How dangerous is ovarian cystadenoma, is treatment possible without surgery. Options for benign neoplasms

Content

Cystadenoma of the ovary is a benign tumor of the epithelial tissue and is called a cystic formation. An ovarian cyst is not identical to a cystadenoma, since it does not imply the growth of the epithelium, but is initiated by other pathological processes. The accumulation of fluid in the cystic formation is associated with the peculiarities of the functioning of the epithelial cells of the ovary.

According to statistics, in every tenth gynecological patient, regardless of age, an ultrasound scan reveals a cystic formation in the ovary. It is impossible to determine the nature of the process with a 100% guarantee on ultrasound, which is why doctors are wary of various kinds of formations, prescribing additional examinations.

Classification

According to the morphological (tissue) classification, ovarian cystadenoma belongs to the group of epithelial tumors. These formations are formed from the integumentary epithelium of the ovaries and are benign in their structure. In turn, these cystic formations are classified into:

• serous;
• mucinous.

Mucinous and serous cysts are divided into smooth-walled and papillary forms.

The simplest is the serous ovarian cyst, which is sometimes called that. Mucinous formations are considered more complex in structure, and cysts with papillae on the inner walls are considered dangerous.

Low-grade tumors are called borderline tumors. This variety is more related to papillary cystadenoma.

The issue of the borderline state of ovarian cystadenomas is still being discussed. It has been proven that a mutation of the p53 gene leads to malignancy of adenomas, if such a mutation is absent, then the cystic formation will not be reborn. Some experts note the genetic role of the degeneration of cystadenomas, denying the presence of borderline tumors.

With malignancy, cystadenoma of the right ovary more often and faster provides metastasis in the abdominal cavity to the liver capsule and the right half of the diaphragm, and the pleura.

According to the international classification ICD-10, the code for ovarian cystadenoma is D 27, meaning benign formations.

Epithelial cystic ovarian masses are most common in women over 40 years of age.

In young women, cystic masses are almost always benign.

Smooth-walled serous ovarian cystadenoma

A serous tumor of the ovary is characterized by a unilateral lesion. As a rule, a simple smooth-walled cyst has the following characteristics:

• located most often above the uterus;
• have a leg;
• easily displaced by palpation;
• one camera, less often - 2-3;
• the capsule is dense, reaches a thickness of 1-4 mm;
• both the inner and outer surfaces are smooth;
• serous contents anechoic on ultrasound - light and transparent;
• the probability of malignancy is minimal;
• the danger lies in the compression of organs and tissues.

So, serous cystadenoma of the left ovary often leads to constipation and intestinal problems, squeezing the sigmoid colon. Localization of the cyst on the right can lead to pressure on the ureter and kidney, since it is located below the left.

Serous papillary cystadenoma of the ovary

Serous papillary cystadenoma of the ovary is described by the presence of papillary outgrowths on the inner or outer surface of the formation.

Papillary cystadenoma of the ovary is characterized by:

• bilateral defeat;
• location in the thickness of the ligaments;
• leg;
• the presence of adhesions in the abdominal cavity.

The grubopapillary cystadenoma of the ovary is described as a frequent malignancy of the process, therefore it is subject to immediate removal.

Mucinous

Mucinous cystadenoma is described as follows:

• multi-chamber;
• the presence of contents with different echogenicity on ultrasound;
• uneven surface due to bulging chambers;
• partitions;
• with a smooth outer surface or with the growth of papillae on the capsule;
• have a leg;
• the contents are colored yellow, brown, green, cloudy;
• high risk of malignancy.

Tumors are often accompanied by ascites - the accumulation of fluid in the abdominal cavity. Most often, such cystic formations are diagnosed in older women.

Predisposing factors

An unambiguous cause of cystadenoma has not been identified, however, there are several theories of its occurrence.

1. Hormonal imbalance. The epithelium of the ovary, as a result of monthly ovulatory proliferation, undergoes hyperplasia over time. A large number of pregnancies, as well as the use of COCs, reduce the likelihood of cystadenoma formation.
2. Heredity. It is considered a leading and fundamental factor, in particular, familial ovarian and breast cancer. Specialists pay attention to mutations in the BRCA1 and BRCA2 genes.
3. Pathologies of the ovaries: recurrent follicular and corpus luteum cysts, polycystic.
4. Menopausal age, when hormonal surges and impaired functioning of the ovarian epithelium are observed.

Exposure to ionizing radiation is also considered as a provoking factor in the development of cystadenoma.

Symptoms

On average, when the cyst reaches a size of 3 cm, women do not notice specific symptoms. Such formations are differentiated from a follicular cyst, a cyst of the corpus luteum. The patient is observed, oral contraceptives are prescribed. If the cyst does not decrease in size, more detailed examinations are prescribed, suspecting a cystadenoma.

When the adenoma reaches a size of 5-7 cm, a woman may present certain complaints.

Clinical signs of ovarian cystadenoma are:

• aching pain in the lower back and in the lower abdomen;
• constipation;
• violation of the process of urination (increased frequency, difficulty, false urge);
• an increase in the size of the abdomen (more often with mucinous cysts);
• acute pain up to loss of consciousness during cyst torsion and necrosis.

Cystadenomas do not have hormonal activity.

A serous cyst of the right ovary can compress the tissues of the kidney and its ureter, leading to a violation of the outflow of urine. The serous cyst of the left ovary is often manifested by constipation due to pressure on the sigmoid part of the intestine.

Diagnosis

Diagnosis of cystic formation has a number of difficulties, and the differential diagnosis of ovarian cystadenoma with a simple cyst is of paramount importance. Doctors face this situation in young and middle-aged women who have normal ovarian function.

Fertility involves the production of estrogen by the sex glands, ovulation and a biphasic cycle. With hormonal failures, immune disorders, such ovarian pathologies as endometrioid, follicular cysts develop. It is these conditions that are differentiated from cystadenoma and cancer (cystadenocarcinoma). Therefore, a specialist who has discovered a liquid formation must compare it with the menstrual cycle, the woman's history and the presence of other diseases of the genital organs.

Diagnostics involves the use of the following methods:

• palpation of the appendages;
• determination of the level of oncomarkers;
• multislice CT and MRI;
• laparoscopy;
• biopsy;
• mammography;
• colonoscopy;
• gastroscopy.

The set of methods for diagnosing ovarian cystadenoma is determined, first of all, by age and menstrual function. The younger the woman, the less the specialist will be biased towards fluid education.

The traditional use of CA-125 levels has some limitations in young women.

This tumor marker can be elevated in the second phase of the cycle, during breastfeeding, during pregnancy, as well as in endometriosis, fibroids, inflammatory diseases of the pelvic organs, hepatitis, cholecystitis. In addition, in women with stage 1-2 ovarian cancer, this indicator is increased only in 50% of cases, which means the need for an integrated approach to diagnosis.

CA-125 above 35 U / ml is a reason for suspecting a malignant process.

Ultrasound determines the following:

• the presence of chambers and additional cavities in the cystadenoma;
• soft tissue content (cystic-solid, solid structure);
• the presence of inclusions in the cavity;
• the thickness of the cystadenoma capsule;
• involvement in the process of the opposite ovary;
• size of education;
• structure of the inner surface of the cavity wall.

The "simpler" the structure of the cyst, the higher the likelihood of a benign process.

Unlike a simple follicular formation, the fibrous capsule of a serous ovarian cyst is thick and may have a smooth inner surface or papillary. The cystadenoma capsule is essentially an ovarian membrane with a stretched part of the wall.

The size of ovarian cystadenoma can be different: mucinous cystic formation can reach large sizes (20-30 cm or more), serous cysts most often measure up to 6-7 cm.

The serous ovarian cyst in the ultrasound photo below shows typical anechoic formations that have several chambers with smooth and thin walls, a thick fibrous capsule. At the same time, the mucinous cyst contains solid components, the internal contents are hypo and anechoic.

Diagnosis of suspicious cystadenoma is necessarily accompanied by the determination of levels and other tumor markers:

• oncofetal antigens - chorionic gonadotropin, alpha-fetoprotein, necessary to exclude germ cell tumors, the higher the values, the worse the prognosis;
• calculation of the ROMA index, including the definition of HE4 and CA-125 and calculation;
• SA-199;
• cancer-embryonic antigen;
• inhibin B (marker for estrogen-producing tumors).

The first three markers are determined in young women.

After laboratory studies, they proceed to instrumental methods:

• mammography;
• colonoscopy;
• FGDS.

These methods for diagnosing cystadenoma are necessary to exclude metastasis.

Ovarian cystadenoma in menopause should preclude a sparing approach in diagnosis and treatment. The most detailed examination is required using various methods, including laparoscopy.

According to statistics, 70% of detected cancer is already detected in the advanced stage, which is especially important for older women who have undergone hormonal menopause jumps. The main reason for underdiagnosis is an incomplete list of prescribed studies.

Excessive radicalism in appointments is not welcome in women of the active reproductive phase. Operative interventions on the ovaries can lead to a decrease in ovarian reserve and the inability to conceive.

It is very difficult to determine the risk of malignancy of a liquid formation based on the traditional set of techniques, therefore, patients with suspicious cysts should be referred for a consultation with an oncologist without fail.

A complete diagnosis of ovarian cystadenomas is crucial in the prevention of cancer.

For screening and early detection of ovarian cancer, specialists use the calculation of the MI index (malignancy index) according to the formula: A * B * C.

Multiplier A (1 or 4):

• reproductive age and premenopausal period - 1 point;
• postmenopause - 4 points.

The B factor (0, 1 or 4) implies ultrasonic features:

• multichamber cystic tumor;
• solid component;
• bilateral process;
• ascites (accumulation of fluid in the abdominal cavity);
• metastases.

If there are no indicated signs, choose 0, if there is 1 sign - one is awarded, more than one sign - 4 points.

The factor C means the content of the CA-125 tumor marker in the blood (U/ml).

With an MI score of less than 200, the cystic mass is considered potentially benign.

For example, in a postmenopausal woman, a multi-chamber cystic formation with a solid component in the cavity was revealed, and the CA-125 index was 30 units. Total:

4 (postmenopausal)*4 (solid inclusion, multichamber) *30=480, which means a high risk of malignancy and requires removal of the ovaries.

If the index of malignancy is more than 200, the patient is undoubtedly sent for a consultation with an oncologist. Borderline ovarian cystadenoma with an MI of 200 is also a reason for more careful examination and alertness.

Treatment

All benign ovarian tumors, after the exclusion of follicular cysts, are subject to surgical removal. The operation is performed laparoscopically and laparotomically (open intervention). Laparoscopy is performed in young women, and laparotomy in patients who have reached the premenopausal age and older.

The treatment of cystic formations in young women and menopausal women has significant differences. Women in the active reproductive phase try to preserve the ovarian tissue as much as possible, considering it to be their property. Some patients after surgery are recommended pregnancy through the use of assisted reproductive technologies.

Older patients undergo open surgery to optimally assess the nature of the tumor process.

Hormonal treatment after surgery is not required.

Treatment during pregnancy

If a cystic formation was found in a pregnant woman, she is subject to careful observation. The main danger in the process of gestation is torsion of the leg, necrosis, rupture and the need for urgent surgery.

The growing uterus and the tumor put pressure on the bladder, intestines, kidneys, which leads to aggravation of the work of organs and an increase in the clinic. In emergency cases during pregnancy, laparoscopy is performed. In most cases, they are observed, and during or after childbirth, which is carried out by surgery, the cyst is removed.

Treatment of ovarian cystadenoma without surgery

Cystadenomas are subject to surgical removal, since there is no conservative method for their treatment. These cystic formations are not amenable to hormone therapy. The radical tactics of doctors is due to the impossibility of completely excluding the malignant process and predicting the subsequent "behavior" of the cyst.

If surgery is contraindicated for a woman, the cyst is observed by performing ultrasound and determining tumor markers in the blood. Exclude all possible thermal procedures on the abdomen and the whole body.

Laparoscopy of ovarian cystadenoma

Video-assisted laparoscopy is considered the leading treatment for cystadenomas.

Young women undergo a sparing laparoscopy, which involves enucleation (husking), rather than excision of the cyst.

According to the patients' reviews, the laparoscopic treatment of ovarian cystadenoma is characterized by a quick recovery period, a small number of complications and consequences, and no effect on reproductive function.

In the process of laparoscopy for diagnostic purposes, an examination of the abdominal cavity and a biopsy are performed. If the doctor suspected a malignant process during the examination, then a certain algorithm is observed:

• video recording;
• biopsy;
• in case of opening the formation after a biopsy, the abdominal cavity is washed, the contents are taken for histology;
• biopsy of the opposite ovary, omentum, lymph nodes;
• selection of peritoneal exudate (or washout) for histological examination.

In older women, it is often necessary to resort to extirpation of the uterus and both appendages in order to prevent cancer. During laparoscopy of a simple serous ovarian cystadenoma at first glance, it is often necessary to switch to an open operation and work as with a potentially dangerous tumor.

Prevention

Cystadenoma is formed in women older than 40 years in the vast majority of cases. There are no reliable methods of prevention, since the causes of education have not been fully determined. The most reliable way to prevent the development of cysts is considered to be an annual visit to the gynecologist and an ultrasound scan, which can detect an adenoma and perform a minimally invasive removal laparoscopically.

Diseases of the female internal organs can adversely affect the ability to bear children, as well as health in general. One of the most common pathologies is cystic formations.

Each neoplasm proceeds differently, some do not require removal, and some, on the contrary, need to be removed urgently. One of the varieties of neoplasms is.

The essence of pathology

An epithelial tumor that has formed on the body of the ovary is called a cystadenoma. This neoplasm is benign.

The formation is a fluid-filled cavity with a dense shell. The shape of this tumor is similar to a circle, with clearly defined edges. Cystadenoma is characterized by localization on one, sometimes on two ovaries of a woman.

Cystadenoma is simple, having smooth even edges, and papillary, in which the surface structure of the shell is similar to clots of small processes (papillae). Papillary is the next stage in the development of serous cystadenoma. It is formed years later after the formation of a simple neoplasm.

Papillary cystadenoma is classified depending on the location of the outgrowths:

border papillary cystadenoma of the ovary is characterized by an abundant accumulation of papillary growths.

The tissue structure of the border formation is characterized by atypism, in which there is a significant increase in the nuclear and cytoplasmic ratio. Education involves uncontrolled growth and the emergence of new cells, the development of which is characterized by hyperchromic and huge nuclei.

If cells with tissue atypical development are present in the tumor, an operation should be performed immediately to remove them until they degenerate into malignant ones.

Borderline cystadenoma is found under microscopic examination tumor cell tissue.

Are cysts and cystadenoma the same thing?

A cyst is a benign formation filled with fluid, or not completely filled.

A cystic tumor is an epithelial tumor that looks similar to but differs in cellular structure. A cystic tumor may refer to a cystadenoma.

A cyst, unlike a cystadenoma, does not degenerate into an oncological one. The internal content of the cyst is not epithelial. However, if the cyst has degenerated into a cystic tumor, then it requires surgical intervention. In fact, a cyst is the same cystadenoma, only in modified form.

Cystadenoma is benign. But its cells can acquire a tissue atypical format and be a focus for the development of potentially dangerous formations. In this case, it is necessary to perform an operation to prevent the degeneration of cells into malignant ones.

Symptoms and signs of a cyst

A characteristic phenomenon for all types of cystadenoma is its painless and imperceptible course until the size of the tumor reaches the parameters at which neighboring organs will be affected. In this case, it is possible palpable symptoms:

• from the urinary system. The process of urination is disturbed due to squeezing by the cyst of the ureter, swelling of the legs is possible;
• from the reproductive system. The menstrual cycle is disturbed;
• from the digestive organs. Possible violations of the chair.

Arises feeling of heaviness in the area of ​​\u200b\u200bthe abdominal cavity, the stomach increases, a feeling of a foreign formation inside is possible.

Papillary cystadenoma may be characterized by fluid accumulation in the peritoneum, and acute pain syndromes are possible. Pain signals the twisting of the cystic pedicle or rupture of its walls.

Read about the consequences of torsion of the legs of an ovarian cyst in our article.

With papillary cystadenoma other signs are possible its presence:

• discharge with bloody accumulations that are not menstrual;
• pain during intercourse;
• bouts of nausea and/or vomiting;
• there may be periodic dull pain in the lumbar region, abdomen, lower spine.

Reasons for education

Explicit causes of neoplasms characteristic of papillary cystadenoma have not been identified.

A number of factors accompanying the development of benign formations may indicate the reason for their development. due to hormonal imbalance during menopause, adolescence, as well as as a result of inflammatory processes.

TO risk factors The occurrence of cystadenoma can be attributed to:

1. earlier puberty, in which menstruation begins before age 12;
2. late menopause (after 55 years);
3. hereditary predisposition;
4. reproductive disorders;
5. the first late, ending in childbirth;
6. frequent abortions;
7. ectopic conception;
8. prolonged abstinence from sexual intercourse;
9. infections in the genital area.

Surgical intervention can also cause the development of tumor processes.

Diagnostics

A benign ovarian tumor can be identified by hardware diagnostics prescribed by the doctor:

Sometimes ultrasound of other organs can detect cystadenoma by chance. So you can prevent its development in a timely manner by appropriate treatment.

How to treat?

Given the specifics of the development of a benign formation on the ovary, it can only be cured surgically. Thus, all the consequences and possible risks of tumor spread are eliminated.

Conservative methods of treatment or the use of drugs will only help relieve some pain symptoms.

Depending on the course of the disease, surgical intervention involves several treatment options:

• laparoscopy, in which several small incisions are made, through which the tumor is removed by endoscopic method. This method involves the preservation of the appendage;
• laparotomy, in which one large incision is made to remove the tumor. In order to avoid tumor growth with this method of operable intervention, the ovary is removed.

(Image is clickable, click to enlarge)

Surgery is the only way to get rid of tumors. Can be used as support folk methods of treatment.

Self-prepared treatments in the presence of cystadenoma are designed to alleviate the condition with a tumor formation on the ovary and stop the growth process:

• dandelion root infusion. One teaspoon of dried roots should be poured with a glass of boiling water. Let it brew for 15 minutes, drain the tincture. Reception to produce before meals in the morning and evening, 70 ml. Treatment should be done five days after the menstrual cycle;
• tincture of young walnuts. Divide the fruit into four parts, lay them, filling ¼ of a liter jar. Pour vodka up to the rim of the jar and close the lid. After a month, strain the tincture and take it daily for three months twice a day. Avoid taking on menstrual days;
• burdock juice. Grind the washed burdock leaves in a blender, strain the juice through cheesecloth. Drink a teaspoon twice a day.

At home, prepared remedies require the approval of the attending physician.

According to the course of the disease, the doctor will be able to determine whether it is advisable to carry out additional treatment on their own.

Treatment prognosis

The most exciting issue after the removal of cystadenoma is the possibility of conceiving and having children in the future. Fertility depends on many factors:

• if a benign formation was removed using an endoscope, then the ovary was practically not affected. This circumstance suggests the ability to become pregnant without complications;
• if a large formation was removed even with one ovary, in this case it remains possible to have children, while supportive and hormonal therapy should be carried out in order to ensure the functioning of a healthy ovary;
• when two ovaries are removed, there is no possibility to give birth to children.

Timely detection and appropriate treatment of cystadenoma is the key to maintaining the reproductive function of the female body.

Favorable prognosis possible in most cases if the papillary cystadenoma is a benign formation.

In the absence of treatment of cystadenoma, the likelihood of tumor growth is very high. In this case, damage to neighboring organs, disruption of their functioning is possible.

In addition, a dangerous phenomenon in cystadenoma is the risk of degeneration of tumor cells into malignant formations, which entails cancer metastasis and death.

Can you get pregnant with a cyst?

If pregnancy occurred, and the cyst became known later, then such a combination of circumstances does not guarantee neither in a successful outcome of pregnancy, nor in a fatal one.

Ovarian cyst during pregnancy under the influence of hormones may behave differently: it can both increase, which will entail problems in carrying a pregnancy, and significantly decrease in size.

While maintaining the reduced size of the cyst, the course of pregnancy can pass without complications. But no one can guarantee that this will happen.

When planning a pregnancy, you should undergo a thorough examination and, if a cystic formation is found, it should be cured, and then conception should be planned.

What to do if a cyst is found during pregnancy, find out from the video:

An ovarian cyst is very similar to a serous cystadenoma. These two medical concepts are the most common, which occur in about 70 out of a hundred women with ovarian neoplasms. Especially common are cases when pathology develops after fifty years. Among various diseases, diseases of the reproductive system are quite common.

Cystadenoma is formed from the epidermis and differs from a simple cyst in its tendency to malignant transformation. Previously, when this pathology was detected, it was necessary to remove the ovaries, but modern medicine already has methods, diagnostics and treatments that allow you to get rid of the tumor and at the same time maintain reproductive function. Removal of both ovaries and uterus is usually performed for a malignant tumor with metastases.

Serous ovarian cystadenoma is a benign neoplasm arising from epithelial tissues. Having a capsule no larger than 3 cm, the pathology usually does not cause symptoms, and does not affect pregnancy and childbirth in any way. Gradually, during development, the patient begins to develop aching, dull or contraction-like pain in the lower back and lower abdomen. You can also observe signs caused by compression of neighboring organs:

• frequent urination;
• swelling of the limbs;
• constipation, etc.

If the patient is diagnosed with this disease, it is possible to carry out surgical treatment with several types of operations.

Reasons for development

Medical research is not yet able to determine the exact causes of serous cystadenoma of the ovary. Based on the opinion of some scientific gynecologists, ovarian neoplasms can arise from functional ovarian cysts, that is, formed from follicles. If there is no resorption of such a cyst to the end, it is filled with serous contents. More often this disease is observed in women of reproductive age and in women during menopause. There are also other factors for the development of cystadenomas that are related to the reproductive system:

• Hormonal failures - violations in the female hormonal sphere can contribute to the development of cystadenoma. They are often observed in the presence of endocrine and somatic diseases, with stress, great physical and emotional stress.
• Early puberty - the onset of menstruation between the ages of 10 and 12.
• Inflammatory processes in women - such diseases include endometritis and andexitis. They can develop in the case of a promiscuous sex life without the use of contraceptives, as a result of which cystadenomas may appear.
• Surgical manipulations on the pelvic organs - the occurrence of simple serous cystadenomas can often be found in women who have undergone surgical treatment of gynecological diseases, ectopic pregnancy, abortions or removal of appendages.
• Heredity - statistical studies prove that women who have had cases of serous ovarian cystadenoma in their family suffer from this disease more often.

Whatever the causes of serous cystadenoma, a woman should immediately be examined by a gynecologist, suspecting signs of this disease.

Classification

Papillary ovarian cystadenoma and other types of serous cystadenoma are more often localized in the region of the right ovary, since it is better supplied with blood than the left one. However, sometimes it can also occur. Often there is a location on the left - papillary cystadenoma. Simple serous cystadenoma is:

• smooth-walled (simple);
• papillary (papillary);
• rough papillary;
• mucinous.

Education in the ovary is small and gigantic in size (from 4 to 15 cm). Simple smooth-walled cystadenoma usually affects only one ovary, it has a smooth surface and one chamber. Sometimes there are tumors that have several chambers with serous contents. Simple cystadenomas are usually diagnosed in women over 40 years of age. Borderline papillary cystadenoma is a transitional form from a benign to a malignant tumor.

papillary serous cystadenoma

Serous papillary cystadenoma is called parietal growth of the tumor, which is the main difference from simple serous cystadenoma. In the epididymis, papillary serous cystadenoma forms a cyst that is difficult to diagnose. A feature of papillary cystadenoma is the presence of papillae on the epithelial tissue.

rough papillary serous cystadenoma

Rough papillary cystadenoma is less common, in the form of a chamber formation with the presence of dense whitish papillae. These papillae are formed from fibrous tissue and epithelial cells. The formation of rough papillae is an important diagnostic feature that is not found in non-tumor formations.

Mucinous cystadenoma of the ovary

This cystadenoma of the ovary, by its nature, has much in common with serous, but differs in the mucous substance that is in the cavity. The neoplasm is covered with cells that are similar to those that secrete uterine mucus. The structure of the tumor has chambers with partitions, which are easy to identify using ultrasound of the pelvic organs in gynecology. More often, such pathological foci are formed simultaneously on the left and right ovaries, while the size of the cyst can reach 30 centimeters. Therefore, treatment is usually carried out through surgery.

Symptoms

Signs of the development of pathology primarily depend on the size of the neoplasm. As the tumor grows, patients experience aching pain and discomfort in the area of ​​the cyst. It is also possible to experience back pain. Patients may complain of a sensation of foreign objects in the peritoneal region.

In the case of the papillary form of the disease, fluid accumulates in the cavities, which can lead to ascites, which contributes to the growth of the abdomen. If the patient's abdomen is significantly enlarged, this indicates the neglect of the pathology, which can cause torsion of the leg and rupture of the capsule itself. In this case, there is an outpouring of cystic contents into the peritoneum.

The pain syndrome can radiate to the pubic area, while being accompanied by pressure on the bladder. Another sign is a violation of the cycle of menstruation, disruption of the urinary organs and constipation, as well as pain during urination and a feeling of heaviness in the abdomen.

Diagnostics

If a woman has symptoms of an ovarian cyst, testing should begin immediately. To make a diagnosis, the doctor performs the following activities:

• blood analysis;
• gynecological examination;
• ultrasonography;
• computed or magnetic resonance imaging;
• tests for tumor markers.

If a malignant neoplasm is suspected, a biopsy may be performed followed by a histological examination of the sample taken.

Treatment

During the treatment of serous cystadenoma, a mandatory operation is necessary. Without surgery, getting rid of the tumor will not work. With a small cystadenoma, laparoscopy is performed, during which the doctor makes a small incision on the abdominal wall and excise the tumor. Pregnancy after laparoscopy is possible after three or four months.

For large tumors, a surgical treatment called laparotomy is performed. During this operation, a large incision is made in the abdomen, through which the tumor is removed with part of the ovary or the whole appendage. When one appendage is removed, the recovery period lasts about a month. Six months later, a woman can already plan a pregnancy, since the second ovary is functioning.

Sometimes it is necessary to remove both appendages or even the uterus along with the ovaries and omentum. In this case, the woman will no longer be able to have children and will have to take hormonal drugs for the rest of her life in order to compensate for the lost functions of the reproductive system in the production of hormones.

Consequences and complications

During the appearance of an ovarian cyst, various complications and consequences can occur. Complications of an ovarian cyst are as follows:

• infertility;
• violation of menstruation;
• hormonal disruptions;
• rupture of the capsule and torsion of the legs;
• necrosis;
• bleeding.

The main part of all possible complications is due to the late detection of pathology. The appearance of the first symptoms of such a disease must necessarily alert every woman, and send her to the nearest gynecology for examination.

In the case of a cyst that is too large, the patient may begin a colonoscopy or gastroscopy, since in this case, intestinal damage is not excluded. To avoid such complications is possible only with the timely detection of the disease.

Forecast

When there is discomfort in the abdomen and reproductive organs, every woman should definitely consult a gynecologist for advice. An important factor in the treatment of cystadenoma is timely diagnosis, since as the tumor develops, its size will gradually increase, as a result of which it may be necessary to remove the entire ovary, and even the uterus. The prognosis for a benign pathology is favorable. If the process becomes malignant, the prognosis depends on many factors, such as the stage of oncology, the size of the tumor, and the treatment performed.

- a type of serous tumor of ovarian tissue, which has a pronounced capsule, an inner lining formed by papillary growths of the epithelium, and liquid contents. Papillary ovarian cystoma is manifested by a feeling of heaviness and pain in the lower abdomen, dysuric phenomena, menstrual disorders, infertility, ascites. Some types of tumors of this type can degenerate into adenocarcinoma. Papillary ovarian cystoma is diagnosed using a vaginal examination, ultrasound, MRI, determination of the CA-125 marker, laparoscopy. For reasons of oncology, the presence of a papillary ovarian cystoma requires the removal of the affected ovary or uterus with appendages.

General information

It develops more often in reproductive age, somewhat less often - during menopause and practically does not occur before puberty. The frequency of papillary cystomas in gynecology is about 7% of all ovarian tumors and almost 34% of epithelial type tumors. Papillary ovarian cystomas are prone to blastomatous degeneration in 50-70% of cases, therefore they are considered as a precancerous disease. The presence of papillary ovarian cystoma in 40% of patients is combined with other tumor processes of the reproductive organs - ovarian cyst, uterine myoma, endometriosis, uterine cancer.

Causes of the development of papillary ovarian cystoma

In the question of the causes of papillary ovarian cystoma, modern gynecology has several hypotheses. According to one theory, papillary ovarian cystomas, like other tumor formations of ovarian tissue, develop against the background of chronic hyperestrogenism caused by hyperactivity of the hypothalamic-pituitary system. Another theory is based on arguments about “constant ovulation” due to early menarche, late menopause, a small number of pregnancies, refusal of lactation, etc. According to the theory of genetic predisposition, the presence of ovarian tumors in female family members plays a role in the development of a papillary ovarian cyst and breast cancer.

Classification of papillary ovarian cysts

Morphologically, papillary ovarian cystoma is characterized by papillary growths of the epithelium on its inner and sometimes outer surface. According to the localization of papillary growths, papillary ovarian cystoma can be inverting (30%), everting (10%) and mixed (60%). Inverting cystoma is characterized by individual papillae or massive papillary growths lining only the inner surface of the tumor wall. In an everting cystoma, papillary growths cover only the outer surface of the wall. With a papillary ovarian cyst of a mixed type, the papillae are located both outside and inside the capsule.

In terms of cancer alertness, the histological form of papillary ovarian cystoma is extremely important. There are papillary ovarian cystomas without signs of malignancy, proliferating (precancer) and malignant (malignant). Papillary ovarian cystoma often has a multi-chamber structure, irregularly rounded shape, convex walls, and a short stalk. Inside the chambers of the cystoma there is a yellowish-brown liquid medium.

The walls of the chambers contain unevenly distributed papillary growths, the number of which can vary, and the shape resembles coral or cauliflower in appearance. Small and multiple papillae give the cystoma wall a velvety appearance. With the germination of epithelial papillae through the wall of the cystoma, the parietal peritoneum of the pelvis, the second ovary, the diaphragm and neighboring organs are seeded. Therefore, everting and mixed papillary cystomas are considered as potentially malignant and more prone to transition to ovarian cancer.

Papillary ovarian cystomas are characterized by bilateral localization with multi-temporal development of tumors and intraligamentary growth. Papillary ovarian cystomas of large sizes develop extremely rarely.

Symptoms of papillary ovarian cystoma

At an early stage of the disease, symptoms are not expressed. The clinic of papillary ovarian cystoma manifests itself with the appearance of sensations of heaviness, pain in the lower abdomen; pain often radiates to the lower extremities and lower back. The development of dysuric phenomena, defecation disorders, general weakness is noted early. Some women may experience menstrual irregularities such as amenorrhea or menorrhagia.

With everting and mixed forms of cystoma, serous ascites develops; the hemorrhagic nature of the ascitic fluid indicates the presence of a malignant cystoma. Ascites is accompanied by an increase in the size of the abdomen. The adhesive process in the pelvis often leads to infertility.

Diagnosis of papillary ovarian cystoma

Papillary ovarian cystoma is recognized by conducting a vaginal examination, ultrasound, diagnostic laparoscopy, histological analysis. A bimanual gynecological examination palpates a unilateral or bilateral painless ovoid mass that pushes the uterus to the pubic symphysis. The consistency of the cystoma is tight elastic, sometimes uneven. Everting and mixed cystomas, covered with papillary outgrowths, have a finely tuberous surface. Interligamentous location causes limited mobility of papillary ovarian cysts.

In the process of gynecological ultrasound, the dimensions of the cystoma, the thickness of the capsule are precisely determined, the presence of chambers and papillary growths is specified. On palpation of the abdomen, as well as with the help of

In premenopause and menopause, as well as with borderline or malignant cystomas, supravaginal amputation of the uterus with appendages or panhysterectomy is performed. To clarify the morphological form of the cystoma and determine the extent of intervention during surgery, the tumor tissue is subjected to urgent histological examination.

Intraoperative detection of ascites, dissemination of papillae over the surface of the tumor and peritoneum does not directly indicate the malignancy of the cystoma and cannot be a reason to refuse surgery. After removal of the papillary ovarian cystoma, the foci of dissemination regress, and ascites does not recur.

Prognosis for papillary ovarian cyst

The timeliness of diagnosis and removal of papillary ovarian cystoma virtually eliminates the possibility of their recurrence in the form of ovarian cancer. However, to exclude oncological risks after surgery, patients are subject to observation by a gynecologist. If treatment is refused, papillary ovarian cystoma can take an unfavorable course with the development of ascites, complications (torsion of the leg, rupture of the capsule), and malignancy.

There are many diseases of the reproductive organs in women. Very often, in patients of all ages, special formations are observed during ultrasound diagnostics, which are usually benign. Only a specialist can determine the type of tumor after a thorough examination and monitoring of changes in the size of the neoplasm for several months. Often, cystadenoma is found in women, which requires surgical removal.

What is ovarian cystadenoma

Ovarian cystadenoma is a benign neoplasm that looks like a large cyst. Previously, this disease was called cystoma. In almost all patients, the tumor forms only on one side, so if an ultrasound scan shows a bilateral ovarian lesion, then doctors suspect the presence of a malignant process.

Cystadenoma can appear on both the left and right ovaries, but most often this tumor is right-sided. This is due to the fact that there is more intensive blood supply from this side, and various types of neoplasms are formed here.

Currently, scientists are arguing about exactly what causes ovarian cystadenoma to form. Most experts are inclined to believe that this type of tumor is formed during serious hormonal changes or an inflammatory process in the pelvic organs. There is also a theory that cystadenoma can form from a follicular cyst, which tends to resolve on its own within a few months. But if this did not happen, then in a year a serous cystadenoma may form in its place.

Ovarian cystadenoma is also called cystoma

In addition, surgery on the pelvic organs, abortions and even natural childbirth can become a predisposing factor. Doctors also believe that sexual abstinence and vice versa, frequent change of sexual partners, can provoke the formation of cystadenoma. Sometimes the following diseases and conditions of the body can become the cause of this tumor:

• period of menopause;
• prolonged stressful conditions, nervous strain;
• weight lifting, excessive physical activity;
• ectopic pregnancy;
• endometritis;
• colpitis;
• virus infection.

The average age at which this disease is detected is about thirty years. However, cystadenoma is especially common in women during menopause. This happens due to fluctuations in hormone levels, which at a younger age helped to avoid such diseases.

Video about cystoma, or cystadenoma, of the ovary

Types of tumors and their features

Currently, there are several different types of cystadenomas. They differ in their structure and additional formations that can grow inside the tumor and on its surface.

Serous cystadenoma of the ovary

This type is the most common and is found in 70% of patients with a cyst. The neoplasm can reach a fairly large size, on the outside it is covered with a rather dense and elastic membrane, under which there is a capsule with liquid serous contents. Depending on how the cyst wall is built, serous cystadenoma is divided into papillary and smooth-walled.

The main method for diagnosing various types of tumors is ultrasound, which clearly shows the pathological formation and papillary outgrowths.

Sometimes it is quite difficult to distinguish a serous cystadenoma from a normal functional cyst, and doctors advise observing the change in the size of the neoplasm for several months. If the tumor decreases, then surgery is not required, but in the case when it grows or remains the same size, doctors diagnose the patient with cystadenoma, which requires surgical removal.

Often the operation is minimally invasive, performed using laparoscopy. The ovary is removed only in older women with suspected malignant degeneration of papillary cystadenoma. In other cases, the childbearing function in girls is completely preserved.

On ultrasound, the cystadenoma is seen as a dark, rounded mass.

Simple, or smooth-walled, serous cystadenoma

In this type of cyst, the shell has a smooth and even surface. In different sources, this neoplasm can also be called a smooth-walled goal-epithelial cyst, a serous cyst, and because of its prevalence, doctors often refer to it simply as an ovarian cystadenoma.

Usually this tumor has only one chamber, which is enclosed in a dense capsule. In some patients, the size of the cyst can reach fifteen centimeters. Most often, it affects only one ovary, on the right side.

Papillary, coarse papillary, or papillary, ovarian cystadenoma

A distinctive feature of this type of cyst are special papillae that cover the inner surface of the capsule. They begin to form far from immediately, sometimes several years after the appearance of a simple serous cystadenoma. We can say that this is a more advanced stage, and not a separate species. Sometimes papillae can grow so that they occupy almost the entire cavity of the cyst and even go to the outer part of the tumor. This type of cystadenoma is sometimes multi-chamber and is formed on two ovaries at once, more often than others, malignant degeneration is recorded with this diagnosis.

Papillary cystadenoma has papillary outgrowths on the inner and outer surface

This form of cystadenoma is also quite common. It can reach a gigantic size, in some patients a cyst weighing fifteen kilograms was removed. The walls of this formation are smooth and dense, the ovaries are often affected from both sides at once.

Approximately 5% of patients with mucinous cystadenoma undergo malignant transformation, which requires the removal of not only the tumor itself, but also both ovaries and uterus.

Diagnosing this type of cystadenoma is quite easy; with an ultrasound examination, the doctor discovers rather extensive multi-chamber formations, in which there is a special secret - mucosus. It is heterogeneous, very dense and contains suspension and sediment, which are clearly visible on ultrasound.

Mucinous cystadenoma of the ovary may be multilocular

Endometrioid cystadenoma of the ovary

This type of cystadenoma differs from the rest in the type of tissue that covers the entire inner surface of the cyst. It is formed by the mucous endometrium. Inside the tumor, instead of serous or mucinous contents, old blood accumulates, the amount of which increases with each arrival of menstruation. This species can provoke the appearance of severe pain and spotting spotting. Both the right and left ovaries can be affected at the same time.

It is with this type of cystadenoma that there is a very high risk of developing infertility in women. Endometriosis, which is a provoking factor in the appearance of this cyst, is the reason for the inability to conceive a child in 75% of all cases.

Video about the endometrioid ovarian cyst

Borderline ovarian cystadenoma

This species differs from others in a very large number of papillae and formed fields around them. A molecular study of cystadenoma tissues reveals the presence of nuclear atypism, which is characteristic of oncological tumors. Patients are advised to urgently remove the neoplasm in order to avoid its cancerous degeneration. In appearance, the borderline cystadenoma is no different from the serous one. Ultrasound shows multi-chamber formations with a smooth surface.

In patients with this diagnosis, infertility is established in 20% of cases.

Symptoms and signs

The danger lies in the fact that at the initial stage, cystadenoma may not manifest itself in any way. Patients can live with this tumor for several years and only accidentally detect it on ultrasound. If any symptoms appear, then this indicates a large neoplasm or possible tissue necrosis. There is a certain list of signs that may indicate that a woman has cystadenoma:

Some symptoms are indicators of processes in the body that are very dangerous for the patient's life. When they appear, you must urgently call an ambulance:

1. A woman's blood pressure rises sharply, her pulse quickens. Perspiration appears on the forehead, sweating intensifies.
2. With torsion of the leg and tissue necrosis, symptoms similar to an acute abdomen occur. The pain becomes unbearable, the temperature rises, the patients feel very weak, they may faint.
3. There are attacks of vomiting and at the same time long delays of a chair are characteristic.
4. The mental state of a woman becomes unstable. Attacks of fear can be replaced by periods of apathy and lethargy.

Diagnosis and differential diagnosis

At the first signs of cystadenoma, it is necessary to consult a gynecologist. During the examination, the doctor will examine the symptoms and conduct an examination with palpation to first determine the type of formation, its location, size, and mobility. Various types of instrumental studies are also assigned:

If you suspect the presence of oncological formations, women are assigned a blood test for the number of tumor markers CA-125, HE4. Differential diagnosis should be carried out with various types of tumors, ectopic pregnancy, endometriosis, appendicitis and some other diseases and conditions of the body.

Treatment of cystadenoma

There are currently no conservative treatments for cystadenoma. All patients are scheduled for surgical removal of the neoplasm. Any self-medication and the use of folk remedies is excluded, as this can lead to a strong growth of cystadenoma, as well as to its degeneration into a malignant tumor. Only the surgeon can determine which operation is suitable for the patient after studying the anamnesis, determining the volume of the cystoma and the risk of developing oncology.

Laparoscopy

This type of operation is prescribed for small formations, up to four centimeters in size. Also an important factor is the good quality of the tumor and the childbearing age of a woman who plans to have children in the future.

The operation is performed under general anesthesia, very small incisions are made on the abdominal wall, no more than two centimeters. A video camera with gas supply and surgical instruments are inserted into them. Doctors try to save the ovary and remove only the cystadenoma. In four months, you can plan the conception of a child.

This type of operation is more serious, the surgeon makes a fairly large incision in the abdomen. The indication for laparotomy is the period of menopause, large cystomas, malignant neoplasms. Most often, the doctor removes not only the cystadenoma itself, but also the ovary with the fallopian tubes. This procedure will help to avoid the further appearance of cancerous tumors on the reproductive organs of a woman. If the patient was removed only one ovary, then in the future she will be able to become pregnant and bear the child.

During a laparotomy, the affected ovary is usually removed along with the cystadenoma.

Consequences and complications

In most cases, if no malignant transformation has been detected, the treatment prognosis for patients is favorable. Cystadenomas are easily removed surgically. If there was no timely treatment, then women may experience the following consequences:

• decreased ovarian function;
• infertility;
• malignant degeneration;
• metastasis of cancerous tumors to other organs;
• disruption of the pelvic organs due to compression by cystadenoma;
• circulatory disorders due to squeezing of blood vessels, varicose veins;
• the formation of blood clots;
• spontaneous abortions.

In some cases, patients experience such complications that require immediate hospitalization with an emergency operation:

• rupture of cystadenoma and entry of its contents into the abdominal cavity, which leads to peritonitis;
• twisting of the tumor stem, which contributes to impaired blood supply and the onset of the necrotic process;
• suppuration of cystadenoma.

Cystadenoma is a benign tumor, but it requires careful observation of doctors and surgical removal, since this neoplasm does not resolve on its own. In most situations, women manage to preserve the ovaries, and hence the reproductive function. In some cases, when there is a suspicion of the development of a cancerous tumor, it may be necessary to remove not only the cystadenoma, but also the reproductive organs. Typically, such operations are carried out already at a more mature age, when the patient does not plan to conceive a child.