What is a solid kidney mass: diagnosis and classification. Cystic formation of the ovaries: causes of pathology, treatment methods Cyst with a solid component

The incidence of ovarian tumors is up to 19-25% of all genital tumors. Establishing a diagnosis of a true tumor in the appendage area is an indication for urgent examination and referral to hospital for surgical treatment. The most common ovarian cysts are follicular and corpus luteum cysts, most of which are retention formations.

Follicular cyst- a single-chamber liquid formation that developed as a result of anovulation of the dominant follicle.

Corpus luteum cyst- accumulation of serous fluid in the cavity of the ovulated follicle.

Diagnosis of ovarian cysts is based on bimanual examination, ultrasound followed by Doppler examination of blood flow in the wall and the tumor-like formation itself, computed and magnetic resonance imaging, and diagnostic and treatment laparoscopy. In addition, it is possible to determine tumor markers CA-125, CA19-9 in blood serum.

For the differential diagnosis of fluid formations of the ovaries, ultrasound is important. Follicular ovarian cysts always have ovarian tissue along their periphery. The diameter of the cysts varies from 25 to 100 mm. Follicular cysts are usually single formations with a thin capsule and homogeneous anechoic content. Behind the cyst there is always an acoustic effect of signal amplification. They are often combined with signs of endometrial hyperplasia.

Usually, follicular cysts disappear spontaneously within 2-3 menstrual cycles, therefore, when they are detected during ultrasound, dynamic observation with mandatory echobiometry of the cyst is necessary. This tactic is dictated by the need to prevent ovarian torsion.

The corpus luteum cyst regresses by the beginning of the next menstrual cycle. On an echogram, corpus luteum cysts are located on the side, above or behind the uterus. The sizes of cysts range from 30 to 65 mm in diameter. There are four options for the internal structure of a corpus luteum cyst:

1. homogeneous anechoic formation;
2. homogeneous anechoic formation with multiple or single complete or incomplete septa of irregular shape;
3. homogeneous anechoic formation with moderately dense parietal smooth or mesh structures with a diameter of 10-15 mm;
4. formation, in the structure of which there is a zone of fine- and medium-mesh structure of medium echogenicity, located parietally (blood clots).

Endometrioid cysts on echograms are determined by round or moderately oval formations measuring 8-12 mm in diameter, with an internal smooth surface. The echographic hallmarks of endometrioid cysts are a high level of echo conductivity, unevenly thickened walls of the cystic formation (from 2 to 6 mm) with a hypoechoic internal structure containing many point components - a fine suspension. The size of the endometrioid cyst increases by 5-15 mm after menstruation. This suspension does not shift when the formation is percussed and when the patient’s body is moved. Endometrioid cysts give the effect of double contour and distal enhancement, that is, enhancement of the distant contour.

Pathognomonic features of dermoid cysts are the heterogeneity of their structure and the lack of dynamics in the ultrasound image of the cyst. In the cyst cavity, structures characteristic of fat accumulations, hair (transverse striations) and elements of bone tissue (dense component) are often visualized. A typical echo-graphic sign of dermoid cysts is the presence of an eccentrically located round-shaped hyperechoic formation in the cyst cavity. V. N. Demidov identified seven types of teratomas:

• I - a completely anechoic formation with high sound conductivity and the presence on the inner surface of the tumor of a small formation of high echogenicity, round or oval, representing a dermoid tubercle.
• II - anechoic formation, in the internal structure of which multiple small hyperechoic streak inclusions are determined.
• III - a tumor with a dense internal structure, hyperechoic homogeneous content, with average or slightly reduced sound conductivity.
• IV - formation of a cystic-solid structure with the presence of a dense component of high echogenicity of a round or oval shape with clear contours, occupying from US to % of the tumor volume.
• V - formation of a completely solid structure, consisting of two components - hyperechoic and dense, giving an acoustic shadow.
• VI - a tumor with a complex structure (a combination of cystic, dense and hyperechoic solid components, giving an acoustic shadow).
• VII - tumors with a pronounced polymorphism of the internal structure: liquid formations containing septa of varying thickness, dense inclusions of a spongy structure, fine and medium-dispersed hypoechoic suspension.

Dermoid and large endometrioid formations of the ovaries are subject to surgical treatment.

The treatment strategy for corpus luteum cysts and small (up to 5 cm) follicular cysts is expectant, since most of these formations undergo reverse development within several menstrual cycles on their own or against the background of hormonal treatment. Formations larger than 5 cm in diameter, as a rule, become tolerant to hormonal treatment due to destructive changes in their internal lining resulting from high pressure in the cyst.

If the fluid formation remains unchanged or increases in size during hormonal treatment, then surgical intervention is indicated - laparoscopic cystectomy or resection of the ovary within healthy tissue.

In the postoperative period, all women are advised to use combined oral contraceptives for 6-9 months. Physiotherapeutic methods of treatment include ultrasound, mud, ozokerite, and sulfide waters. Zinc electrophoresis, CMT with fluctuating or galvanic current are less effective. It is advisable to conduct 3 courses of electrophoresis and 2 courses of exposure to other factors.

Under the editorship V. Radzinsky

“Benign tumors and tumor-like formations of the ovaries” and other articles from the section

Ovarian cysts are diagnosed in both young girls and middle-aged women; sometimes the pathology occurs even in newborn girls. During menopause, cystic formations are observed in approximately 10 women out of 100. A benign formation usually affects only one ovary on the right or left side, rarely the pathology is bilateral. This common gynecological disease does not pose a threat to life, but it is important for every woman to know what ovarian cysts are.

A cyst is a pathological neoplasm that looks like a rounded compaction. Cysts are classified as benign tumors that form against the background of hormonal imbalance in the female body. The histological structure of the neoplasm can be completely different, depending on the nature of its origin. The cavity of the cyst contains different contents, it can be liquid, mucous or jelly-like. Inside there may be exudate of blood plasma, blood and purulent cells.

Only one tumor may form, but cases of multiple formations are not uncommon. When several cysts accumulate on the ovaries at once, this condition is called polycystic disease or cystoma. Depending on the intensity of development of the pathology, neoplasms can reach very large dimensions. A cystic formation very rarely transforms into a cancerous tumor, but in the absence of proper treatment it can seriously affect the health and reproductive system of a woman.

Causes of pathology formation

Hormonal imbalances are the main cause of the development of the disease. Low immunity can aggravate the pathology, since a weakened body is unable to resist infections.

Main reasons:

• puberty;
• pregnancy, childbirth, abortion;
• menopause;
• obesity;

• chronic diseases of the reproductive system;
• inflammatory and infectious processes;
• pathologies of the endocrine system;
• hormone replacement therapy;
• poor sexual hygiene.

Features of the pathology

The ovaries are paired sex glands, small in size and located on both sides of the uterus. The main function of these organs is the production of the main female hormones (progesterone and estrogen) and the production of eggs. The functioning of the ovaries determines whether a woman can have children. Therefore, any pathology of these organs seriously affects the reproductive system.

The cyst can be unilateral or bilateral; in the first case, one ovary is affected, in the second, two at once. Symptoms of cystic formations of the right ovary are practically no different from the anomalies of the left ovary.

In 90% of cases, this pathology does not manifest itself for a long time. A doctor can detect a tumor during a routine examination and ultrasound examination.

Main symptoms of the pathology:

• pain in the lower abdomen;
• pain on the right or left side of the abdomen near the ovaries;
• sudden weight fluctuations;
• problems with conception;
• discomfort during sexual intercourse;
• increased vaginal discharge;
• bleeding between periods;
• frequent urination;
• difficulty defecating;
• bloating and the appearance of a rounded tummy;
• intermenstrual vaginal bleeding;
• disruption of the menstrual cycle.

Usually, ovarian cysts do not cause a woman much discomfort, but this pathology can be accompanied by severe complications (torsion of the legs, rupture, suppuration of the cyst) that are life-threatening to the woman. In this case, an emergency operation is performed and the cystic neoplasm is removed. Therefore, it is important to undergo a complete diagnosis in a timely manner and begin the necessary treatment.

Diagnosis and constant monitoring of the development of the disease is carried out using ultrasound. Treatment can be either surgical or medicinal, depending on the clinical picture of the disease.

Types of cysts

The most dangerous and difficult to treat pathology is considered to be a solid cystic formation; such a tumor has a hard shell and clear boundaries. The neoplasm contains the tissue component of the organ. A solid cystic tumor cannot resolve on its own and does not change its size. Over time, such a formation, as a rule, degenerates into a malignant tumor. Therefore, it is important to visit a gynecologist at least once a year, this will help to detect and treat the disease in a timely manner. According to the generally accepted classification, the following types are distinguished:

• Follicular cyst- the most common neoplasm. The cause is failure to ovulate during the menstrual cycle. Most often, such a cyst occurs in teenage girls at the stage of puberty. A functional cyst often resolves on its own within two to three monthly cycles.
• Paraovarian cyst– formed from the epididymis. This cystic tumor can reach the largest size among other types. The symptoms of the pathology are mild and the tumor may not appear for a long time. Due to its large size, pressure occurs on nearby organs. For this reason, frequent urge to go to the toilet and pain when urinating may occur.

• Cyst (luteal) of the corpus luteum– is formed in the ovary in place of the non-regressed corpus luteum. This type of tumor resolves on its own after two to three menstrual cycles. Medical surgery is only necessary if bleeding occurs.
• Dermoid cyst- a benign space-occupying formation, inside the cavity there are sebaceous glands and hair follicles. The tumor slowly increases in size over several years. If this cyst is detected, surgical intervention is required.
• Endometrioid cyst– occurs against the background of endometriosis (proliferation of endometrial cells). Symptoms of the pathology may not appear for quite a long time. The formation is formed from tissues similar to the endometrium, which lines the uterus from the inside. If the contents of the cyst enter the abdominal cavity, adhesions form.

If several cystic lumps form on the ovaries at once, then this pathology is called polycystic ovary syndrome. Specific signs of pathology are increased body hair growth, increased insulin in the blood, sudden weight gain, and the appearance of acne. The disease requires competent comprehensive treatment aimed at eliminating not only tumors, but also accompanying symptoms.

Diagnosis and treatment

Cystic ovarian formations can be diagnosed during a standard gynecological examination. The doctor will be able to determine the size and location of the tumor by palpation. If the cyst is difficult to palpate, then an ultrasound examination is performed.

Treatment of ovarian cystosis will depend on the history and clinical picture of the disease. It is taken into account that this neoplasm can spontaneously resolve within several months. If the tumor grows significantly and intensively, then the woman may experience ovarian dysfunction. In case of a pronounced threat to the health and life of the patient, surgical intervention is used.

If there is a small functional cyst, the doctor prescribes treatment with hormonal drugs. Typically therapy lasts no more than two months. Progress or worsening of the condition is diagnosed by ultrasound.

If drug therapy is ineffective, the woman is recommended to remove the cystic formations. Laparoscopy of the ovary is most often performed; it is the least traumatic operation, after which there are no unsightly scars. In severe cases, when doctors fear for the patient’s life, an oophorectomy is performed - removal of cystic formations along with the ovary. This method is used only in extreme cases.

After timely and high-quality treatment of ovarian cysts, the likelihood of conception in the future is very high. Modern medicine successfully treats various types of cystic formations with minimal consequences for a woman’s health, preserving her reproductive functions.

One of the patients came to me after a control ultrasound examination of the gland. Her face, movements and voice expressed concern about the increasing deterioration.

How is it that I came for an ultrasound, and the doctor began to tell me that I had a very large node and needed to be operated on urgently. That’s what he wrote: a solid knot.

Let me look at the results of the examination,” I suggested.

Please,” the patient replied, handing me the ultrasound report.

I began to carefully study the description of an ultrasound examination of the thyroid gland. In conclusion, in addition to conclusions about the nature of the changes, there was a solid nodular formation... The same node in the ultrasound description was characterized as homogeneous isoechoic.

See how big the knot is!

Yes, indeed, the knot is large. But it's benign...

The ultrasound doctor told me that the node was huge. That's what he wrote - solid. He said that it was necessary to undergo surgery. I didn’t even sleep well at night after what he told me.

What did you say? Solid? - I asked, - This term means fullness, that is, containing not a cavity with something, but biological tissue. In this case, normal thyroid tissue. And this word is pronounced differently. The emphasis should be placed not on the second, but on the first syllable.

And I was wondering why the doctor wrote this so emotionally...

Using the term, the reputable doctor wanted to show that gland tissue was present inside the focal formation he identified. I think it is not entirely appropriate in the ultrasound protocol for two reasons. Firstly, this can affect the mental state of the patient, who, trying to understand the state of his health himself, carefully reads the description of the ultrasound. Secondly, due to the fact that this term refers to pathological changes and is used by pathologists for histological examination.

What is more important than nodes?

Very often, all the attention of patients is focused only on the identified nodes. As a rule, for them nothing is more significant in relation to the thyroid gland itself than nodes. Not infrequently, the entire consultation conversation begins and comes down to knots at the initiative of the patient.

Please tell us about what worries you, I usually suggest to the patient during a consultation.

“I have a nodule in the thyroid gland,” she answers.

How exactly does this node manifest itself? - I clarify, trying to find out the peculiarities of my well-being.

No way. I did an ultrasound. And they found a knot there, I hear in response.

Sooo? - I try to use intonation to encourage further story about myself.

Now, we found a node... So tell me, should it be removed? Is it possible somehow without surgery?

As a result, it is possible to find out that the patient, for example, is worried about weakness, hair loss, dry skin, chilliness and discomfort in the neck. After clarifying the patient’s well-being, I conduct an examination and find out the nature of the node based on ultrasound, scanning, thermography of the gland and the results of a cytological examination of the contents of this node. I am also determining the functional state of the thyroid gland. If I discover that the nodule is benign, colloidal, then I explain how it formed and what awaits it in the future without surgical removal.

I’m talking about whether you can expect a reverse transformation of the node, or whether its state will change in accordance with the stages already familiar to you. At the same time, I always pay attention to a more important circumstance - the reason and reason for the formation of knots! There are no causeless changes in the gland. And it is very important not only to deal with the consequence - the knot, but also to restore the normal functioning of the organ. But, unfortunately, these words are not perceived by the consciousness of the patient, who is absolutely focused on the node.

Often we have to consider cases of new nodes appearing. For example, there was one, and after 2-3 years three more were discovered. There are also frequent cases when, after removing one node, after some time nodes reappear in the place of the gland where they were not previously present. Such cases should make you think!

If the nodule is benign and its appearance is caused by a dysfunction of the gland, then first of all you should think about restoring normal functioning of the thyroid gland. And if such a node is capable of producing hormones, leave it under observation. It is not risky and is better than taking hormonal medications daily.

Let me remind you that the appearance of nodes is caused by functional overload of the gland. Removing nodules does not eliminate the causes of their formation. Without restoring the optimal activity of the thyroid gland, without replenishing its compensatory and adaptive capabilities, we can expect the appearance of new nodes.

The presence of nodes in the gland should be assessed as an adaptive restructuring of the gland tissue in response to a lack of hormone supply to the body. Therefore, restoring the functional ability of the thyroid gland by compensating for conditions in the body allows not only to improve the condition of existing nodes and prevent the appearance of new ones, but also to provide the help the body needs.

In endocrinological practice, a cystic solid formation of the thyroid gland is often encountered, which is dangerous if diagnosed late.

Thyroid nodules can have different etiologies. Only special research methods can help recognize a certain type of formation. Further treatment, medicinal or surgical, will depend entirely on the nature of the formed node. In endocrinology, there are 3 groups of this pathology: cystic, solid and mixed formations.

Endocrinologists divide thyroid nodules into 3 main groups by analyzing the results of ultrasound examination and fine-needle biopsy. If a neoplasm consisting exclusively of a liquid component is clearly visible on an ultrasound monitor, it is classified as a cystic formation. Also, during the study, an experienced endocrinologist will see the absence of blood flow, which is direct evidence of the presence of this particular pathology. It represents a cavity filled with a substance called colloid in scientific language.

Colloids are components that are produced by the gland itself and have a thick or liquid consistency.

Formations in the thyroid gland:

1. A distinctive feature of cystic nodes is that they can change their size throughout life, decrease or, conversely, increase. Typically, such a tumor is benign and is considered the most harmless of all 3 presented. However, to protect the patient, specialists still resort to biopsy.
2. Solid neoplasms represent tissue contents in which there is no liquid component. On ultrasound, the contours can appear either clear or unclear. Unlike cystic nodes, solid ones do not change their size over time and can reach a diameter of about ten centimeters. This type is almost always malignant.
3. The mixed appearance consists of the presence of both liquid and tissue formation, which is why it is often called cystic solid. This species is interesting because the presence of two components in it can be in different variations. Sometimes liquid contents prevail, sometimes tissue contents; this factor depends on the type of node. The cystic solid type of pathology can be malignant, but often a benign tumor is discovered upon diagnosis.

There are several methods for recognizing a mixed node type. Its diagnosis is based on several studies.

Only a specialist can decide which one to resort to.

1. Ultrasound. Ultrasound, first of all, helps to identify the structure of the formed cavity and the nature of its contents. This is the most proven and accurate method for diagnosing pathologies associated with nodular thyroid defects. Using ultrasound, a specialist will be able to see the presence of tissue material and a liquid component and, accordingly, draw a conclusion about the presence of a mixed node. But this study is not enough to make a diagnosis, much less for adequate treatment, since it is necessary to find out what type of pathology, malignant or benign, is.
2. Fine needle biopsy. With the help of an aspiration biopsy, a specialist can understand what type of tumor he is dealing with and prescribe appropriate treatment. The procedure itself, despite the seriousness of its name, is not difficult or painful for the patient. To take the material, a needle is used so thin that the patient does not even need local anesthesia.
3. When diagnosing a mixed nodule, it is impossible to do without a blood test aimed at identifying dysfunctions of the thyroid gland. The endocrinologist examines the level of hormones T3, T4, TSH.
4. Computed tomography. It is carried out only as a result of detection of a malignant tumor and if the cystic solid tumor is large. This study is necessary in order to obtain more accurate and valuable information about the nature of the pathology before surgery.

Treatment of cystic solid formations directly depends on several factors:

• knot dimensions;
• nature of the tumor (malignant or benign).

If the pathology is small in size, up to 1 cm, then usually this type does not require special drug treatment; it only implies periodic examination in order to monitor its development.

If the size, on the contrary, reaches a figure exceeding the threshold of 1 cm, then the doctor may prescribe a puncture during which the entire contents are pumped out. Even if the tumor is benign, it can sometimes recur. Moreover, puncture does not solve the entire problem with a mixed type of pathology. The tissue affected area remains and continues to develop.

If a malignant formation is discovered during a puncture or fine-needle biopsy, then treatment is based on surgical intervention. Moreover, during the operation, not only the affected area is removed, but also neighboring tissues.

Usually, doctors decide to remove half of the thyroid gland or the entire organ to prevent the patient’s condition from worsening.

When planning surgery on the thyroid gland, it is best to go to a specialized center, where endocrinologists and surgeons encounter a mixed type of endocrine pathology almost every day. This will help the patient to be more confident in the correct outcome of the operation.

The word ‎ means nothing more than compaction or thickening. This does not say anything about its properties. The word itself simply describes a solid (solid, as it is commonly called in medicine) clearly limited growth from its own mature ( ‎ ) tissue or immature (rudimentary, ‎ ) tissue. Sometimes this tissue can be as immature ( ‎ ) as the tissue of a child before birth (fetal fetus).

In medical terminology, the word part/suffix “om” indicates in the name of the disease that it is a tumor. And the first part of the name of the disease, as a rule, is a term from the Latin language. This part of the word names the specific tissue from which the tumor began to grow. For example, the term “lipoma” means a tumor of adipose tissue, “osteoma” means a tumor of bone tissue.

Solid tumors can be benign or malignant:

Benign solid tumors are not cancer! They grow slowly, are locally limited and most often fenced off from surrounding tissues (they have their own membrane). They do not metastasize. Sometimes benign solid tumors can resolve or they stop growing. However, malignant tumors can also begin with them.

Malignant solid tumors relate to cancer. A malignant tumor is called a primary tumor by the place where it originates. The possible spread of such a tumor to other parts of the body is called metastasis ( ‎ ).

To choose treatment tactics, it is necessary to accurately determine (classify) the type and properties of a solid tumor or cancer. Depending on the specific type of disease, special examinations are carried out.