Reticulated ovarian cyst. Anechogenic ovarian cyst

Ovarian cyst- this is a formation with thin walls in the thickness or on the surface of an organ, inside which there is a cavity with liquid or semi-liquid contents. In its structure, the cyst resembles a bubble.

Among other gynecological diseases, ovarian cysts occupy from 8 to 20% in prevalence.

Anatomy and physiology of the ovary

ovaries refer to the internal female genital organs. They are paired - they distinguish between the right and left ovaries.

Basic functions of the ovaries:

• development, growth and maturation of eggs in follicles (cavities in the form of vesicles that are located in the thickness of the ovarian tissue);
• release of a mature egg into the abdominal cavity (ovulation);
• synthesis of female sex hormones: estradiol, estriol, progesterone, etc.;
• regulation of the menstrual cycle through secreted hormones;
• ensuring pregnancy through the hormones produced.

The ovaries are oval and located near the fallopian tubes. They are attached by ligaments to the uterus and pelvic walls.

The size of the ovaries in women of reproductive (childbearing) age:

• length - 2.5 - 5 cm;
• width - 1.5 - 3 cm;
• thickness - 0.6 - 1.5 cm.

After menopause, the ovaries decrease in size.

The structure of the ovarian tissue

The ovary has two layers:

1. Cortical layer located outside and contains follicles in which the eggs are located. It has a maximum thickness at the reproductive (childbearing) age, and then gradually begins to thin and atrophy.
2. Medulla- internal. It contains connective tissue fibers, muscles, blood vessels and nerves. Due to the medulla, fixation and mobility of the ovary is ensured.

Functioning of the ovary

In the cortical layer of the ovary, new follicles with eggs are constantly developing. 10% of them remain functioning, and 90% undergo atrophy.

By the time of ovulation, a new egg has matured in one of the follicles. The follicle increases in size and approaches the surface of the ovary. At this time, the development of all other follicles is inhibited.

At ovulation, the mature follicle ruptures. The egg in it enters the abdominal cavity, and then enters the fallopian tube. In place of the bursting follicle, a corpus luteum is formed - an accumulation of glandular cells that secretes the hormone progesterone, which is responsible for carrying a pregnancy.

By the time of the onset of menstruation, ovarian function decreases. The body is deficient in hormones. Against the background of this “hormonal deficiency”, part of the mucous membrane is rejected, bleeding develops. Menstruation is coming.

What is a cyst?

Ovarian cysts can have a different structure and origin. They are united by the fact that they all look like a bubble that is filled with liquid or semi-liquid content.

Types of ovarian cysts:

• dermoid cyst;
• endometrial cyst;
• polycystic ovary syndrome;
• cystadenoma;
• serous;
• follicular;
• ovarian corpus luteum cyst.

Dermoid cyst

Dermoid ovarian cyst(synonyms: mature teratoma, dermoid) is a benign tumor of the female internal genital organs. Among all ovarian cysts in terms of prevalence, it occupies 15 - 20%.

The dermoid cyst may be round or oval in shape. Its walls are smooth on the outside. The diameter can reach 15 cm.

This tumor contains almost all types of tissues: nervous, connective, muscles, cartilage, adipose tissue.

In the dermoid cyst there are sebaceous and sweat glands, hair. Inside there is a cavity that is filled with contents resembling jelly in consistency.

The most common dermoid ovarian cyst on the right. Almost always it is only on one side. This type of cyst grows very slowly. In 1 - 3% of cases, it transforms into cancer.

Causes of a dermoid cyst

The reasons for the development of dermoid are not fully understood. It is believed that the tumor is formed as a result of a violation of the development of tissues in the embryo, hormonal changes in the body of a girl and a woman during puberty, menopause. The provoking factor is abdominal trauma.

A dermoid ovarian cyst may first be diagnosed in childhood, adulthood, or adolescence.

Symptoms of a dermoid cyst

A dermoid ovarian cyst gives the same symptoms as any other benign tumor. Until a certain time, she does not manifest herself in any way. When the dermoid has significantly increased in size (usually 15 cm), characteristic symptoms occur:

• feeling of heaviness and fullness in the abdomen;
• pain in the lower abdomen;
• an increase in the abdomen due to the tumor itself and the accumulation of fluid in the abdominal cavity;
• with pressure of the tumor on the intestines - constipation or diarrhea.

Complications of a dermoid cyst

• Inflammation. Body temperature rises to 38⁰C and above, weakness, drowsiness are noted.
• Torsion of the peduncle of the cyst, in which the vessels and nerves pass. There is an acute pain in the abdomen, a sharp deterioration in the general condition. There may be symptoms of internal bleeding (pallor, severe weakness, etc.).

  Diagnostics of the dermoid cyst

• Manual inspection. It can be performed in two versions: vaginal-abdominal (one hand of the doctor is in the vagina, the second is on the stomach), recto-abdominal (the doctor inserts a finger into the rectum and probes the ovarian cyst through it). At the same time, the gynecologist can feel the ovary, roughly estimate its size, consistency, density, etc. The dermoid cyst is felt as a rounded, elastic, mobile, painless formation.
• Ultrasound procedure. When conducting this study, the structure of the walls of the teratoma, the consistency of its internal contents are well defined. A characteristic feature of the tumor: in the thickness of its wall, calcifications are often detected - areas of calcification.
• Computed tomography and magnetic-resonance imaging. These two studies allow us to study in detail the internal structure of the dermoid cyst and establish the final diagnosis.
• Laparoscopy (culdoscopy) - endoscopic diagnosis of a dermoid cyst by introducing miniature video cameras into the abdominal cavity through punctures (with laparoscopy, punctures are made on the anterior abdominal wall, with culdoscopy, the endoscope is inserted through the vagina). The indication for this study is the complicated course of the dermoid cyst.
• Blood test for tumor markers(substances that signal the presence of a malignant tumor in the body). Due to the risk of malignancy of the dermoid cyst, a blood test for the CA-125 tumor marker is performed.

Dermoid ovarian cyst and pregnancy

Treatment of a dermoid ovarian cyst is best done before pregnancy. But sometimes the tumor is detected for the first time after the woman became pregnant. If the dermoid is small and does not exert pressure on the internal organs, it is not touched during pregnancy. During the entire period, the pregnant woman should be under the supervision of a doctor of the antenatal clinic.

Treatment of a dermoid ovarian cyst

The only treatment for ovarian dermoid is surgery. Its volume and features depend on the size of the tumor, the age and condition of the woman.

Types of operations for dermoid ovarian cyst:

• in girls and women of childbearing age, the cyst is completely removed, sometimes part of the ovary is excised;
• in women after menopause, the ovary is most often removed, sometimes along with the fallopian tube;
• if the ovarian dermoid cyst is complicated by inflammation or torsion, emergency surgery is performed.

The operation can be performed through an incision or endoscopically. The endoscopic technique is less traumatic, but the final choice is made by the attending physician, depending on the availability of indications.

After 6 to 12 months after the removal of the cyst, pregnancy can be planned.

Endometrial cyst

endometriosis(synonym - endometrioid heterotopias) is a disease characterized by the growth of tissue identical to the uterine mucosa in other organs. Endometriosis of the ovaries occurs in the form of an endometriosis cyst.

Endometrial cysts are usually 0.6 - 10 cm in size. Larger ones are extremely rare. They have a strong thick capsule 0.2 - 1.5 cm thick. Often there are adhesions on its surface. Inside the cystic cavity is the contents of the chocolate color. Basically, it consists of the remnants of blood, which here, as in the uterus, is released during menstruation.

Causes of endometriosis cysts

To date, they have not yet been fully studied.

Theories for the development of ovarian endometriosis:

• reverse reflux of cells from the uterus into the fallopian tubes during menstruation;
• transfer of cells from the uterine mucosa to the ovaries during surgical interventions;
• the entry of cells into the ovary with the flow of blood and lymph;
• hormonal disorders, changes in ovarian function, pituitary gland, hypothalamus;
• immune disorders.

Symptoms of endometriosis cysts

• constant pain in the lower abdomen aching nature, which periodically increase, give to the lower back, rectum, increase during menstruation;
• sharp sharp pains occur in about 25% of patients who have a rupture of the cyst and the outflow of its contents into the abdominal cavity;
• painful menstruation(algomenorrhea), accompanied by dizziness and vomiting, general weakness, cold hands and feet;
• constipation and urinary incontinence- caused by the formation of adhesions in the pelvic cavity;
• small bleeding from the vagina after menstruation has already ended;
• constant small increase in body temperature, occasional chills;
• inability to get pregnant for a long time.

Diagnosis of endometriosis ovarian cysts

• General blood analysis. In women with endometriosis, an increase in the erythrocyte sedimentation rate is often detected - a sign of an inflammatory process in the body. Sometimes such patients are mistakenly treated for a long time in the clinic for adnexitis, an inflammatory disease of the uterus and appendages.
• Gynecological examination. During examination by a gynecologist, endometriosis cysts can be detected on the right, left, or both sides. To the touch they are elastic, but quite dense. They are in one place and practically do not move.
• Laparoscopy. Endoscopic examination, which is the most informative for endometriotic ovarian cysts. Laparoscopy allows you to examine the pathological formation, which has a characteristic shape.
• Biopsy. Allows you to establish the final diagnosis and distinguish endometriotic ovarian cysts from other pathological formations. A doctor takes a piece of tissue for examination with the help of special tools during a laparoscopic examination.
• Ultrasound, CT and MRI - highly informative studies that help to examine in detail the internal structure of the cyst.

Classification of endometriotic ovarian cysts:

• I degree. As such, there are no cysts yet. There are small, in the form of dots, endometriosis formations in the ovarian tissue.
• II degree. There is an ovarian cyst of small or medium size. There are adhesions in the pelvic cavity that do not affect the rectum.
• III degree. Cysts are located on the right and left, on both ovaries. Their sizes reach more than 5 - 6 cm. Endometrial growths cover the outside of the uterus, fallopian tubes, walls of the pelvic cavity. The adhesive process becomes more pronounced, the intestines are involved in it.
• IV degree. Endometriosis ovarian cysts are large. The pathological process extends to neighboring organs.

Treatment of an endometrial ovarian cyst

Treatment goals for ovarian cysts associated with endometriosis:

• elimination of symptoms disturbing a woman;
• preventing further progression of the disease;
• fight against infertility.

Modern methods of treatment of endometriotic ovarian cysts:

Method	Description
Conservative methods
hormone therapy	Endometriosis is almost always accompanied by a hormonal imbalance that must be corrected. Hormonal drugs used to treat endometriosis: synthetic estrogen-progestin(analogues of female sex hormones estrogen and progesterone) drugs: Femoden, Microgynon-30, Anovlar, Ovidon, Marvelon, Rigevidon, Diane-35; progestogens(analogues of the female sex hormone progesterone): Norkolut, Dufaston, Orgametril, Turinal, Gestrinone, Oxyprogesterone capronate, Medroxyprogesterone, Depo Provera, etc .; antiestrogen(drugs that suppress the effects of estrogen): Tamoxifen and etc.; androgens(male sex hormones, which are normally present in the female body in small quantities): Testenat, Methyltestosterone, Sustanon-250; antigonadotropins(drugs that suppress the influence of the pituitary gland on the ovaries): Danoval, Danol, Danazol; anabolic steroid: Nerobol, Retabolil, Methylandrostenediol and etc. *.The average duration of treatment is 6-9 months.
vitamins	They have a tonic effect, improve ovarian function. The most important vitamins are E and C.
Anti-inflammatory drugs	Eliminate the inflammatory process that accompanies endometrioid heterotopias. Indomethacin is used in the form of tablets or rectal suppositories. *All of these drugs are taken strictly according to the doctor's prescription..
Painkillers	The fight against pain, the normalization of the woman's condition. Analgin, Baralgin is used. *All of these drugs are taken strictly according to the doctor's prescription..
Immunomodulators	Medicines that boost the immune system. They are prescribed in cases where endometriotic cysts are accompanied by significant immune changes. Immunomodulators that are used for endometriosis ovarian cyst: Levamisole (Decaris): 18 mg 1 time per day for three days. Repeat the course 4 times with 4-day breaks. Splenin- a solution of 2 ml intramuscularly once a day, daily or every other day, 20 injections. Timalin, Timogen, Cycloferon, Pentaglobin. *All of these drugs are taken strictly according to the doctor's prescription..
Surgical techniques
Laparotomy interventions	Laparotomy is a surgical intervention that is performed through an incision. Tactics of surgical intervention for endometriosis: in women of reproductive age: removal of an ovarian cyst within the affected tissues, while the ovary itself is completely preserved; in women after menopause: complete removal of the ovary can be performed.
Laparoscopic interventions	Operations to remove endometriosis cysts, which are performed endoscopically, through a puncture. Laparoscopic removal of endometriotic ovarian cysts is less traumatic, rarely leads to complications, and does not require long-term rehabilitation treatment after the operation.
Combined treatments
A course of conservative therapy is carried out, after which the endometriosis cyst is removed by surgical methods.

Pregnancy with endometriosis ovarian cysts

Patients with endometriotic ovarian cysts cannot become pregnant for a long time. Sometimes infertility is the only complaint with which the patient comes to the doctor.

If the diagnosis is established before pregnancy, it is recommended to first remove the cyst, and then plan the child.

If the cyst is detected already during pregnancy, but it is small and does not compress the internal organs, then there are no contraindications to childbirth. Women with endometrioid heterotopias have an increased risk of miscarriage, so they should be under special medical supervision during the entire pregnancy.

polycystic ovary syndrome

polycystic ovary syndrome(synonyms: polycystic ovaries, ovarian sclerocystosis) is a hormonal disease in which the functioning and normal structure of the ovaries is disrupted.

Polycystic ovaries look normal but are enlarged. In the thickness of the organ there are many small cysts, which are mature follicles that are not able to break through the ovary membrane and release the egg out.

Causes of polycystic ovary syndrome

First, insulin resistance develops in a woman's body: organs and tissues become insensitive to insulin, a hormone that is responsible for the absorption of glucose and a decrease in its content in the blood.

Because of this, the pancreas increases the production of insulin. The hormone enters the bloodstream in large quantities and begins to have a negative effect on the ovaries. They begin to secrete more androgens - male sex hormones. Androgens do not allow the egg in the follicle to mature normally and come out. As a result, during each next ovulation, the mature follicle remains inside the ovary and turns into a cyst.

Pathological conditions predisposing to the development of polycystic ovary syndrome:

• Overweight (obesity). If the body receives a large amount of fat and glucose, the pancreas is forced to produce more insulin. This leads to the fact that the cells of the body quickly lose their sensitivity to the hormone.
• Diabetes. In this disease, either insulin is produced in insufficient quantities, or it ceases to act on the organs.
• Burdened heredity. If a woman suffers from diabetes and polycystic ovaries, then her daughters are at increased risk.

Symptoms of polycystic ovaries

• Delays in menstruation. Breaks between them can be months and years. This symptom is usually noted in girls immediately after the first menstruation: the second comes not a month later, but much later.
• hirsutism- excessive growth of hair on the body, as in men. The appearance of this secondary male sexual characteristic is associated with the production of a large amount of androgens in the ovaries.
• Increased oily skin, acne. These symptoms are also associated with an excess of androgens.
• Obesity. Adipose tissue in women with polycystic ovary syndrome is mainly deposited in the abdomen.
• Cardiovascular disorders-vascular system. Such patients develop early arterial hypertension, atherosclerosis, coronary heart disease.
• Infertility. The egg cannot leave the ovarian follicle, so the conception of a child becomes impossible.

Diagnosis of polycystic ovary syndrome

Polycystic ovary syndrome is easily confused with other endocrine diseases. Especially if the woman has not yet tried to conceive a child, and infertility has not been identified.

The final diagnosis is established after the examination:

• ultrasound. One of the most informative methods that allows you to examine and evaluate the internal structure of the ovary, to detect cysts. Ultrasound examination for polycystic is performed using a probe that is inserted through the vagina.
• Study of the content of female and male sex hormones in the blood. Assess the hormonal status of a woman. With polycystic ovary syndrome, an increased amount of androgens, the male sex hormones, is found.
• Blood chemistry. Elevated levels of cholesterol and glucose are detected.
• Laparoscopy (culdoscopy). An endoscopic examination is indicated for a woman if she has dysfunctional uterine bleeding (bleeding from the vagina that is not associated with menstruation and other diseases of the genital organs). During laparoscopy, the doctor performs a biopsy: a small piece of the ovary is taken for examination under a microscope.

Treatment of polycystic ovary syndrome

When prescribing treatment for polycystic ovaries, the doctor takes into account the severity of the symptoms and the desire of the woman to become pregnant.

Treatment begins with conservative methods. If they do not bring results, surgical intervention is performed.

Treatment regimen for polycystic ovary syndrome

Direction of therapy	Description
Fighting overweight	total daily calorie content of food - no more than 2000 kcal; reduction of fats and proteins in the diet; physical activity.
Combating disorders of carbohydrate metabolism caused by a decrease in tissue sensitivity to insulin	Metformin is usually prescribed. The course is held for 3 - 6 months. *All of these drugs are taken strictly according to the doctor's prescription..
Infertility, hormone therapy	Drug of choice - Clomiphene citrate. Reception is carried out on the 5th - 10th day from the beginning of the menstrual cycle. Usually after this, in more than half of the patients, the eggs become able to leave the ovary, the menstrual cycle is restored. More than a third of the patients get pregnant. Hormone preparations gonadotropin (Pergonal or Humegon) is prescribed in the case when Clomiphene citrate does not bring effect. *All of these drugs are taken strictly according to the doctor's prescription..
Hormone therapy in women who do not plan pregnancy	Contraceptives with antiandrogenic action (suppressing the function of male sex hormones): Yarina, Jeanine, Diane-35, Jess. Antiandrogenic drugs that suppress the production and effects of male sex hormones: Androkur, Veroshpiron. *All of these drugs are taken strictly according to the doctor's prescription..

Surgical treatment for polycystic ovary syndrome

The purpose of the operation for polycystic ovaries is to remove parts of the organ that produce male sex hormones.

Almost always resort to laparoscopic intervention under general anesthesia. Small incisions-punctures are made on the wall of the abdomen, through which endoscopic instruments are inserted.

Surgical options for polycystic ovary syndrome:

• Excision of part of the ovary. With the help of an endoscopic scalpel, the surgeon excises the part of the organ that produces the most androgens. This method is good because at the same time it is possible to eliminate the accompanying adhesions between the ovary and other organs.
• Electrocoagulation- spot cauterization of areas of the ovaries in which there are cells that produce testosterone and other male sex hormones. The operation has minimal trauma, is carried out very quickly, and does not require long-term rehabilitation.

Usually within 6 to 12 months from the date of surgery for polycystic ovary syndrome, a woman is able to become pregnant.

Polycystic ovary syndrome and pregnancy

Since the disease is accompanied by the inability of the egg to leave the ovary, all such patients are infertile. It is possible to get pregnant only after the cure of the disease and the normalization of ovulation.

Follicular ovarian cyst

A follicular ovarian cyst is a cystic formation, which is an enlarged follicle.

Such a cyst has thin walls and a cavity with liquid contents. Its surface is even and smooth. Its dimensions usually do not exceed 8 cm.

The formation of follicular cysts usually occurs in young girls during puberty.

Follicular cysts of the right and left ovaries are equally common.

Symptoms of a follicular ovarian cyst

A follicular cyst, the size of which does not exceed 4-6 cm, most often does not give any symptoms.

Sometimes there is an increased formation in the ovaries of female sex hormones - estrogens. In this case, the regularity of menstruation is disturbed, acyclic uterine bleeding occurs. Girls have precocious puberty.

Sometimes a woman is disturbed by aching pains in the abdomen.

An increase in the diameter of the cyst to 7-8 cm creates a risk of torsion of its legs, in which the vessels and nerves pass. In this case, there are acute pains in the abdomen, the woman's condition deteriorates sharply. Emergency hospitalization is required.

During ovulation, in the middle of the menstrual cycle, a rupture of the follicular cyst may occur. At the same time, the woman also experiences acute pain in the abdomen - the so-called ovarian pain.

Diagnosis of follicular ovarian cysts

• Gynecological examination. A vaginal-abdominal or recto-abdominal examination is performed. In this case, the doctor detects a formation to the right or left of the uterus, which has a dense elastic consistency, easily shifts relative to the surrounding tissues, and is painless when palpated.
• ultrasound– ultrasonography(a study based on the use of high frequency ultrasound to detect deep-seated structures). Allows a good study of the internal structure of the ovary and cysts.
• Laparoscopy and culdoscopy with a follicular ovarian cyst, they are used only for special indications.

Treatment of a follicular ovarian cyst

Small cysts may resolve on their own without treatment.

Conservative treatment of a follicular ovarian cyst consists in the appointment of hormonal preparations containing estrogens and gestagens. Usually recovery occurs in 1.5 - 2 months.

Indications for surgical treatment:

• the ineffectiveness of conservative treatment, which is carried out for more than 3 months;
• large cysts (diameter more than 10 cm).

A laparoscopic surgical intervention is performed, during which the doctor ejects the cyst and sutures the resulting defect.

Follicular ovarian cyst and pregnancy

This type of cyst does not interfere with the onset of pregnancy. As a result of changes in the hormonal background of a pregnant woman, the follicular cyst usually disappears on its own at 15-20 weeks. Such patients should be under special supervision of an obstetrician-gynecologist in the antenatal clinic.

Serous ovarian cystoma (serous cystoma, cilioepithelial cystoma)

Serous cystoma ovary - a benign tumor that has a cavity inside with a clear liquid.

The main difference between a serous cystoma and other cysts and tumors is the structure of the cells that line it. In structure, they are identical to the mucous membrane of the fallopian tubes or to the cells that cover the surface of the ovary from the outside.

Cystoma, as a rule, is located only on one side, near the right or left ovary. Inside there is only one chamber, not divided by partitions. Its diameter can be up to 30 cm or more.

Causes of serous ovarian cystoma

• endocrine diseases and hormonal imbalance in the body;
• infections of the external and internal genital organs, sexually transmitted diseases;
• inflammatory diseases of the fallopian tubes and ovaries (salpingoophoritis, adnexitis);
• transferred abortions and surgical interventions on the pelvic organs.

Symptoms of a serous ovarian cystoma

• usually the disease is detected in women over the age of 45;
• while the cystoma is small, it gives practically no symptoms: there may be periodic pain in the lower abdomen;
• an increase in the tumor in size of more than 15 cm is accompanied by compression of the internal organs and symptoms such as constipation, urination disorders;
• ascites(enlargement of the abdomen as a result of the accumulation of fluid in the abdominal cavity) is an alarming symptom that should cause an immediate visit to the oncologist and an examination.

Serous ovarian cystomas can transform into malignant tumors. True, this happens only in 1.4% of cases.

Diagnosis of serous ovarian cystoma

• Gynecological examination. It makes it possible to detect a tumor formation near the right or left ovary.
• Ultrasound procedure. During the diagnosis, the doctor discovers a single-chamber cavity filled with fluid.
• Biopsy. Examination of the tumor under a microscope. Allows you to distinguish benign serous cystoma from other tumor neoplasms of the ovary. Most often, the cystoma is sent for histological examination as a whole, after it has been removed.

Treatment of serous ovarian cystoma

Treatment of serous ovarian cystoma is surgical. There are two options for surgical intervention:

• If the tumor is small, it is removed completely. Sometimes - with part of the ovary.
• With a sufficiently large cystoma, the ovary atrophies and becomes part of the cyst wall. In this case, it is advisable to remove the tumor along with the ovary on the side of the lesion.

Surgical intervention can be performed using laparotomy or laparoscopy. The tactics are chosen by the attending physician, focusing on the characteristics of the tumor, the condition and age of the patient.

Serous ovarian cystoma and pregnancy

If the serous cystoma is within 3 cm, then it usually does not affect the process of carrying a pregnancy.

The large size of the tumor poses a danger to the pregnant woman and the fetus. At a period of 12 weeks, when the uterus begins to rise from the pelvic cavity into the abdominal cavity, there is an increase in the torsion of the cyst leg. This is an emergency condition that requires immediate surgical intervention and can cause a miscarriage.

Large serous ovarian cystomas must be removed before pregnancy.

Papillary ovarian cystoma

under the term " papillary ovarian cystoma"understand such a cystoma, on the inner or outer surface of the wall of which, during ultrasound, growths in the form of papillae are found.

Papillary ovarian cyst refers, according to the classification of the World Health Organization (WHO), to precancerous conditions. It becomes malignant in 40-50% of cases.

The detection of papillary cystoma is an absolute indication for surgical treatment. The removed tumor is necessarily sent for a biopsy.

Mucinous ovarian cystoma

Mucinous ovarian cystoma (synonym: pseudomucinous cyst) is a benign tumor. Its main difference from a serous cystoma is the cells that line the cavity of the cyst from the inside: in structure, they resemble the mucous membrane of the vagina in the place where it passes into the cervix.

Mucinous ovarian cysts are detected at different ages. Most often they are found in women in their 50s.

Usually, a mucinous cystoma has a round or oval outline, an uneven, bumpy surface. Inside are several chambers filled with mucus. The tumor grows very quickly, reaches a huge size.

Mucinous cysts are prone to malignancy. In 3-5% of cases they transform into cancer. If the tumor has a rapid growth and a characteristic cell structure, then the risk of malignancy is 30%.

Symptoms and features of the diagnosis of mucinous ovarian cystoma

Symptoms and examination for mucinous ovarian cysts are practically the same as those for serous cysts.

Treatment of mucinous ovarian cystoma

This tumor requires surgery.

Possible tactics of surgical treatment:

• In young nulliparous girls, the tumor is completely removed. The ovary is saved if the examination does not reveal the risk of malignancy.
• In women of childbearing age, the cyst and ovary on the affected side are removed.
• In postmenopausal women, removal of the uterus along with appendages is indicated.
• With the development of complications (torsion of the cyst leg), an emergency surgical intervention is performed.
• If a malignant process is detected during the study, chemotherapy and radiation therapy are prescribed before and after the operation.

The type and extent of surgical intervention is determined by the doctor after the examination.

Pregnancy with mucinous ovarian cyst

A small tumor does not interfere with pregnancy. In the presence of a mucinous cystoma, there is always a risk of miscarriage and the development of an emergency condition requiring immediate surgical intervention, with torsion of the cyst leg.

It is necessary to conduct an examination and remove the tumor before planning a child. Attempts to get pregnant should be made only after the operation and the rehabilitation period, which is usually about 2 months.

After the operation, the woman is observed by a gynecologist, oncologist, mammologist.

ovarian corpus luteum cyst

ovarian corpus luteum cyst (synonym: luteal cyst) - a cyst that forms in the cortical layer of the ovary from the corpus luteum.

The corpus luteum is an accumulation of endocrine cells that remains in place of a burst follicle (see above "ovarian anatomy"). For some time, it releases the hormone progesterone into the bloodstream, and then, by the time of the next ovulation, it atrophies.

The luteal ovarian cyst is formed due to the fact that the corpus luteum does not undergo regression. Violation of the blood flow in it leads to the fact that it turns into a cystic cavity.

According to statistics, cysts of the corpus luteum occur in 2 - 5% of all women.

The cyst has a smooth rounded surface. Its dimensions usually do not exceed 8 cm. Inside is a yellowish-red liquid.

Causes of a corpus luteum cyst

The causes of the development of the disease are not well understood. The leading role is given to such factors as hormonal imbalance in the body and impaired blood circulation in the ovaries. A corpus luteum cyst can occur during or outside of pregnancy, in which case the course of the disease is somewhat different.

Factors that contribute to the development of a corpus luteum cyst of the ovary:

• taking medications that simulate the release of an egg from the follicle during infertility;
• taking medications to prepare for in vitro fertilization, in particular, clomiphene citrate;
• taking drugs for emergency contraception;
• prolonged intense physical and mental stress;
• malnutrition, starvation;
• frequent and chronic diseases of the ovaries and fallopian tubes (oophoritis, adnexitis);
• frequent abortions.

Symptoms of a corpus luteum cyst

This type of ovarian cyst is not accompanied by almost no symptoms. Sometimes a cyst arises and passes on its own, while the woman does not even know about its existence.

Symptoms of a luteal ovarian cyst

• slight pain in the lower abdomen on the side of the lesion;
• a feeling of heaviness, fullness, a feeling of discomfort in the abdomen;
• delays in menstruation;
• prolonged periods due to uneven rejection of the uterine mucosa.

Cysts of the corpus luteum never transform into malignant tumors.

Diagnostics of the cyst of the corpus luteum

Treatment of luteal ovarian cysts

Newly diagnosed corpus luteum cyst
Dynamic observation by a gynecologist, ultrasound and dopplerography for 2-3 months.	In most cases, luteal cysts resolve on their own.
Recurrent and long-lasting cysts
Conservative therapy	hormonal preparations for contraception; balneotherapy- irrigation of the vagina with solutions of medicines, therapeutic baths; pelotherapy– treatment with mud; laser therapy; SMT-phoresis- a physiotherapeutic procedure in which medicinal substances are injected through the skin using SMT current; electrophoresis- a physiotherapeutic procedure in which medicinal substances are injected through the skin using a low current; ultraphonophoresis- physiotherapy, in which a medicinal substance is applied to the skin, and then ultrasound is irradiated; magnetotherapy.
A corpus luteum cyst of the ovary that does not resolve within 4 to 6 weeks with conservative treatment
Surgery	Most often, laparoscopic surgery is performed. The cyst is husked, the defect site is sutured. Sometimes part of the ovary is removed.
Complicated luteal cyst
bleeding; torsion of the cyst leg; necrosis (death) of the ovary.	Emergency operation by laparotomy, through an incision.

ovarian corpus luteum cyst and pregnancy

A luteal cyst discovered during pregnancy is not a cause for concern. Normally, it should occur and secrete the hormones necessary to maintain pregnancy. From the 18th week of pregnancy, the placenta takes over these functions, and the corpus luteum gradually atrophies.

In contrast, the absence of a corpus luteum during pregnancy is a risk factor for miscarriage.

Treatment of ovarian corpus luteum cyst with folk remedies

Below are some folk remedies for the treatment of ovarian cysts. It is worth remembering that many types of cysts are treated only with surgical methods. Before using these or other alternative methods, be sure to consult your doctor.

Raisin tincture

Take 300 grams of raisins. Pour 1 liter of vodka. Infuse for a week. Take one tablespoon three times daily before meals. Usually the specified amount of tincture is enough for 10 days. The general recommended course of treatment is 1 month.

Burdock juice

Take burdock leaves and stems. Squeeze juice. Take one tablespoon three times a day before meals. Once the juice has been squeezed, it must be stored in the refrigerator and used within three days. After that, it becomes unusable - you need to prepare a new remedy.

Folk ointment used for ovarian cysts

Pour 1 liter of vegetable oil into an enamel pan. Place a small piece of beeswax in it. Heat on a gas stove until the wax melts. Continuing to keep the resulting solution on fire, add chopped egg yolk to it. Remove from heat, let stand for 10-15 minutes.
Strain. Moisten the tampons with the resulting ointment and insert them into the vagina in the morning and evening for two hours. The course of treatment is 1 week.

Folk remedy against functional ovarian cysts based on walnut

Take walnut shell partitions in the amount of 4 teaspoons. Pour in 3 cups of boiling water. Boil for 20 minutes over low heat. Take half a cup 2-3 times a day.

Can a girl develop an ovarian cyst?

Many believe that girls who do not live sexually have no problems with the organs of the reproductive system. But, unfortunately, ovarian cysts can occur in children and grandmothers in menopause. In girls, this pathology is detected, although infrequently, in 25 cases per million annually. The cysts can be huge and lead to the removal of the ovary. Most often (more than half of the cases), girls aged 12 to 15 get sick, that is, during the period when the menstrual cycle is established. But sometimes cysts are found in newborn babies.

Causes of cysts in girls:

• heredity - the presence of cystic formations in close blood relatives;
• hormonal imbalance during puberty and the formation of the menstrual cycle;
• early age of menarche - first menstruation;
• the use of various hormonal drugs ;
• thyroid disease ;
• heavy physical activity ;
• excess weight and obesity - a large amount of fat in the body contributes to imbalances in female sex hormones;
• .

What cysts are most common in girls?

1. Follicular cyst.
2. Cysts of the yellow body.

Girls in most cases develop functional cysts, but this does not mean that they do not have other types of cysts.

Features of the manifestations of ovarian cysts in adolescent girls:
1. May be asymptomatic course ovarian cysts, if its size is less than 7 cm.
2. Of the symptoms, the most characteristic:

• pain in the lower abdomen , aggravated by physical activity;
• violation of the menstrual cycle;
• painful periods and premenstrual syndrome;
• from the vagina are possible bloody issues , unrelated to menses.

3. Often follicular cysts in girls are accompanied by juvenile uterine bleeding which can last long and hard to stop.
4. Due to the anatomical features of the structure of the small pelvis in girls and the high location of the ovaries, it is often found complication in the form of torsion of the legs of an ovarian cyst . Unfortunately, this "accident" in the pelvis is often the first symptom of a cyst.
5. Adolescents may have huge multilocular cysts , which is associated with the fusion of several follicular cysts. This describes cases of cysts in girls larger than 20-25 cm in diameter. The most striking symptom of such cysts is an increase in the volume of the abdomen, very reminiscent of 12-14 weeks of pregnancy.
6. With timely detection, small size of education and competent approach possible resorption of cysts without treatment and surgery .

Treatment of ovarian cysts in girls.

Given the very young age, the main principle of the treatment of ovarian cysts in girls is the maximum saving of the ovary and the preservation of its functions. This is necessary in order to preserve the reproductive function of the future woman.

Principles of treatment of ovarian cysts in girls:

• Ovarian cysts in newborns usually go away on their own, because they arise due to the action of the mother's hormones. If the formation does not resolve and increases in size, then the cyst is punctured and the fluid is sucked out of it, or the cyst is removed, saving the organ (laparoscopic surgery).
• Small cyst (up to 7 cm), if it is not accompanied by uterine bleeding, torsion of the leg or rupture of the cyst, then simply observe for 6 months. During this time, in most cases, the cyst resolves on its own. Perhaps the appointment of hormonal or homeopathic drugs.
• If the cyst increases in size during the observation then an operation is required. At the same time, if possible, they try to remove the cyst, preserving the gonad.
• When complications of the cyst appear (inflammation, rupture, torsion of the cyst leg), as well as with ongoing uterine bleeding, the operation is inevitable, and is performed according to health indications. If it is not possible to save the ovary, then it is possible to remove it, and in especially severe cases, the ovary with all appendages is removed.

In most cases, an ovarian cyst in adolescents proceeds favorably and does not lead to the removal of the gonad, which does not affect the childbearing function of the girl in the future. During the observation of the cyst and after the operation, observation by a gynecologist and a sparing regimen of physical activity are necessary.

What is a paraovarian ovarian cyst, what are the causes, symptoms and treatment?

Paraovarian cyst- this is a cavity formation, a benign tumor that does not occur on the ovary itself, but in the area between the ovary, the fallopian tube and the wide uterine ligament, the cyst is not attached to the ovary. A paraovarian cyst is not a true ovarian cyst.

Schematic representation of possible localization sites of the paraovarian cyst.

This formation is a cavity with thin elastic walls, inside which fluid accumulates.
Such a tumor is quite common among young women, and every tenth diagnosis of a benign tumor of the female reproductive system falls on a paraovarian cyst.

Reasons for the development of a paraovarian cyst:

The main reason for the development of a paraovarian cyst is violation of the laying of the genital organs in the fetus during pregnancy, while this education is not inherited. Violation of the development of the reproductive system of the fetus is associated with viral infections:

Treatment for ovarian cysts during pregnancy:

• If the cyst does not bother and does not affect the bearing of the child, they do not touch it, but observe it, in this case, the question of surgical treatment is taken after childbirth. Pregnancy itself can contribute to self-resorption of cysts, because it is a powerful hormonal therapy.
• If a large ovarian cyst is detected, the patient is recommended bed rest, and in the third trimester, a planned operation is prescribed - a caesarean section. During a caesarean section, the ovarian cyst is also removed.
• With the development of complications of ovarian cysts, emergency surgical intervention is performed, as this can threaten not only pregnancy and the fetus, but also the life of the mother.

Does an ovarian cyst resolve without surgery?

Ovarian cysts can resolve, but not all. Moreover, more than half of the ovarian cysts are able to resolve on their own.

But before deciding whether to treat immediately or use surveillance tactics, you must definitely contact a specialist and undergo the necessary examination.

Types of ovarian cysts that can resolve without surgery:

• follicular ovarian cyst of small size (up to 4 cm);
• yellow body cyst of small size (up to 5 cm);
• retention cysts of the ovary;

Types of ovarian cysts that will never resolve on their own:

• dermoid cyst;
• endometrial cyst;
• paraovarian cyst;
• cystoadenoma;
• serous ovarian cyst;
• cancerous tumors of the ovary.

Therefore, having a diagnosis of such types of ovarian cysts, it is not worth hoping that it will pass on its own, and even more so, it is not worth treating them with traditional medicine. It is necessary to consult a doctor, follow his recommendations and not refuse if they offer the necessary surgical intervention. After all, the risk of complications is high, and many complications threaten the patient's life and can lead to infertility and removal of the sex gland.

Predominantly pathology affects children, adolescents and young adults, much more often than women. Almost 90% of patients with ACC are under 20 years of age, but the neoplasm is rare in children under 5 years of age.

Histology and pathogenesis of aneurysmal bone cyst

An aneurysmal bone cyst is a bone lesion consisting of large thin-walled cavities filled with blood and communicating with each other, having tissue fragments in the walls, resembling a blood-filled sponge. The walls separating the cavities are composed of fibroblasts, giant osteoclast-like cells, and coarse fibrous bone. Approximately in 1/3 of cases, characteristic reticulate-lace chondroid structures are found in the walls of the cysts.

Aneurysmal bone cyst can develop after injury, and in 1/3 of cases it accompanies benign tumors: most often (19-30% of cases) GCT, less often - chondroblastoma, chondromyxoid fibroma, osteoblastoma, solitary cyst, FD, EG, as well as malignant bone tumors : osteosarcoma, fibrosarcoma and even cancer metastasis. In such cases, ACC is called secondary, in contrast to primary ACC, in which no previous bone lesions are detected, although theoretically hemorrhage can completely destroy the tissue of such a lesion. Based on these data, it has been suggested that ACC arises from intraosseous hemorrhages caused by trauma or vascular changes in the previous tumor. This idea goes back to the works of one of the founders of the doctrine of ACC H.L. Jaffe (1958). S.T. Zatsepin (2001) actually considers ACC as a pseudoaneurysm, highlighting in its course:

• an acute stage with a very rapid increase in size due to intraosseous hemorrhage and with the destruction of bone tissue;
• chronic stage, when the process stabilizes and reparative changes occur.

By M.J. Kransdorf et al. (1995), the development of ACC reflects only non-specific pathophysiological mechanisms, and the main task of the clinician is the recognition of pre-existing lesions, when possible. If no such lesions are found, ACC is treated with curettage and bone grafting. If more aggressive lesions are identified, treatment should be directed at them. In other words, in osteosarcoma with secondary ACC, osteosarcoma should be treated, and in GCT with secondary ACC, local recurrences are more likely to be expected.

Although ACC is not considered a true tumor and does not metastasize, and in rare cases even spontaneously regress after biopsy, its rapid growth, extensive bone destruction, and spread to adjacent soft tissues require aggressive therapy. Not less than in 10-20% of cases there are single or repeated relapses after surgery. We should also mention the good effect of radiation therapy, after which the growth of ACC stops and recovery processes develop.

The solid variant of aneurysmal bone cyst are lesions that contain the lace-laced chondroid material seen in conventional ACCs, but without the typical cystic cavities. This variant accounts for 5-7.5% of all ACC cases. Its similarity with giant cell reparative granuloma of the jaws, as well as giant cell granuloma of long bones and small bones of the feet and hands was noted. All of them are regarded as a reaction to intraosseous hemorrhage. Clinical and imaging manifestations of classical ACC and the solid variant do not differ.

Symptoms and radiodiagnosis of an aneurysmal bone cyst

Clinical examination

The lesions of long bones predominate: of these, ACC is most often located in the tibia, femur, and humerus. Frequent localization is the spine (from 12 to 30% of cases) and pelvic bones. These three main sites account for at least 3/4 of ACC cases. The bones of the feet and hands account for approximately 10% of cases. Most patients present with pain and swelling for no longer than 6 months.

In the spine, the thoracic and lumbar regions are more commonly affected. ACC is usually located in the posterior sections of the vertebra: in the pedicle and plate of the arch, in the transverse and spinous processes. A paravertebral soft tissue component is often formed, which can lead to pressure atrophy of the adjacent vertebra or rib. The vertebral bodies are less frequently involved in the process, and their isolated lesion is rare.

Radiation diagnostics

In most cases of secondary ACC, the imaging pattern is typical of the original lesion. Primary ACC is manifested by a bone defect, often eccentrically located, with a swollen "ballooning" cortical layer and often with a delicate trabecular pattern. In about 15% of cases, x-rays show a flaky induration within the lesion (mineralized chondroid in the cyst wall), and in some cases it may mimic a cartilaginous tumor matrix.

In long bones, metaphyseal involvement predominates, diaphyseal localization is less common, and epiphyseal localization is very rare. The most typical is an eccentric or marginal (with initial intracortical or subperiosteal localization of the ACC) position of the destructive focus with significant swelling and a sharp thinning of the cortical layer.

With the marginal location of the aneurysmal bone cyst, in the foreground in the X-ray picture is a soft tissue formation with penetration of the cortical layer, traces of the periosteal shell and Codman's triangle, which resembles a malignant tumor. The similarity can be completed by trabeculae extending perpendicular to the axis of the bone into soft tissues. However, the soft tissue component corresponds in length to the length of the bone lesion and is covered at least partially by the periosteal bone shell. The initial period is characterized by a dynamic x-ray picture with very rapid growth, like no other bone tumor. At this stage, the inner contour becomes blurred, later it can become clear, sometimes bordered by a sclerotic rim. In such cases, the picture is quite indicative and often allows you to confidently diagnose an aneurysmal bone cyst.

When the vertebrae are affected, radiographs show bone destruction and swelling. Sometimes there are lesions of adjacent vertebrae, sacrum and pelvis.

The picture of an aneurysmal bone cyst during osteoscintigraphy is nonspecific and corresponds to the cystic nature of the lesion (accumulation of radiopharmaceuticals along the periphery with low activity in the center of the lesion). CT is most useful for assessing the size and localization of intraosseous and extraosseous components in anatomically difficult areas. CT and MRI reveal a well-defined focus of the lesion (often with a lobular outline), bone swelling and septa delimiting individual cyst cavities. MRI on the T2-weighted image also reveals solitary or multiple levels between fluid layers with different density or magnetic resonance signal, which is due to sedimentation of hemoglobin breakdown products. Although these levels are less common on the T1-weighted image, an increased signal on the T1-weighted image both below and above the levels confirms the presence of methemoglobin in the fluid. Horizontal levels can also be observed in secondary aneurysmal bone cysts in various tumors. Around the lesion and along the course of the internal septa, there is often a thin, well-defined border of reduced signal, probably due to fibrous tissue. After the introduction of a contrast agent, an increase in the signal of the internal septa is observed.

With large cysts and their superficial location, signs of swelling of the surrounding soft tissues are possible according to MRI. The value of MRI lies in the fact that it allows:

• establish a diagnosis in cases with an uncertain or suspicious picture on radiographs (up to 40% of cases);
• plan a biopsy of a solid component when this intervention is decisive in the differential diagnosis;
• early detection of postoperative relapses.

Differential Diagnosis

In the bones of the hands and feet, ACC is characterized by a central location in the bone and symmetrical swelling, and it must be differentiated from enchondroma and bone cyst, in which swelling is usually less pronounced, as well as with a brown tumor that accompanies hyperparathyroid osteodystrophy, and other lesions. When the epiphysis of the aneurysmal cyst is involved, the bones may resemble GCT, differing from it in a greater degree of swelling, and in children also in a periosteal reaction at the edges of the lesion focus. However, the exact distinction between ACC and GKO can be difficult. It should be taken into account that ACC is most often found in the immature skeleton, while GKO, almost without exception, occurs after the completion of bone growth.

When a vertebra is affected, the X-ray picture of ACC is characteristic, when the tumor is limited only to the transverse or spinous process of the vertebra, although osteoblastoma and hemangioma can cause similar changes. It is more difficult to distinguish from malignant tumors other localizations of the aneurysmal bone cyst, accompanied by a pronounced soft tissue component, in the pelvic bones, ribs, scapula and sternum.

On MRI, along with a cystic component, a solid component can also be detected, which does not refute the diagnosis of primary ACC, but requires differential diagnosis with telangiectatic osteosarcoma and secondary ACC.

In an ultrasound examination of the ovaries, the main "screening" task of the doctor is to identify volumetric formations of the appendages, since they are quite common and may be malignant. However, taking into account the intensive development in recent years of reproductive technologies and gynecological endocrinology, a need arose for a rigorous assessment of the structure and function of non-enlarged ovaries. Therefore, in an extended examination, when describing the ovaries, it is necessary to indicate not only their size, structure, the presence or absence of a dominant follicle (corpus luteum), but it is also necessary to evaluate intraovarian blood flow and blood flow in the vessels of the follicle (corpus luteum) in color and pulse Doppler modes.

When an ovarian formation is detected, the following characteristics are indicated: location, relationship with adjacent organs, shape, size, edges, contours, echostructure, echogenicity, the presence of internal and external parietal growths, as well as, if possible, the nature and speed characteristics of blood flow.

LACK OF OVARIAN IMAGE AND DEVELOPMENTAL ABNORMALITIES

The absence of an image of one of the ovaries is not uncommon in clinical practice and can be associated with a wide range of reasons. Difficulties with visualization of the ovary may be associated with inadequate preparation of the patient for examination, a history of surgical interventions, an atypical location of the organ, as well as an infrequent malformation - a unicornuate uterus, when one of the paramesonephric canals that form the ovary and fallopian tube does not develop. The absence of an image of the ovaries can be observed in the period of deep postmenopause due to a significant decrease in the size of the organ and its isoechogenicity in relation to surrounding tissues.

Ovarian abnormalities include: ovarian agenesis, gonadal dysgenesis, and, very rarely, an increase in

ovaries. Since it is impossible to prove the complete absence of gonadal tissue sonographically, suspicion of ovarian agenesis may arise in cases where the examination of the small pelvis fails to obtain an image of the uterus, but it must be remembered that a similar picture occurs with some forms of hermaphroditism and gonadal dysgenesis.

Gonadal dysgenesis is a rare genetically determined malformation of the gonads, in which there is no functionally active hormone-producing ovarian tissue. In the vast majority of cases, in patients with gonadal dysgenesis, it is not possible to obtain a conventional echographic image of the ovaries, since they are replaced by undifferentiated strands in the form of fibrous strips 20-30 mm long and about 5 mm wide. When examining the pelvis, a wide variety of options for the image of the uterus are possible - from pronounced hypoplasia with a barely visible endometrium to a slight decrease in size and a practically unchanged structure. If gonadal dysgenesis is suspected, the patient should be directed to determine the karyotype, and the ultrasound examination itself should be carried out with a targeted search for tumors, since in the presence of the Y chromosome, malignant neoplasms occur in 20-50% of cases.

UNCHANGED IN STRUCTURE AND SIZE,

BUT DEFECTIVELY FUNCTIONING OVARIANS

Luteinization of an unovulated follicle is a condition in which regular menstrual bleeding occurs against the background of cyclic hormonal changes, however, due to the inferiority of these changes, ovulation of the follicle does not occur. Over time, the follicle does not break, but decreases, luteinizes and disappears by the beginning of the next cycle. At the same time, there is no decrease in the numerical values ​​of the resistance index (IR) of blood flow in the vessels of the ovary - the indices of vascular resistance of the follicle remain at a constant sufficiently high level during all phases of the cycle (0.54-0.55). The endometrium in terms of echostructure and thickness corresponds to the phase of the cycle (Fig. 3.1). In some cases, a non-ovulated follicle can be determined within several menstrual cycles.

Insufficiency of the luteal phase of the cycle is a hypofunction of the corpus luteum of the ovary, echographically manifested by a decrease

echogenicity, a decrease in wall thickness, hypovascularization of the wall of the corpus luteum (a decrease in the intensity of blood flow when assessed in the CFM mode and an increase in IR), a decrease in the thickness of the endometrium (Fig. 3.2).

ALTERED IN THE STRUCTURE, BUT SLIGHTLY CHANGED IN THE SIZES OF THE OVARIANS

No image of the dominant follicle.

When visualizing ovaries of normal size, it is necessary to evaluate their structure and its correspondence to the phase of the menstrual cycle. Pay attention to the absence of a dominant follicle in the periovulatory phase of the cycle. This sign, with normal ovarian sizes, can be observed in the following pathological conditions: resistant ovary syndrome, ovarian exhaustion syndrome, postpartum hypopituitarism, hyperthecosis. In the case of resistant ovary syndrome, about half of the patients on the background of amenorrhea with a normal level of gonadotropins have no image of the follicular apparatus. In the remaining patients, follicles of small sizes are determined, but there is no maturation of the dominant follicle. The uterus may be normal or slightly reduced in size.

Patients younger than 40 years of age with amenorrhea are often diagnosed with ovarian wasting syndrome. At the same time, a significant increase in the level of gonadotropins is determined in the laboratory, and on ultrasound, the size of the ovaries is somewhat reduced, the follicular apparatus is practically absent (Fig. 3.3), the uterus is reduced in size, the endometrium is thinned, and the intraovarian blood flow is depleted.

Postpartum hypopituitarism develops after massive blood loss or bacterial shock in the postpartum period. Clinically, the syndrome is manifested by oligomenorrhea, anovulation, and infertility. Sonographically, the syndrome is characterized by normal or slightly reduced size of the ovaries, a decrease in the number of follicles to single small ones (up to 5 mm), the absence of visualization of the dominant follicle, and thinning of the endometrium.

Hyperthecosis is a disease characterized by the growth of the ovarian stroma, which undergoes proliferation and luteinization processes, as well as hyperproduction of androgens with clinical manifestations of virilization. Echographic signs of hyperthecosis - enlarged ovaries due to stromal hyperplasia, a decrease in the number of follicles to single small ones, lack of visualization of the dominant follicle, thickening of the albuginea.

The absence of an image of the dominant follicle can be observed in the case of drug exposure, for example, when taking oral contraceptives. As a complication after the abolition of long-term hormonal contraception, sometimes there is

syndrome of hyperinhibition of the gonadotropic function of the pituitary gland. The main echographic sign of this pathological condition, clinically manifested by amenorrhea, is the absence of visible structures of the follicular apparatus in the reduced ovaries. The condition may be accompanied by a decrease in the thickness of the endometrium and the size of the uterus.

And, finally, the dominant follicle may not be visualized and is normal - 2-3 anovulatory cycles per year are natural, and in women older than 35 years there may be more.

Microtumors of the ovary: tumors of the sex cord stroma that produce hormones (thecoma, granulosa cell tumor, androblastoma) can be small and practically do not lead to an increase in the ovary, but are accompanied by clinical symptoms and a change in the structure of the affected organ.

It is also necessary to take into account the possibility of the existence of metastatic tumors in the ovaries. Metastatic tumors are characterized by bilateral lesions of the ovaries and are often small in size. In the initial stages of development, metastatic tumors are oval in shape, repeating the outlines of the ovary, and imitate somewhat enlarged ovaries. The echostructure of the affected ovary is almost homogeneous, predominantly of low and medium echogenicity, a characteristic feature is the absence of an image of the follicular apparatus.

ALTERED AND ENLARGED OVARIANS

Bilateral increase and change in structure occurs in patients with multifollicular ovaries, with polycystic ovaries, with ovarian hyperstimulation, endometriosis, acute oophoritis, Krukenberg tumors. Unilateral ovarian enlargement occurs in acute oophoritis, ovarian torsion, ovarian pregnancy, tumor-like masses, and ovarian neoplasms, including cancer.

The term "multifollicular ovaries" should be used to describe ovaries with multiple follicular structures found in women without clinical or other manifestations of polycystic ovaries. The main echographic characteristics of multifollicular ovaries are: moderate or slight increase in the size of the ovaries, visualization of more than 10 small follicles (5-10 mm)

in one section, unchanged stromal echogenicity, maturation of the dominant follicle, ovulation and formation of the corpus luteum (Fig. 3.4). During a dynamic ultrasound examination, the disappearance of structural changes in the ovaries may be observed. A transient change in the structure of the ovaries in the form of multiple anechoic inclusions of small sizes can be observed in a number of conditions in the puberty period, with psychogenic dysmenorrhea, with hormonal contraception, with chronic inflammatory diseases and other processes that in most cases reverse development.

The term "polycystic ovaries" is understood as a pronounced and persistent change in the structure and function of the ovaries as a result of neuroexchange endocrine disorders leading to mass atresia of the follicles and anovulation. The frequency of this pathological condition in the structure of gynecological morbidity ranges from 0.6 to 11%. Most often, an ultrasound examination reveals enlarged ovaries, the volume of which exceeds 9-13 cm 3. In most cases, polycystic ovaries acquire a rounded shape. At the same time, an oblong form is not uncommon due to the predominant increase in the length of the ovary. Characteristic of polycystic ovaries are multiple anechoic inclusions (more than 10 in one section with two-dimensional echography and more than 20 in the entire volume of the ovary when scanning in the volumetric echography mode) of small sizes (from 2 to 8 mm) (Fig. 3.5). In most cases, the latter are located along the periphery of the ovary (the “necklace” symptom, peripheral cystic type), less often they can be located diffusely, i.e. both along the periphery and in the central part of the ovary (generalized cystic type).

An additional sign can be considered thickening and increased echogenicity of the ovarian stroma. Due to this, the area of ​​the hyperechoic stroma increases in relation to the area of ​​the follicles (>0.34). The thickness of the ovarian albuginea is not an indicative echographic sign of polycystic disease. The leading criterion is that during the dynamic ultrasound examination during the menstrual cycle, the dominant follicle and corpus luteum are not detected. An additional sign is the discrepancy between the structure of the endometrium and the phase of the menstrual cycle; hyperplastic processes are often observed. Doppler examination reveals an increase in vascularization of the stroma, monotonous

highly resistant nature of intraovarian blood flow throughout the entire menstrual cycle.

It should be emphasized that ultrasound signs are not an unambiguous basis for establishing a diagnosis of polycystic ovaries. This diagnosis is clinical and can only be made in the presence of other criteria for this disease.

Against the background of taking drugs that induce ovulation, ovarian hyperstimulation syndrome may occur. With a mild form of the syndrome, a small number of echo-negative structures with a diameter of about 20 mm are determined in the ovaries. In the moderate and severe form, the size of the ovaries increases significantly due to the multitude of thecalutein cysts up to 50-60 mm in size (Fig. 3.6). At the same time, free fluid can be determined in the pelvic cavity, abdominal and pleural cavities. In such cases, the emerging image of the ovaries practically does not differ from the echograms of cystadenomas. With Doppler sonography, pronounced vascularization of the “septa” is noted, which also complicates differential diagnosis with multi-chamber neoplasms. However, unlike them, in ovarian hyperstimulation syndrome, all of these changes undergo spontaneous regression within 2-3 (maximum 6) months after cessation of stimulation or drug correction. The basis of differential diagnosis is an indication of the use of ovulation stimulants.

Rice. 3.6. The ovary in the syndrome of hyper- 3.7. Endometriosis of the ovary. TV stimulation. scanning.

Endometriosis occupies one of the first places in the structure of causes of infertility. However, echographic detection of endometrioid heterotopias in the ovaries, which look like small-focal or even point inclusions, is an extremely difficult diagnostic task. No less difficult is the differentiation of ovarian endometriosis from other, sometimes sonographically very similar pathological processes. Among the few ultrasound signs, one can note a slight increase in the ovaries, the fuzziness of their contours, the appearance in them of hypoechoic structures about 2-3 mm in diameter during menstruation, the presence of small hyperechoic inclusions along the periphery, as well as an adhesive process leading to a fixed position of the ovaries on TV examination (Fig. 3.7). Larger endometrioid heterotopias are commonly referred to as ovarian endometriomas. They are rounded anechoic with a dense echo-positive suspension of inclusions with clear even contours, poor peripheral blood flow.

Inflammatory diseases are the most common cause of ovarian enlargement. In the initial stages of acute oophoritis, there is an increase in the ovaries, while the shape of the ovary becomes round, the structure is hypoechoic, and the contour is fuzzy. The follicular apparatus may not correspond to the phase of the menstrual cycle and may not be clearly visualized. Additionally, the following can be determined: fluid in the small pelvis, changes in other organs (sactosalpinx). Dopplerometry shows an increase in blood flow with an increase in speed and a decrease in resistance. TV study is usually painful.

Subsequently, small hyperechoic inclusions can be determined, both on the surface and in the stroma of the ovary.

Chronic oophoritis, in contrast to the acute inflammatory process, is practically devoid of specific echographic signs.

Ovarian pregnancy is extremely rare - an average of 1 case in 25,000 - 40,000 births. Adnexal formation in combination with the absence of a fetal egg in the uterine cavity and a positive pregnancy test (hCG) is an important echographic sign, most often observed in ectopic pregnancy. With a carefully conducted ultrasound examination, a fetal egg is found in the structure of an enlarged ovary. With a progressive ovarian pregnancy, visualization of the embryo is possible (Fig. 3.8). During Doppler sonography, a “vascular ring” of an ectopically located trophoblast can be determined if the gestation period exceeds 5 weeks. It should be remembered that the corpus luteum and tubo-ovarian formations can give an echographic and Dopplerographic picture similar to that of an ectopic pregnancy.

Rice. 3.8. Progressive ovarian pregnancy: the embryo is clearly visible.

TUMORS OF THE OVARIAN

Among the various pathological conditions that cause ovarian enlargement, cysts are the most common. Distinguish

follicular cysts, corpus luteum cysts, endometrioid and tecalutein ovarian cysts. Paraovarian cysts are a variant of an anomaly of development and are defined as formations of the adnexal region. The main clinical symptoms in patients with functional ovarian masses are pain in the lower abdomen and / or menstrual irregularities.

Follicular cysts are formed due to the accumulation of fluid by osmosis in a non-ovulated follicle. The sizes of follicular cysts range from 2.5 to 10 cm, but are rarely more than 6-7 cm in diameter. On ultrasound examination, these cysts have the form of unilateral thin-walled single-chamber formations of a rounded shape, usually located on the side or posterior to the uterus, easily displaced during examination. The internal contours are always even, the structure is completely echo-negative (Fig. 3.9). Behind the cyst, a pronounced acoustic effect of distal amplification (“track”) is determined. With small sizes (30-50 mm), ovarian tissue is often visualized along the periphery of the formation. Most follicular cysts are characterized by spontaneous disappearance within 4-8 weeks, a maximum of 12 weeks. One of the most common complications is the torsion of the feeding pedicle, which is sonographically manifested by a fragmentary thickening of the cyst wall (up to the appearance of a double contour) and a change in the internal echo-negative echostructure to a heterogeneous echo-positive one. With spontaneous rupture of the cyst, no echographic signs, except for the presence of fluid in the retrouterine space, usually do not appear. With CDC, single zones of vascularization located along the periphery of the cyst are revealed.

The image of a follicular cyst can almost completely coincide with the image of a smooth-walled serous cystadenoma, so some oncological alertness should be exercised, especially in postmenopausal patients.

Cysts of the corpus luteum are formed due to hemorrhage and accumulation of fluid in the cavity of the ovulated follicle. Cysts of the corpus luteum can reach 9-10 cm in diameter, but on average they are about 5 cm. In some cases, cysts of the corpus luteum can look like completely echo-negative formations and practically do not differ from follicular and paraovarian cysts (Fig. 3.10.). However, the most common cysts of the corpus luteum on echograms

Rice. 3.9. Follicular cyst. Rice. 3.10. Yellow cyst.

are represented mainly by regular rounded echo-negative formations with echo-positive inclusions of various shapes and sizes, more often in the form of tender, increased echogenicity of mesh structures. The walls of the cysts are usually thickened. The inner contour is fuzzy. It should be emphasized that the internal contents of the corpus luteum cysts can be extremely polymorphic and often creates the illusion of partitions of various thicknesses and even solid inclusions, especially in the case of massive hemorrhage into the cyst (Fig. 3.11).

The bizarre internal structure can lead to false positive diagnoses of an ovarian tumor or tubo-ovarian inflammatory mass. However, with any variants of a complex structure, a pronounced effect of distal amplification is always present. Clinical symptoms and laboratory examination data contribute to the differentiation of the corpus luteum from the tubo-ovarian inflammatory formation. For the purpose of differential diagnosis, the CDI mode should also be used, which helps to exclude the presence of vascularization zones in the internal structures of the corpus luteum cysts (characteristic of cystic ovarian tumors). It should be added that intensive blood flow along the periphery of corpus luteum cysts with a low resistance index in some cases can mimic malignant neovascularization. To clarify the diagnosis, dynamic ultrasound monitoring of the ovary is carried out, the next study is carried out after the next menstruation. The cysts of the corpus luteum tend to regress after menstruation, in more rare cases within 8-12 weeks.

Rice. 3.11. Cyst of the corpus luteum with blood 3.12. Thecalluteal cysts with left effusion (arrows). ovary.

A feature of the development of cysts of the corpus luteum is the tendency to spontaneous ruptures, leading to the occurrence of ovarian apoplexy. Apoplexy often occurs in the stage of development of the corpus luteum, i.e. at the beginning of phase II of the cycle. In this case, a rupture of the right ovary is more often noted. Sonographic signs in apoplexy, with the exception of the accumulation of fluid (blood) in the retrouterine space, are not demonstrative. The ovary increases in size, the contours become fuzzy, uneven, the echogenicity of the parenchyma increases. The structure is heteroechoic with small hypo- and anechoic inclusions. It is necessary to differentiate this condition from ectopic pregnancy and appendicitis. Ectopic pregnancy is characterized by delayed menstruation and other subjective and objective signs of pregnancy. Bleeding is not typical for appendicitis.

Thecalutein cysts occur when the ovary is exposed to high concentrations of human chorionic gonadotropin, for example, with trophoblastic disease, with ovulation hyperstimulation, sometimes with multiple pregnancies. These tumor-like formations tend to disappear after the action of the source of chorionic gonadotropin ceases (within 8-12 weeks). Thecalyutein cysts sometimes reach large (up to 20 cm in diameter) sizes and in most cases occur in both ovaries. Multiple cysts can be determined, which gives the impression of a multi-chamber neoplasm. The internal structure of the cysts is predominantly echo-negative, with numerous linear echo-positive inclusions (Fig. 3.12), which often makes them

Rice. 3.13. Endometrial cyst Fig. 3.14. Two endometrial cysts of the right ovary. in the right ovary.

indistinguishable from epithelial cystadenomas, cystadenocarcinomas, polycystic ovaries, pelvic inflammatory lesions. In moderate and severe forms of hyperstimulated ovary syndrome, ascites and effusion in the pleural cavity can be determined. In the course of a Doppler study, the intensive nature of the blood flow is determined. Of decisive importance for the diagnosis should be the data of the anamnesis and the determination of the level of chorionic gonadotropin.

endometrioid, or "chocolate" cysts, which received this name due to the old blood they contain, are a form of external genital endometriosis. They are very diverse in size - from 3 to 20 cm in diameter. In a third of cases, they develop in both ovaries. For cysts, localization behind the uterus is quite characteristic. A pronounced adhesive process arising due to multiple microperforations makes endometrioid cysts immobile. Endometrioid cysts are more often single-chamber, but several closely spaced cysts may occur, giving the impression of a 2-3-chamber formation. Endometriomas can have different types of ultrasound images (Fig. 3.13, 3.14). The most common first type is characterized by the presence of a homogeneous echopositive (low and medium echogenicity) internal contents, creating the effect of "frosted glass". The second type, which has a heterogeneous, predominantly echopositive structure with single or multiple inclusions of various shapes and sizes, is indistinguishable from inflammatory

formations and some types of ovarian cystadenomas. The third, the most rare, type with an echopositive (high echogenicity) homogeneous structure has a certain acoustic similarity with solid ovarian formations, but unlike the latter, it has a noticeable effect of distal amplification of the echo signal. The walls of endometrioid cysts are usually thickened, often a double contour of the formation is visualized. With CDI, the internal contents of endometrioid cysts always appear avascular, while isolated areas of vascularization are found along the periphery. Endometrioid cysts not only do not disappear during dynamic observation, but can increase.

Paraovarian cysts are quite common, accounting for about 10% of adnexal formations. They may develop from the pelvic mesothelium, from the supraovarian epididymis, or are of paramesonephric origin. Typical is the location of cysts in the mesosalpinx - part of the broad ligament between the tube and the ovary. Often they are visualized above the fundus of the uterus. Their sizes usually do not exceed 5-6 cm in diameter, although they can reach very large sizes. On echograms, cysts look like unilateral thin-walled formations of a rounded or ovoid shape with a completely echo-negative internal structure. However, only visualization of separately located both ovaries makes it possible to suggest the genesis of the formation (Fig. 3.15). Paraovarian cysts do not undergo spontaneous regression.

Torsion of the ovary, adnexa - this acute condition occurs infrequently and, as a rule, is neither clinically nor sonographically accurately assessed before surgery. There is no specific echographic picture, as it depends on the degree of torsion and the presence or absence of concomitant ovarian pathology. On echograms, first of all, an increase, sometimes very significant, of the ovary with a pronounced change in its internal structure is determined (Fig. 3.16). In some cases, the ovary turns into a predominantly echopositive formation with single or multiple inclusions of various shapes and sizes. In contrast to ectopic pregnancy, the contours of the formation are even and clear, the internal contents are avascular, the blood flow in the walls is either represented by venous plethora or is absent. In some cases, a symptom of a twisted vascular pedicle may be visualized.

Rice. 3.15. Paraovarian cyst. Rice. 3.16. Torsion of the ovary.

in the form of a rounded hyperechoic structure with multiple concentric hypoechoic bands, giving a resemblance to the target, then when using CFD, you can see the symptom of "whirlpool" along the twisted vessels of the pedicle. In most women, the process affects the right ovary. Additionally, fluid in the pelvis can be determined. Approximately in a third of observations, ascites develops.

Changes in the ovaries that occur during inflammatory processes are extremely variable - from formations of the correct form with clear contours to shapeless, poorly defined conglomerates that merge with the uterus. In acute oophoritis, there is a noticeable, sometimes significant, increase in the ovaries. In this case, the shape of the ovary becomes round, the structure is hypoechoic, the contour is fuzzy, and sound conductivity increases. The follicular apparatus may not correspond to the phase of the menstrual cycle and may not be clearly visualized. Additionally, fluid in the small pelvis and sactosalpinx can be determined. Dopplerometry shows an increase in blood flow with an increase in speed and a decrease in resistance. TV ultrasound is usually painful. Piovar - purulent fusion of the ovary. The ovary takes the form of a predominantly echopositive formation with single or multiple inclusions of various shapes and sizes. When involved in the inflammatory process of the fallopian tubes, the formation of tubo-ovarian formations or complexes occurs. In these cases, the altered ovary and the fallopian tube filled with contents are visualized closely adjacent to each other (Fig. 3.17). It is believed that for acute processes, the presence of bilateral formations is more characteristic, and for chronic processes, unilateral ones.

With further progression of inflammation, a tubo-ovarian abscess. A distinctive feature of tubo-ovarian abscesses is an extremely polymorphic echographic image and blurring of the boundaries between the organs involved in the process. The internal structure sometimes changes to such an extent that it gives the impression of a tumor. However, the disease has a rather bright and specific clinical picture. On ultrasound examination, a tubo-ovarian abscess is characterized by the presence in the area of ​​​​the appendages (often adjacent to the posterolateral wall of the uterus) the formation of a complex echostructure with a predominance of the cystic component. Cystic cavities can be multiple, different in size and shape. In the structure of the conglomerate, hyperechoic inclusions with a shadow can occur - gas bubbles, partitions, suspension. On TA sonography, the contours of the abscess may appear blurred, in most cases the ovary is not clearly identified. In these cases, TV sonography is critical in establishing an accurate diagnosis. Sometimes it is possible to visualize the contour of the formation, find the wall and determine the blood flow in it. In the acute phase of inflammation, intensive blood supply is noted with a decrease in the resistance index (Fig. 3.18). In the future, the blood supply decreases, the resistance index increases. The size of a unilateral abscess averages 50-70 mm, but can reach 150 mm. With bilateral localization of a tubo-ovarian abscess, it is not always possible to establish even conditional boundaries between the organs of the small pelvis.

In these observations, inflammatory formations are visualized as a single conglomerate of irregular shape, with a thickened capsule, multiple internal septa, and heterogeneous contents. The interpretation of echograms in patients with suspected tubo-ovarian abscess should be carried out in accordance with the clinical symptoms of the disease.

TUMORS OF THE OVARIAN

Tumors of the ovaries are a common gynecological pathology, which ranks second among tumors of the female genital organs. According to various authors, the frequency of ovarian tumors among other tumors of the genital organs is increasing and over the past 10 years has increased from 6-11 to 19-25%.

Unlike earlier ones, the current WHO classification does not provide for the division of ovarian tumors into benign and malignant. It identifies benign, borderline and malignant variants among various histotypes of tumors. The borderline type includes tumors that have some but not all of the morphological features of malignancy (eg, no infiltrative growth).

The main proportion of ovarian tumors (approximately 70%) are epithelial tumors. Among them, benign and borderline variants account for about 80%, and malignant variants for about 20%. They are divided depending on the type of content into serous and mucinous. According to the presence or absence of partitions and growths, serous cystadenomas are divided into smooth-walled and papillary.

Serous smooth-walled cystadenomas in 75% of cases on ultrasound are characterized by completely echo-negative contents with clear internal contours. The shape of the formations, as a rule, is round or oval (Fig. 3.19). Serous cystadenomas can be large, but usually do not exceed 15 cm in diameter. Dopplerography revealed single vessels with medium resistance blood flow in the tumor walls. These features make cystadenomas similar to follicular cysts. Main

diagnostic difference from follicular cysts is their long existence (they do not disappear and do not decrease during dynamic observation for 8-12 weeks). Approximately 10% of patients with tumors can be found in both ovaries, sometimes tumors have an intraligamentary location. Ascites is rare. "Benign" echographic characteristics cannot exclude the malignant nature of the neoplasm, so some oncological vigilance should be exercised, especially in postmenopausal patients.

Serous papillary cystadenomas characterized by multi-chamber and the presence of papillary growths in 60% of cases inside and 40% outside. Papillary growths on echograms look like parietal echo-positive structures of various sizes and echogenicity. Partitions, as a rule, are single, have the form of thin echogenic linear inclusions. Quite characteristic of this type of tumor is the presence in papillary structures and septa of neovascularization zones with an average level of blood flow resistance (Fig. 3.20). Bilateral ovarian involvement can be expected in about 25% of cases. The mobility of formations is often reduced. Often there is ascites. It should be remembered that these formations are borderline tumors and the risk of malignancy can be 50%.

Superficial papillomas on echograms, they may look like vegetations on the surface of the ovary - an irregularly shaped mass

with indistinct contours, heterogeneous internal structure (with multiple areas of low and high echogenicity), directly adjacent to the tissue of an almost normal image of the ovary.

Smooth-walled mucinous cystadenomas on ultrasound, they look like oval-shaped formations with clear internal contours, a predominantly echo-negative structure with the presence of multiple linear echogenic inclusions (suspension). Multi-chamber is characteristic (Fig. 3.21). The contents of some chambers may be hypoechoic. Bilateral ovarian damage and interligamentous location is quite rare. Ascites is rare. Mucinous tumors tend to grow rapidly and can be very large. With CDI, zones of neovascularization can be detected in septa and echogenic inclusions. When a formation ruptures, most often resulting from a rupture of the tumor capsule, for example, during surgery, a serious complication arises - peritoneal myxoma, almost always accompanied by ascites. Ovarian myxoma is a type of mucinous cystadenomas. On echograms, myxoma has similar features with the maternal tumor (Fig. 3.22). Almost always ovarian myxoma accompanies ascites.

Papillary mucinous cystadenomas. A feature of papillary mucinous cystadenomas are echopositive

inclusions of an oval or irregular shape (papillary growths) of various localization (Fig. 3.23).

Rare types of epithelial tumors that do not have sufficiently specific echographic features include endometrioid cystadenomas, Brenner tumors, clear cell and mixed epithelial tumors.

germ cell tumors- a group of tumors originating from the germ cells of the ovary. This group includes teratomas and dysgerminomas. These neoplasms have age-related features. In the reproductive period, they account for approximately 15% of all ovarian tumors, and only 3-5% of them are malignant. In childhood and adolescence, germ cell tumors prevail, with malignant tumors accounting for 30%. This group of neoplasms is often found in pregnant women.

Teratoma Depending on the degree of differentiation of tissue elements, they are divided into mature (benign) and immature (malignant). The ratio of mature to immature teratomas is approximately 100:1. Mature teratomas make up about a quarter of benign ovarian tumors. The most common type of mature teratoma are dermoid cysts. Most of the tumors are unilateral, rarely bilateral. The average size of teratomas is from 5 to 10-15 cm. Tumors are mobile, as they have a long feeding leg. Pronounced morphological polymorphism leads to a variety of ultrasound images (Fig. 3.24). In 60% of cases, teratoma has a typical heteroechoic picture - mostly hypoechoic

echopositive formation with echogenic inclusion of a rounded shape. This component in most cases is characterized by fairly smooth contours. In a third of observations, an acoustic shadow appears immediately behind it, since it usually contains hair, bone fragments, teeth, and other derivatives of the dermis. In 20% of patients, teratomas may have a completely echopositive (high echogenicity) formation. In some observations, there are "invisible tumors", characterized by a structure of medium echogenicity with almost blurred contours, merging with the surrounding tissues (Fig. 3.25). With CDI in mature teratomas, there are single zones of vascularization, and the resistance index is within the normal range.

Immature teratomas, like all malignant neoplasms, have an irregular shape, a bumpy surface and are characterized by a chaotic internal structure. On echograms, tumors are detected as formations of a mixed structure with uneven contours. Doppler sonography reveals areas of pronounced neovascularization with low resistance index values. Ascites is almost non-existent.

Dysgerminomas can be benign but are often malignant, being the most common malignant tumor found during pregnancy and childhood. On echograms, the tumor has a predominantly echopositive structure and uneven contours; a “lobular” structure is typical. Multiple echo-negative and echogenic inclusions are reflections from frequently occurring areas of degenerative changes and petrifications. The shape of the tumor is usually irregular, tuberous. Bilateral involvement occurs in 10% of cases. The tumor grows rapidly, reaching a fairly large size. The parameters determined by dopplerometry are usually non-specific, but it is quite typical to determine the zones of vascularization along the septa. In the presence of a mixed structure of the tumor (with elements of choriocarcinoma), a high level of hCG can be determined.

Sex cord stromal tumors arise from the sex cord cells of the embryonic gonads and account for approximately 10% of all ovarian tumors. These include hormonally inactive fibromas and hormonally active theca-, granulosa- and adrenocellular tumors.

Fibromas they are almost always unilateral and, on two-hand examination, are characterized by a dense, almost stony texture. Tumors are more common in postmenopausal women. On echograms, they look like formations of a round or oval shape with fairly clear, even contours (Fig. 3.26). The internal structure is echopositive, of medium or low echogenicity. In a third of cases, multiple echo-negative inclusions are detected, indicating the presence of degenerative necrotic changes. Directly behind the tumor, a rather pronounced effect of absorption of ultrasonic waves often occurs. Fibroids may be multiple. As a rule, blood vessels in fibromas are not detected during CDI, in rare cases, single color loci are determined along the periphery of the tumor. The main differential diagnosis should be made with subserous myomatous nodes, in which visualization of intact ovaries is possible. Despite their benign nature, fibromas in some cases accompanies Meigs syndrome, characterized by ascites, pleural effusion, and anemia. After removal of the tumor, the above complications disappear. Hormonal activity of fibromas is not peculiar.

A characteristic feature of hormone-producing neoplasms is the severity of clinical symptoms with their relatively small size.

Granulosa cell tumors(folliculomas) are more common between the ages of 40 and 60 years. On echograms, they usually look like unilateral rounded formations with a predominantly echopositive (solid) internal structure, sometimes lobulated, and echo-negative, often multiple, inclusions

(areas of hemorrhagic changes and necrosis). The tumor may have cystic variants and practically does not differ from ovarian cystadenomas. The size of the tumor rarely exceeds 10 cm in diameter. Characteristic is the visualization of intratumoral blood flow of a mosaic type (heterogeneous in speed and direction). The frequency of malignant variants of granulosa cell tumors ranges from 4 to 66%. Often, the tumors themselves have a benign course, but the hyperestrogenization they cause is a risk factor for the development of endometrial hyperplastic processes. Given the high likelihood of developing pathological processes in the endometrium, its thorough examination is recommended. Additionally, signs of Meigs syndrome can be determined: ascites, pleural effusion.

Thecacellular tumors (thecomas) are usually unilateral and often have a predominantly solid, fibroma-like structure with possible dystrophic changes. Sonographically, the internal structure of thecacellular tumors may also resemble ovarian follicles. Tumors are usually less than 10 cm in size. Theca cell tumors are three times less common than granulosa cell tumors. Characteristic is the visualization of the central intratumoral blood flow of the mosaic type. Additionally, signs of Meigs syndrome can be determined: ascites, pleural effusion. In most cases, tumors are characterized by distinct symptoms of hyperestrogenization, and therefore, examination of the uterus helps to identify the tumor, since excess estrogen levels cause changes in the endometrium.

Adrenocellular tumors (androblastomas) have similar ultrasound features with granulosa and theca cell tumors - a predominantly echopositive structure with multiple hyperechoic areas and hypoechoic inclusions. Visualization of intratumoral blood flow is also characteristic. The tumor is characterized by slow growth and a predominantly benign course. In most cases, the size of the tumor does not exceed 15 cm in diameter. Malignant variants occur in about a quarter of patients. The tumor in most cases has virilizing properties, leading to defeminization of patients. The average age of patients is 25-35 years. Bilateral lesion is quite common.

ovaries. Androblastomas make up about 1.5-2% of ovarian neoplasms.

MALIGNANT TUMORS OF THE OVARIAN

In the structure of female mortality from malignant neoplasms of the internal genitalia, ovarian cancer occupies approximately 50%. The sensitivity of TV echography in the diagnosis of ovarian cancer is about 85%, the specificity is about 70%, i.e. in ultrasound examination, malignancy is not detected in approximately 15% of malignant tumors, and in 30% of cases an erroneous diagnosis of non-existent cancer is made.

Serous, mucinous, endometrioid cystadenocarcinomas, malignant cystadenofibromas and other malignant variants of epithelial tumors are sonographically very similar to each other and in most cases look like formations of a mixed structure (Fig. 3.27). The content of cancerous tumors on echograms often acquires a bizarre character, and the more bizarre the structure of the formation, the greater the likelihood of cancer. Hilly, uneven and indistinct contours also testify in favor of a malignant process. The presence of echogenic structures and inclusions (papillary growths) in predominantly echo-negative formations is characteristic of 80% of malignant tumors and only 15% of benign ones. Linear echogenic inclusions (septa) are not a differential diagnostic sign, however, if they are detected in a significant amount and at the same time have fragmentary thickenings with signs of vascularization, then the conclusion about the possibility of a malignant process is quite reasonable. Involvement of neighboring organs, the appearance of free fluid in the pelvis and abdominal cavity are prognostically unfavorable signs. In the absolute majority of cases, numerous neovascularization zones with chaotically scattered vessels are revealed inside malignant tumors in the absolute majority of cases (resistance index< 0,4, максимальная систолическая скорость >15 cm/s) (Fig. 3.28).

Ovarian cancer is characterized by the appearance of ascites. At the same time, for cancerous ascites, the image of loops of the small intestine in the form of an immobile "atomic mushroom" that occurs due to damage to the mesenteric lymph nodes is quite specific. With ascites

accompanying benign disease, intestinal loops remain free-floating. With "malignant" ascites against the background of free fluid, metastatic nodules of various sizes scattered throughout the peritoneum can be detected.

METASTATIC TUMORS

Tumors of various localizations and histological structures - cancers, sarcomas, hypernephromas, melanomas, etc. can metastasize to the ovaries. The first place is occupied by breast cancer metastases (about 50%), followed by metastases from the gastrointestinal tract (about 30%) and genitals (about 20%). Metastatic tumors are characterized by bilateral lesions of the ovaries and are often small in size. In the initial stages of development, metastatic tumors are oval in shape, repeating the outlines of the ovary, and resemble enlarged ovaries. With small sizes, a characteristic feature of the internal structure of the tumor, predominantly echopositive (low and medium echogenicity), is the absence of an image of the follicular apparatus. Increasing in size, the tumors acquire uneven, bumpy contours, the internal structure becomes heterogeneous - predominantly echopositive with numerous echo-negative inclusions. Metastatic tumors practically do not change the size of the ovary, but can also reach quite large sizes - 30-40 cm in diameter. Ascites is detected in 70% of cases.

Content

An anechoic formation in the ovary is a darkening visualized by sonologists during an ultrasound examination. The term may refer to a normal ovarian condition, a malignant tumor, or a cyst. Anechoic cysts are filled with fluid and appear as a dark spot on the monitor.

What is an anechoic formation in the ovary

Anaechogenic formation is not a diagnosis. This term is used in ultrasound diagnostics to define the reflection of waves. The presence of pathology is evidenced by cysts that are characterized by low echogenicity.

The echogenicity index is used in ultrasound diagnostics of the whole body. Formations with low echogenicity are not detected by a sound signal when the probe is directed to them.

Echogenicity decreases if air, liquid, dense tissues are present in the ovary. Reduced echogenicity is visualized as a dark spot. Increased echogenicity is displayed in light color.

The following ovarian formations are distinguished:

• cysts;
• corpus luteum;
• embryo.

The ovary may contain a dark spot before and after ovulation:

• follicle maturation. Before the release of the egg, the size of the follicle can be up to 2.5 cm.
• Formation of the corpus luteum. It is formed after the violation of the integrity of the follicle and the release of the egg. The corpus luteum produces progesterone for the onset and prolongation of pregnancy. Before menstruation, this temporary gland dissolves and disappears.

An anechoic ovarian cyst is a dark round-shaped spot that the doctor sees on the screen. Cystoma is a cavity with exudate that disrupts the functioning of the ovary.

Anechogenic ovarian formations often imply cysts, which may differ in oval and round inclusions, thick walls. Anechoic also refers to exudate with a liquid consistency. Sometimes the cavitary formation has a reticulate arachnoid structure and includes septa, blood clots with high density and different shapes.

Ovarian cysts can be:

• single, multiple;
• single-chamber (safer), multi-chamber (the presence of a partition).

Tactics of treatment of anechoic cysts depends on their options:

• Endometrioid. Round anechoic formation in the right ovary or on the left side has a heterogeneous structure and a hard outer layer. Such a cyst is characterized by an increase during the cycle.
• Follicular. Cysts form as a result of follicle growth and lack of ovulation. The main cause of follicular formations is considered hormonal disorders, characterized by improper production of sex steroids. Such anechoic cysts in most cases resolve on their own. In the absence of regression, medications are prescribed.
• Serous. The cyst can be single-chamber and multi-chamber. The formation is formed by serous tissue and is filled with a clear liquid.
• Paraovarian. This is a sedentary dense formation along the perimeter of the ovary with transparent contents. The development of a cyst often provokes pain in the lower abdomen.
• yellow body. Anechogenic inclusions in the ovary up to 10 mm or more. Such a formation appears in the absence of regression of the corpus luteum with its subsequent increase.
• Dermoid. The variety implies a congenital formation, characterized by the presence of fragments of teeth, hair, skin.

Cystomas and malignant tumors are also anechoic in nature. These formations have rapid growth and cell division.

The presence of blood vessels in anechoic cysts requires an examination to exclude a malignant tumor. Cancers always have blood circulation.

The reasons

There are many factors that can lead to the occurrence of pathological formations. Among the causes of anechoic cysts are:

• hormonal dysfunction leading to a violation of the ratio of sex steroids;
• inflammatory processes of the reproductive sphere, infections;
• anomalies in the development of a paired organ;
• surgical interventions and abortions in history;
• endometriosis.

Cysts that are functional in nature occur with changes in the hormonal background.

Symptoms

Usually, anechoic cysts are detected in women in the reproductive cycle, which is associated with the hormonal activity of the ovaries. There is a possibility of detecting formations in adolescent girls. Anechogenic formation in the ovary in postmenopausal women is rare.

Small ovarian cysts progress latently. The clinical picture joins when the formation reaches a significant volume:

• drawing pains, usually one-sided;
• a feeling of fullness in the intestines;
• false urge to urinate due to bladder compression.

An anechoic fluid formation in the ovary can cause pain that is aggravated during sexual intercourse and physical activity.

Effects

In most cases, anechoic cysts are benign. However, their growth can provoke serious complications:

• Torsion of the leg and rupture of the formation. These pathologies can lead to the development of tissue necrosis, intra-abdominal bleeding and are accompanied by signs of an acute abdomen. Treatment involves surgery.
• Compression of the pelvic organs. Usually, with the growth of the cyst, there is a frequent urge to urinate and defecate.

Endometrioid cysts are often found in infertility and severe pain. About 20% of cysts are malignant.

Diagnostics

Identification of the cyst is carried out during a gynecological examination and ultrasound. Large cysts are palpable during the use of the bimanual method. In some cases, when determining an anechoic mass, a series of ultrasounds is required.

The occurrence of neoplasms is often observed with hormonal imbalance, which is an indication for diagnosing the level of sex steroids. To exclude the malignant nature of the pathology, it is necessary to determine the concentration of the CA-125 tumor marker.

Puncture or puncture of the posterior vaginal fornix is ​​required if there is evidence of blood or fluid in the abdominal cavity. The method is used in case of suspicion of a complication of the course of a benign neoplasm.

Computed tomography is used for the purpose of differential diagnosis. Laparoscopy allows you to diagnose and remove the cyst during surgery.

To exclude the inflammatory process, it is necessary to perform general blood and urine tests.

Anechogenic formation in the ovary during pregnancy

An anechoic formation in the ovary during pregnancy may be a corpus luteum. This is a temporary hormonal gland that produces progesterone.

During pregnancy, endometrioid and dermoid cysts can progress. With their rapid growth, surgical removal is recommended. For up to 20 weeks, laparoscopy is performed. Removal of cysts can be carried out during delivery by caesarean section.

Treatment

The choice of treatment tactics depends on the type of neoplasm, its size and morphological characteristics. Gynecologists use:

• observational tactics;
• conservative treatment;
• surgical intervention.

The age of the woman and her reproductive plans are also significant.

Expectant tactics

Observation of cystic neoplasms is possible with their benign nature, the absence of progression. As a rule, expectant management is carried out in relation to functional, luteal, paraovarian cysts.

Conservative therapy

Treatment consists in the use of hormonal drugs, the choice of which depends on the type of neoplasm:

• estrogen-progestin drugs;
• progestogens;
• antiestrogen;
• androgens;
• antigonadotropins;
• anabolic steroid.

Treatment is supplemented by taking anti-inflammatory drugs, vitamins. Physiotherapy has a good effect.

Surgical intervention

For some types of cystic tumors (dermoid, serous), treatment involves surgery:

• cyst removal;
• excision of a part of the affected ovary;
• removal of an organ (with a fallopian tube);
• electrocoagulation.

Operations are performed both laparoscopically and laparotomically. If a malignant process is suspected, the appendages and uterus can be removed.

Prevention

Often thin-walled anechoic formation in is a consequence of hormonal disorders and inflammatory processes. If there are signs of diseases of the organs of the reproductive system, it is necessary to contact a gynecologist and undergo an examination.

Experts emphasize that it is necessary to monitor menstrual function, the work of the thyroid gland. Pathological symptoms are not an indication for self-treatment. Improper therapy can lead to the progression of the disease and the deterioration of the general condition.

Women with a history of benign tumors should not sunbathe, visit a solarium, sauna. Any thermal procedures, physical exercises aimed at the area of ​​the lower abdomen can provoke the growth of a neoplasm.

Conclusion

An anechoic formation in the ovary is not always a cause for concern. Depending on the phase of the cycle, such an ultrasound picture may be the norm. To confirm or refute the diagnosis, it is necessary to undergo an additional examination.

Patients consider an anechoic neoplasm in the paired female gonad to be a verdict. Pathogenic formation is not a diagnosis, but evidence of the non-reflection of ultrasonic waves on the appendages. Anechoic cysts are considered normal, but cysts of low echogenicity indicate a pathological process.

Echogenicity is used in ultrasound diagnostics of the whole body. On inclusions of low echogenicity, there is no sound when directed by the probe. Morphological data of the studied organ play an important role. In the organ under study there is liquid, air, dense tissues - echogenicity is reduced. On an ultrasound examination, the body is displayed as a dark spot. Inclusions with increased echogenicity are shown in light color. Formations in the ovaries:

• corpus luteum;
• follicular, endometrioid, serous cyst;
• embryo

After an ultrasound, a woman needs to contact a gynecologist to rule out any cause for concern.

Based on the ultrasound examination, the doctor shows the patient a reflection on the spectrogram. Studying the formations in detail, additional studies are carried out to reveal the full picture of the state of the ovaries.

An anechoic ovarian cyst is a dark round spot visible to the doctor on the monitor screen. Cystomas are cavities with accumulated exudate that interfere with the functioning of the female paired glands, disrupting the hormonal balance.

Reasons for education:

• lack of estrogen;
• inflammatory diseases of the uterus, ovaries;
• diseases of an infectious nature;
• inferiority of uterine appendages;
• operational consequences on the rectum, bladder, vagina;
• adhesive process

ovary on ultrasound

The anechoic cavity in the ovary has different sizes. The work of a healthy ovary during the menstrual cycle: after menstruation, follicles grow in one or two ovaries. In the first 14 days, the anechoic body in the ovary, which has a size of 1-3 mm, increases to 7-8 mm. The dominant follicle with the released egg grows 16-30 mm. By releasing an egg, the anechoic structure becomes smaller, turning into a specific endocrine gland. The corpus luteum does not work, breaks 2-3 days before menstruation, the fluid leaves. From the first to the last day of menstruation in a healthy woman, there is no anechoic ovary in the ovary. With the onset of pregnancy, on one ovary, a round corpus luteum is mistaken for an anechoic formation.

Cystoma classification

Due to hormonal imbalance, ovarian function decreases. Anechogenic formations appear - ovarian cysts with thick walls, round, oval inclusions. Anechogenicity contains liquid exudate, blood is added to it. Anechoic cavitary formation with a cobweb-like, mesh structure contains septa of irregular appearance, areas of high density - blood clots - of different sizes and shapes.

Ovarian cyst:

• single;
• multiple;
• single-chamber - a simple bubble with no partitions;
• multi-chamber - less secure

1. Endometrioid with a heterogeneous structure, a solid outer layer, retaining its original parameters for a long time, increasing every menstrual cycle.
2. Follicular - education comes from the follicle. The structural component of the ovary did not burst in time - an avascular mass formed. It is manifested by improper functioning of hormones. The function of the ovaries is disturbed by the lack of progesterone, estrogen, the egg does not go into the fallopian tube from the ovary, it is impossible to get pregnant. Capsules with a liquid mass disappear on their own or have to be treated with medications.
3. Serous - a single-multi-chamber cystoma of a benign nature. If you suspect a malignant tumor, you need to consult an oncologist. The bubble is formed by serous tissue. A clear liquid fills the capsule.
4. A parovarial inactive, dense cystoma with thin chambers, a clear liquid containing protein, is located along the perimeter of the ovary. Sprouting between the uterus and the gland, acute pain is provoked in the lower abdomen.
5. A corpus luteum cyst is formed by an accumulation of fluid, blood secretions at the site of a ruptured follicle. Hormones are produced incorrectly, fluid fills the corpus luteum.

The cavity formation disappears after 2-3 menstrual cycles. If blood vessels are found in the cysts, the woman undergoes an additional examination, excluding malignancy. A benign tumor is easily differentiated from oncology. Cystomas that appear on low-frequency ultrasound, without blood vessels. The size of the pathologies is 25-100 mm. 20% of patients have malignant tumors in paired female gonads.

Suspecting malignancy, conduct additional examinations.

Teratoma, serving as an infection, a malignant tumor, turns out to be an anechoic formation.

4 types of morphological structure

1. Anechogenic elements of a homogeneous structure
2. Homogeneous formations of low echogenicity
3. Mesh smooth types with a diameter of 10-15 mm
4. Structural elements of moderate anechoicity

Symptoms of the disease

Women of childbearing age are prone to ovarian cysts. In girls before the onset of menstruation, in menopausal women, cystomas form less frequently. The female of the menopausal period should understand that abdominal formations require more serious attention than in young women. During menopause, ovarian cancer is more likely to develop. Inclusions formed in the ovary are carefully examined.

Women do not allow the thought of the appearance of a cyst. Small cystomas are asymptomatic. Increasing, in a woman:

• pressure, heaviness in the pelvic area;
• it hurts in the right, left parts of the abdomen during increased physical activity, sexual intercourse;
• false bowel movements;
• pain when urinating, frequent urge to go to the toilet in a small way;
• with torsion, rupture in the abdomen, groin, cramping pains appear, body temperature rises, vomits, and feels sick.

Natural phenomena of the appearance of benign tumors

• congenital, dermoid cysts;
• hormonal dysfunction;
• epithelial neoplasms;
• polycystic, endometriosis;
• carcinomas

Pregnancy

A mature ovum has left the ovary, an anechoic inclusion is visible on ultrasound, a corpus luteum is noticeable. With a delay in menstruation, pregnancy is suspected. The fetus grows and develops due to the luteal body, which is active up to 12-16 weeks. The placenta then protects the embryo.

A dermoid cyst is rarely diagnosed. The uterus grows, putting pressure on neighboring organs, which are displaced. There is a danger of torsion of the cyst stem, necrosis, rupture of the membrane.

When a rapidly growing oncology is established, a decision is made to operate. The cyst is husked, taking into account the type, size, gestational age. The laparoscopic method is used up to 20 weeks. After the middle of the "interesting position", a laparotomy is used.

When diagnosing endometritis, the problem is removed before the baby is born. Carrying out a caesarean section, operations are combined.

Medical tactics

The gynecologist makes a decision on the treatment with drugs, surgery based on the results of ultrasound, auxiliary examinations.

The identified corpus luteum does not require treatment. Over time, anechoicity goes away, which is replaced by menstruation, pregnancy. The endocrine gland produces hormones before the formation of the placenta.

Therapeutic directions:

1. Waiting - luteal, follicular cysts are monitored for several months, assessing the dynamics. Sometimes the liquid capsule dissolves on its own. If it does not disappear, hormonal treatment is prescribed.
2. Treatment with medications - the appointment of OK helps to produce the necessary hormones. A competent doctor prescribes modern drugs with a minimum dose of hormones that normalize ovarian functioning. Drug efficacy is confirmed by the resorption of the disease.
3. Destruction of cystoma in the ovary - aspiration is carried out with a special instrument with a puncture nozzle. The contents are examined histologically, ethanol is injected. Methylcarbinol destroys the cyst.
4. Surgical operation - non-disappearing cavities with liquid contents affect the menstrual cycle. Endometritis, dermoid cavity - intractable cysts. The gynecologist directs for removal.

Having made an ultrasound examination of the uterus and appendages, a conclusion is made, a preliminary diagnosis is made.

No need to assume what female diseases are fraught with the body. A visit to the gynecologist should not be postponed. It is important to know about the presence, absence of anechoic formation in the ovary. If the diagnosis is clarified, the attending physician will explain what treatment is needed.