to an enlarged abdomen or its visible asymmetry. Menstrual cycle with serous cystadenomas it is usually not impaired. However, if the neoplasm is large enough and puts pressure on the ovary and/or uterus, the nature of menstruation changes - they become more abundant or too scanty and are accompanied by painful sensations. It is extremely rare with uncomplicated simple cystomas that a general reaction of the body is observed in the form of fatigue, weakness, lethargy, decreased performance, and irritability.

Complications

The main danger of untimely detection and inadequate treatment of serous ovarian cystadenoma is compression of neighboring organs with disruption of their functions and the occurrence of acute conditions. Most serious complications cystomas requiring urgent surgical treatment, are torsion of the legs (if present) with necrosis of the neoplasm and rupture of the capsule (ovarian apoplexy) with its contents entering the abdominal cavity and causing bleeding. A complicated course of the disease may be indicated by an increase in temperature, a sharp increase in pain, severe nausea or vomiting, severe malaise with headaches, dizziness and loss of consciousness, severe pallor, bloody issues from the vagina. Sometimes there is a relapse of the disease after organ-preserving surgery and malignant degeneration of the tumor.

Diagnostics

To confirm or clarify the diagnosis of the disease, carry out differential diagnosis and choice optimal method treatment, patients with suspected serous cystadenoma are prescribed a comprehensive gynecological examination. It includes:

Examination by an obstetrician-gynecologist. A bimanual examination in the area of the uterine appendages usually reveals a tight-elastic, mobile, painless formation with a smooth surface, not associated with neighboring organs.
Pelvic ultrasound. Allows you to identify a homogeneous hypoechoic tumor with a dense, smooth capsule measuring 3 cm or more. For small cystadenomas, transvaginal access is used, for large cystadenomas, transabdominal access is used.
Computed tomography or magnetic resonance imaging. During the tomographic examination, a three-dimensional model of the cystadenoma and adjacent organs is created to conduct a more thorough differential diagnosis and exclude tumor growth.
Blood test for tumor markers. The study of tumor antigens (CA-125, CA 19-9, CA 72-4) allows us to exclude the development oncological process or purulent abscess in the ovary and other pelvic organs.
Color Dopplerography. The diagnostic method is additional and, in doubtful cases, allows one to differentiate a benign ovarian tumor from a malignant one based on the intensity of blood flow.

Simple serous cystadenoma must be distinguished from others benign neoplasms ovaries, primarily functional cysts, papillary and pseudomucinous cystoma. To exclude metastasis to the ovary of one of the forms of stomach cancer for patients in mandatory fibrogastroduodenoscopy is prescribed. Carrying out fibrocolonoscopy allows you to assess the degree of involvement of the sigmoid and rectum in the process. An alternative solution if it is impossible to conduct an endoscopic examination of the stomach, direct and sigmoid colon is radiography of the gastrointestinal tract.

Also, during the differential diagnosis, malignant ovarian lesions, tubovarial abscess, ectopic pregnancy, pathology of nearby organs - acute appendicitis, kidney dystopia and other malformations of the urinary system, diverticulosis of the sigmoid colon, bone and extra-organ tumors of the pelvis. In such cases, in addition to laboratory and instrumental examination, appoint consultations with related specialists - a surgeon, gynecological oncologist, gastroenterologist, oncologist, urologist.

Treatment of serous cystadenoma

The main method of treating simple serous cystoma is surgical removal tumors. There is no reliable data on the effectiveness of drug and non-drug methods of treating this disease in gynecology. When choosing a specific type of surgical intervention, the patient’s age, the presence or planning of pregnancy, and the size of the tumor are taken into account. Main goals of patient treatment reproductive age- maximum preservation of healthy ovarian tissue and prevention of tubo-peritoneal infertility (TPI). For women during perimenopause, radical surgeries are recommended to prevent recurrence of cystadenoma and maintain quality of life.

The indication for planned surgery is the presence of a tumor-like formation with a diameter of 6 cm, which persists for 4-6 months. The decision on the timing of removal of smaller neoplasms is made individually by the gynecologist, taking into account the results dynamic observation. IN urgently surgical intervention is performed if there is a suspicion of torsion of the leg or rupture of the cystoma capsule. Usually elective surgery performed laparoscopically. Main types surgical interventions for smooth-walled serous cystadenoma are:

Cystectomy(cyst removal) or wedge resection(excision of damaged tissue in the form of a wedge) with preservation of the ovary, revision of the contralateral ovary and emergency histological diagnosis. Organ-conserving surgeries are recommended for young women planning pregnancy with cystadenoma no more than 3 cm in diameter.
Unilateral oophorectomy or adnexectomy. The intervention involves removal of the entire ovary or ovary on the affected side fallopian tube and is considered the optimal solution for women of reproductive age with tumors larger than 3 cm.
Bilateral adnexectomy or hysterectomy with adnexa. The recommended method of surgical treatment in women during perimenopause and in patients with bilateral ovarian damage. Its advantage is a significant reduction in the risk of developing cancer.

Prognosis and prevention

With timely detection and surgical treatment The prognosis of the disease is favorable: serous cystadenoma extremely rarely recurs and becomes malignant. Women of reproductive age who have undergone organ-preserving interventions, unilateral oophorectomy or adnexectomy are recommended to plan pregnancy no earlier than 2 months after surgery. Full recovery after laparoscopic conservative removal serous smooth-walled cystadenoma of the ovary occurs in 10-14 days, after radical operations recovery period lasts up to 6-8 weeks. Patients are advised to undergo clinical observation by a gynecologist. According to observations American specialists, preventive effect in relation to the development of benign ovarian cystadenomas, the use of combined oral contraceptives monophasic action.