3 cysts on the ovary. Colloid cyst of the third ventricle of the brain

Ovarian retention cysts. These formations do not belong to true tumors; they are often called tumor-like formations. They can occur in utero in fetuses and newborn girls. However, more often retention cysts occur in girls during puberty and can be caused by a violation of the subthalamic (hypothalamic) - pituitary regulation of ovarian function.

Both follicular and luteal ovarian retention cysts are usually not large and do not exceed 3-4 cm in diameter.

Cystadenoma , or cystoma - a true ovarian tumor - a space-occupying formation with a pronounced capsule, epithelial lining; unlike ovarian cysts, it is capable of proliferation and blastomatous growth (malignancy).

4. Ovarian retention cysts

Ovarian cysts are predominantly retention. They develop from follicles and corpora lutea.

There are two main theories of the occurrence of ovarian retention cysts.

The first theory explains their appearance by changes associated with inflammation of the uterine appendages (51.6% of cases). Congestive hyperemia of the pelvic organs and the development of perio-oophoritis are of great importance. In addition, hyperemia is observed under physiological conditions in connection with the menstrual cycle (ovulation, the developmental phase of the corpus luteum), pregnancy, childbirth, the postpartum period and lactation; reasons may be interrupted sexual intercourse , failure to achieve orgasm with severe sexual arousal, as well as uterine tumors (fibroids) in 34.2% of cases.

The second theory is hormonal - a hormonal imbalance in the patient’s body.

The development of cysts can occur in various ways. In some cases, there is a violation of the relationship between LH and FSH, an increase in FSH, ovulation disorders with follicular cysts (lack of luteinizing hormone in the body), and corpus luteum cysts develop with excess production of luteinizing hormone by the pituitary gland. In other cases, cysts arise against the background of congestive hyperemia, in third cases, the tunica albuginea of ​​the ovary thickens, as a result of which the mature follicle cannot open.

Highlight:

Follicular cysts.

Corpus luteum cyst.

Paraovarian cyst.

Thecal lutein cysts.

Endometrioid cyst.

5. Clinic, diagnosis and principles of treatment of ovarian cysts

Follicular ovarian cyst

This is a single-chamber formation, which arose due to the fact that the Graafian follicle did not open; its cavity is filled with a clear liquid, which is a product of the vital activity of granulosa cells

The presence of a follicular cyst does not disrupt the processes of egg maturation and ovulation in the remaining follicles.

Follicular cyst is observed most often. When small in size, it is asymptomatic, can reach a size of up to 10 cm in diameter, round in shape, single-chamber, with a smooth surface, tight-elastic consistency, thin-walled, mobile, painless on palpation, has a stalk, can spontaneously burst and often ruptures during bimanual examination.

Diagnosis is based on data from a bimanual ultrasound examination (a thin-walled, hypoechoic formation measuring from 3 to 10 cm is visualized in the ovary).

Corpus luteum cyst

Corpus luteum cysts, unlike follicular cysts, are much less common. Their development is due to the fact that after ovulation the follicle cavity does not collapse and is not filled entirely with luteal cells, as is normal, but remains to exist and is stretched with serous fluid. The cyst wall consists of several rows of luteal and thecaluteal cells. As the cyst grows, atrophy of the luteal cells and cystic elements of the inner wall occurs. Corpus luteum cyst is hormonally inactive.

The cyst is usually one-sided, small in size - 3-4 cm in diameter, tight-elastic consistency, painless. The section shows a scalloped yellow or orange color. The luteal tissue of the cyst undergoes the usual cyclic changes for the corpus luteum. In this regard, during the vascularization phase of the corpus luteum, bleeding occurs into the cyst cavity. As a rule, the cyst appears and enlarges in the 2nd phase of the menstrual cycle.

Symptoms of early pregnancy occur - delayed menstruation, engorgement of the mammary glands; During vaginal examination, an increase in the size of the uterus and the appearance of blood discharge from the genital tract are noted. At this stage, it is necessary to carry out a differential diagnosis with pregnancy, both uterine and ectopic. The diagnosis is clarified by testing urine for hCG, which is not detected with a corpus luteum cyst. To make a diagnosis, as a rule, a bimanual examination and ultrasound are sufficient.

Waiting tactics. As a rule, corpus luteum cysts and follicular cysts undergo reverse development. If this is not observed within 2-3 months or there is a tendency for the cyst to enlarge, an operation is indicated during which resection of the ovary is performed within healthy tissue. Corpus luteum cysts, like follicular cysts, can recur.

Thecal lutein cysts

Thecal lutein cysts are formed under the influence of the stimulating effect of human chorionic gonadotropin, which contains a large amount of luteinizing hormone, on follicular leakage. They are bilateral, reach gigantic sizes, and are companions of diseases such as trophoblast diseases. As the underlying disease is treated, thecal lutein cysts resolve and therefore cannot be treated surgically.

Paraovarian cyst

A paraovarian cyst is formed from the epiophoron - the supraovarian appendage (paraovary), a remnant of the mesonephric duct.

The cyst is most often single-chamber, thin-walled, located interligamentously, the contents are transparent, liquid, poor in proteins, and do not contain mucin. In terms of volume, a paraovarian cyst can range from several centimeters in diameter to the size of a newborn’s head. The shape is spherical or ovoid. The ovary is not involved in the pathological process; the fallopian tube is most often spread out on the surface of the cyst. The wall of the paraovarian cyst consists of connective tissue, the inner surface is smooth, lined with single-layer cylindrical or squamous epithelium.

It usually occurs at the age of 20-30 years and accounts for about 10% of all tumors and tumor-like formations of the ovary. If the cyst is small, it does not manifest itself in any way. With significant sizes, symptoms appear - pain in the lower abdomen and sacrum, dysuria. The cyst develops slowly, malignancy is extremely rare. Bimanual examination reveals a cystic formation with limited mobility due to its intraligamentary location. At the lower pole of the cyst, it is sometimes possible to palpate the ovary. The diagnosis is clarified by ultrasound examination (a tumor-like hypoechoic (liquid) formation is detected next to the ovary).

Treatment

Treatment of the cyst is surgical, since parovarian cysts do not undergo reverse development. The operation consists of enucleating the cyst. The fallopian tube and ovary are preserved. There are no recurrences of paraovarian cysts. The prognosis is favorable.

The words “colloid cyst of the 3rd ventricle” mean a round-shaped neoplasm, which is located in the cavity of the 3rd ventricle of the brain. The opinion that this neoplasm metastasizes or is capable of growth is erroneous. For the patient, there is a danger only if, as a result of the development of hydrocephalic syndrome, the circulation pathways are blocked.

With small sizes, the colloid brush of the third ventricle does not manifest itself in any way, while its progressive growth can be characterized by sudden attacks of headache, which in some certain situations are even supplemented by vomiting or tinnitus. What can I say, sometimes it is accompanied by weakening and visual impairment. As for the immediate treatment process, its essence lies in the surgical removal of the entire cyst and the subsequent restoration of cerebrospinal fluid. By the way, its diagnosis is made through CT and MRI images.

The main reasons for the appearance of colloid cyst of the 3rd ventricle

Despite the development of modern medicine, the reasons that lead to the occurrence of colloid cysts of the 3rd ventricle still remain unknown. At the same time, there are several basic assumptions. So, for example, some researchers believe that their formation occurs as a result disorders of the development of the nervous system during the prenatal period.

The thing is that the human embryo, even before the formation of the cerebral hemispheres, has a special outgrowth, which some researchers also call the rudiment of nervous tissue. During individual development, it gradually dissolves and is completely destroyed by the time the fetus is born. The process of normal brain development can be disrupted by a variety of factors.

Probably the most important of them are bad ecology, bad habits of a pregnant woman, stress, and sometimes even the occurrence of the so-called Rhesus conflict in the early stages of pregnancy. As a result of all this, a section of embryonic tissue remains, the cells of which gradually begin to produce a jelly-like liquid, which is first limited to the dense connective tissue membrane, and then completely contributes to the formation of the colloid brush of the 3rd ventricle.

From the very beginning, the size of the neoplasm does not exceed a few millimeters. But ultimately, facilitated by the influence of the above-mentioned provoking factors, the colloid cyst of the 3rd ventricle gradually increases.

How does the treatment take place?

In order to eliminate the current problem, in neurology departments, during the treatment of colloids of the 3rd ventricle, they try to adhere to the already familiar and therefore quite standard sequence of actions, which consists of the following stages:

• In the event that we are talking about a small-sized formation, then without the presence of appropriate symptoms, no self-respecting doctor will undertake its treatment. As a last resort, you will be sent for an annual MRI or CT scan. Guided by it, the specialist will be able to determine the size of the formation, as well as its tendency to grow.
• If circumstances have developed in such a way that surgical intervention is necessary, then in such a situation, its main goals will be the complete and immediate removal of the hand, the subsequent release of the cerebrospinal fluid ducts, which will thereby eliminate the syndrome. The most common surgical techniques are craniotomy or conventional endoscopic removal.

It deserves special attention cranitopia. This procedure is not only an opening of the skull, but also a subsequent operation on the open brain. With its help, it is possible to first completely remove the tumor that has arisen, and then, after first examining the cavity of the third ventricle, restore all the necessary cerebrospinal fluid pathways.

There are as many advantages to endoscopic removal as there are disadvantages. The most significant of these disadvantages would include greater trauma, as well as a not very positive cosmetic defect, which will make itself felt some time later. The thing is that endoscopic removal of a colloid cyst can be carried out exclusively through a small hole in the bones of the skull, which afterwards will probably catch your eye.

Colloid cyst of the third ventricle is a disembryogenetic benign formation with an epithelial lining and colloidal contents (Fig. 1830, 1831), sometimes with a tendency to increase and, as a consequence, occlusion of the foramina of Monroe with the development of hydrocephalus.

Fig. 1830, 1831

Epidemiology

1-3% of all intracranial formations. Peak age of detection is 30-40 years.

Morphology and localization

A colloid cyst of the third ventricle is a rounded volumetric formation with clear contours, always located in the third ventricle near the foramina of Monroe. Colloid cysts contain mucin, blood derivatives, cholesterol, which, depending on the content of these substances, determines the signal on MRI (↓T1, as well as ↓or → T2 and Flair) and density on CT (usually).

Rice. 1834, 1835 and 1836. A rounded formation with clear contours, a capsule and homogeneous liquid contents (arrow head in Fig. 1834), located in the third ventricle at the foramen of Monro, having an MR signal in T2 and ↓ in T1 (arrow in Fig. 1835 ), slightly higher than the intensity of the MR signal from the cerebrospinal fluid, causing obstructive hydrocephalus and dilatation of the lateral ventricles (arrowheads in Fig. 1836). On CT, the colloid cyst has a high density (arrow in Fig. 1836). Note the decrease in the density of the periventricular white matter (arrowheads in Fig. 1836) due to transependymal permeation of the cerebrospinal fluid due to increased intraventricular cerebrospinal fluid pressure against the background of outflow disturbance caused by the cyst.

When using PI T1 with suppression of the signal from fat, there is no change in the signal intensity from the colloid cyst. After IV enhancement, there is no accumulation of contrast, but contrast in the adjacent subependymal veins may simulate its accumulation in the walls of the cyst.

A colloid cyst of the third ventricle is always identified in its typical location - in the third ventricle, at the interventricular foramen of Monroe (arrowhead in Fig. 1837, 1839). If there is an MR signal from it along T1 (arrowhead in Fig. 1838), which is due to the nature of the contents, it retains the same signal even when gradient fat suppression is added (arrow in Fig. 1838).

Differential diagnosis

Ependymoma

Fig.1840-1842

Ependymoma in the lumen of the anterior horn of the right lateral ventricle (arrow in Fig. 1840), has an uncharacteristic localization for a colloid cyst of the third ventricle, an MR signal intensity similar to the brain, and also accumulates a contrast agent (arrow head in Fig. 1841, 1842 ) after intravenous enhancement.

Metastasis to the septum pellucidum

Metastases are well contrasted and are accompanied by perifocal edema. If you suspect metastatic brain damage, priority should be examined: lungs, kidneys, skin, bladder, mammary gland and gastrointestinal tract. Also, in order to find the source and assess the generalization of the tumor process, it is worth deciding on conducting scintigraphy or PET-CT.

Fig.1843-1845

Formation in the area of ​​the transparent septum (arrow in Fig. 1843), accompanied by perifocal edema of the surrounding areas of the brain (arrow head in Fig. 1843). After intravenous contrast enhancement, this formation intensively accumulates contrast (arrows in Fig. 1844, 1845).

Giant cell astrocytoma

Hamartoma of the gray tuberosity

Lipoma

In the area of ​​the anterior horn and foramen of Monroe of the lateral ventricle, in Bourneville-Pringle disease, in 17% of cases, an astrocytoma is found, while there are other brain changes characteristic of tuberous sclerosis.

Abnormal heterotopia in the area of ​​the gray tuberosity (hamartoma), isointense to the brain in any IP. Lipoma in the area of ​​the midline structures has changes in the MR signal characteristic of fat.

Fig.1846-1848

Nodes of giant cell subependymal astrocytoma (arrow head in Fig. 1846), hypothalamic hamartoma in the area of ​​the papillary bodies (arrow in Fig. 1847), as well as a lipoma with a T1 MRI signal in the chiasmatic-sellar region (arrow head in Fig. 1848) .

Pilocytic astrocytoma

Fig.1849-1851

A space-occupying formation, represented by a pilocytic astrocytoma, in the form of a heterogeneous structure is detected in the third ventricle (arrow head in Fig. 1849), intensively accumulating a contrast agent (arrow in Fig. 1851). Note the large cyst in the basal ganglia on the right (asterisk in Fig. 1850).

Clinical picture, treatment and prognosis

In the vast majority of cases, colloid cysts are asymptomatic and are discovered accidentally. Their position in the roof of the third ventricle, directly adjacent to the foramen of Monro, can lead to sudden obstructive hydrocephalus, and may manifest as headache and loss of consciousness. Headaches tend to depend on the location of the mass, and patients may know how to relieve symptoms (forced positioning). Education growth is slow.

Colloid cyst in the area of ​​the left interventricular foramen (arrow in Fig. 1852), leading to expansion of the left lateral ventricle (arrow head in Fig. 1852). Colloid cyst of the third ventricle (arrows in Fig. 1853, 1854), enlarged during pregnancy, complicated by hydrocephalus (arrowheads in Fig. 1854).

Treatment consists of surgical removal. An osteoplastic craniotomy is performed and the formation is removed through the wall of the lateral ventricle. There are no postoperative relapses.

Closure of one or both foramina of Monroe leads to an increase in cerebrospinal fluid pressure in the cavities of the lateral ventricles, which leads to their dilation, which can be assessed on CT or MRI.

Literature

1. Gaidar B.V., Rameshvili T.E., Trufanov G.E., Parfenov V.E. Radiation diagnostics of tumors of the brain and spinal cord. practical guide. - St. Petersburg. Folio,
2. - 336 p.
3. Kornienko V. N., Pronin I. N. Diagnostic neuroradiology: in 3 volumes. - T. 3. - M., 2009. - 462 p.

- These are non-tumor formations of a benign nature. These cysts are quite rare, grow slowly and are localized mainly in the anterior parts of the ventricle. Colloid cysts are usually observed in the age range from 20 to 40 years.

Despite their benign quality, these formations pose a certain threat to the life and health of the patient. The thing is that colloid cysts are located in the brain opposite the so-called Monroe holes– a channel through which constant circulation of cerebrospinal fluid occurs. The cyst, like a locking valve, closes the hole from time to time, disrupting the normal flow of fluid.

2. Symptoms of the disease

In some cases, such cysts can be completely asymptomatic and discovered by chance during an examination, while in others they can provoke manifestations that pose a serious threat to the patient’s life. If the cyst of the foramen of Monroe is constipated and the circulation of the cerebrospinal fluid is disrupted as a result, hydrocephalus develops, and the following symptoms are observed:

• severe attacks of headache, dizziness;
• nausea, vomiting;
• memory impairment;
• loss of consciousness several times a day;
• urinary incontinence;
• weakness in the limbs.

If the Monroe foramen is blocked for a long time, a cerebral coma may develop, which has a chance of being fatal.

3. Treatment of colloid cysts

In some cases, if the cyst is small and there are no signs of hydrocephalus, doctors consider it possible to postpone removal and offer the patient permanent cyst monitoring. If the cyst shows a tendency to increase, it must be removed.

There are several types of operations that are used to treat colloid cysts:

• traditional transcranial intervention using microsurgical instruments using craniotomy. This operation allows not only to remove the contents of the cyst, but also to completely excise its walls, which ensures the highest treatment result;
• endoscopic gentle surgical intervention performed without trephination using special endoscopic instruments, which are inserted into the intracranial space through a small hole;
• shunt surgery is a palliative intervention to install a special shunt system aimed at diverting excess cerebrospinal fluid from the brain cavities to other natural cavities of the body (for example, the abdominal cavity), where this fluid will not pose a threat to the normal functioning of the body.

In some circumstances, bypass surgery must be performed urgently in order to stabilize the patient's condition, and only after that proceed directly to the removal of the cyst.

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

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

Anatomy and physiology of the ovary

Main 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 production of hormones.

Size of ovaries in women of reproductive (childbearing) age:

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

Structure of ovarian tissue

The ovary has two layers:

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

Functioning of the ovary

By the time of ovulation, a new egg matures 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.

During ovulation, a mature follicle ruptures. The egg in it exits into the abdominal cavity and then enters the fallopian tube. At the site of the burst follicle, a corpus luteum is formed - a cluster of glandular cells that secretes the hormone progesterone, which is responsible for pregnancy.

By the time menstruation occurs, ovarian function decreases. There is a deficiency of hormones in the body. Against the background of this “hormonal deficiency,” part of the mucous membrane is rejected and bleeding develops. Your period is coming.

What is a cyst?

Types of ovarian cysts:

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

Dermoid cyst

A dermoid cyst can 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 tissue: nervous, connective, muscle, cartilage, adipose tissue.

A dermoid cyst contains sebaceous and sweat glands and hair. Inside there is a cavity that is filled with contents that resemble jelly in consistency.

The most common dermoid cyst of the ovary is 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 dermoid cyst

Ovarian dermoid cyst can be first diagnosed in childhood, adulthood or adolescence.

Symptoms of a dermoid cyst

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

Complications of a dermoid cyst

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

  Diagnosis of dermoid cyst

• Manual inspection. It can be performed in two versions: vaginal-abdominal (one hand of the doctor is in the vagina, the other on the stomach), recto-abdominal (the doctor inserts a finger into the rectum and probes the ovarian cyst through it). In this case, the gynecologist can palpate the ovary, approximately assess its size, consistency, density, etc. A dermoid cyst is felt as a round, elastic, mobile, painless formation.
• Ultrasonography. When conducting this study, the structure of the walls of the teratoma and the consistency of its internal contents are well determined. A characteristic feature of the tumor: in the thickness of its wall, calcifications are often detected - areas of calcification.
• Computed tomography and magnetic-resonance tomography. These two studies allow us to study in detail the internal structure of the dermoid cyst and establish a final diagnosis.
• Laparoscopy (culdoscopy) – endoscopic diagnosis of a dermoid cyst by introducing miniature video cameras into the abdominal cavity through punctures (during 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 a 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 is performed for the tumor marker CA-125.

Ovarian dermoid cyst and pregnancy

Treatment of ovarian dermoid cyst

Types of operations for ovarian dermoid cyst:

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

6 to 12 months after removal of the cyst, you can plan a pregnancy.

Endometriotic cyst

Endometriotic cysts usually measure 0.6–10 cm. 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 there is chocolate-colored contents. It mainly consists of the remains of blood, which here, as in the uterus, is released during menstruation.

Causes of endometriosis cysts

Theories of 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 surgery;
• entry of cells into the ovary through the blood and lymph flow;
• hormonal disorders, changes in ovarian function, pituitary gland, hypothalamus;
• immune disorders.

Symptoms of endometriosis cysts

• constant pain in the lower abdomen aching in nature, which periodically intensify, radiate to the lower back, rectum, and intensify during menstruation;
• sharp sharp pains occur in approximately 25% of patients in whom the cyst ruptures and its contents spill into the abdominal cavity;
• painful menstruation(algomenorrhea), accompanied by dizziness and vomiting, general weakness, cold hands and feet;
• constipation and urinary dysfunction– caused by the formation of adhesions in the pelvic cavity;
• slight bleeding from the vagina after your period has already ended;
• constant small increase in body temperature, periodic chills;
• inability to get pregnant for a long time.

Diagnosis of endometriotic ovarian cysts

• General blood analysis. Women with endometriosis often exhibit an increase in erythrocyte sedimentation rate, 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 an examination by a gynecologist, endometriotic cysts can be detected on the right, left, or both sides. They are elastic to the touch, 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 a final diagnosis and distinguish endometriotic ovarian cysts from other pathological formations. The doctor takes a piece of tissue for examination using special instruments during a laparoscopic examination.
• Ultrasound, CT and MRI – highly informative studies that help to examine in detail the internal structure of the cyst.

• I degree. There are no cysts as such yet. There are small, dot-shaped endometriotic formations in the ovarian tissue.
• II degree. There is a small or medium sized ovarian cyst. 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. Endometriotic growths cover the outside of the uterus, fallopian tubes, and the walls of the pelvic cavity. The adhesive process becomes more pronounced, and the intestines are involved.
• IV degree. Endometriotic ovarian cysts are large. The pathological process spreads to neighboring organs.

Treatment of endometriotic ovarian cyst

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

Pregnancy with endometriotic ovarian cysts

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

If a cyst is detected already during pregnancy, but it is small in size and does not compress 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 throughout the entire pregnancy.

Polycystic ovary syndrome

Polycystic ovaries look like normal ones, 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 ovarian membrane and release the egg out.

Causes of polycystic ovary syndrome

Because of this, the pancreas increases insulin production. 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 prevent the egg in the follicle from maturing normally and being released. As a result, during each regular ovulation, the mature follicle remains inside the ovary and turns into a cyst.

Pathological conditions predisposing to the development of polycystic ovary syndrome:

• Excess body weight (obesity). If a large amount of fat and glucose enters the body, the pancreas is forced to produce more insulin. This leads to the body cells quickly losing sensitivity to the hormone.
• Diabetes. With 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 ovary syndrome, then her daughters have an increased risk.

Symptoms of polycystic ovary syndrome

• Delayed periods. The intervals between them can be months or years. This symptom is usually observed in girls immediately after the first menstruation: the second does not come a month later, but much later.
• Hirsutism– Excessive hair growth on the body, as in men. The appearance of this secondary male sexual characteristic is associated with the production of large amounts of androgens in the ovaries.
• Increased oily skin, acne. These symptoms are also associated with excess androgens.
• Obesity. Adipose tissue in women with polycystic ovary syndrome is mainly deposited in the abdominal area.
• Cardiovascular disorders-vascular system. In such patients, arterial hypertension, atherosclerosis, and coronary heart disease develop early.
• Infertility. The egg cannot leave the ovarian follicle, so conceiving a child becomes impossible.

Diagnosis of polycystic ovary syndrome

The final diagnosis is established after examination:

• Ultrasound. One of the most informative techniques that allows you to examine and evaluate the internal structure of the ovary and detect cysts. Ultrasound examination for polycystic disease is carried out using a sensor that is inserted through the vagina.
• Study of the content of female and male sex hormones in the blood. A woman's hormonal status is assessed. With polycystic ovary syndrome, an increased amount of androgens is detected - male sex hormones.
• Blood chemistry. Increased levels of cholesterol and glucose are detected.
• Laparoscopy (culdoscopy). Endoscopic examination is indicated for a woman if she has dysfunctional uterine bleeding (discharge of blood 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

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

Treatment regimen for polycystic ovary syndrome

The purpose of surgery for polycystic ovary syndrome is to remove parts of the organ that produce male sex hormones.

Almost always they resort to laparoscopic intervention under general anesthesia. Small puncture incisions are made on the abdominal wall through which endoscopic instruments are inserted.

Surgical options for polycystic ovary syndrome:

• Excision of part of the ovary. Using an endoscopic scalpel, the surgeon excises the area of ​​the organ that produces the most androgens. This method is good because at the same time it is possible to eliminate concomitant adhesions between the ovary and other organs.
• Electrocoagulation– pinpoint cauterization of areas of the ovaries in which there are cells producing testosterone and other male sex hormones. The operation is minimally traumatic, is performed very quickly, and does not require long-term rehabilitation.

Polycystic ovary syndrome and pregnancy

Follicular ovarian cyst

Such a cyst has thin walls and a cavity with liquid contents. Its surface is flat 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 ovary are equally common.

Symptoms of follicular ovarian cyst

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

Sometimes a woman is bothered by aching pain in her stomach.

An increase in the diameter of the cyst to 7–8 cm creates a risk of torsion of its pedicle, in which the vessels and nerves pass. In this case, acute pain in the abdomen occurs, and the woman’s condition worsens sharply. Emergency hospitalization in a hospital is required.

During ovulation, in the middle of the menstrual cycle, a follicular cyst may rupture. At the same time, the woman also experiences acute pain in the abdomen - 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 discovers a formation to the right or left of the uterus, which has a dense elastic consistency, easily moves relative to the surrounding tissues, and is painless when palpated.
• Ultrasound– ultrasonography(a study based on the use of high frequency ultrasound to identify deep structures). Allows a good study of the internal structure of the ovary and cysts.
• Laparoscopy and culdoscopy for follicular ovarian cysts they are used only for special indications.

Treatment of follicular ovarian cyst

Conservative treatment of follicular ovarian cysts consists of prescribing hormonal drugs containing estrogens and gestagens. Usually recovery occurs in 1.5 - 2 months.

Indications for surgical treatment:

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

Laparoscopic surgery is performed, during which the doctor removes the cyst and sutures the resulting defect.

Follicular ovarian cyst and pregnancy

Serous ovarian cystoma (serous cystoma, cilioepithelial cystoma)

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 the cells that cover the outside surface of the ovary.

The cyst, as a rule, is located only on one side, near the right or left ovary. There is only one chamber inside, not separated 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);
• previous abortions and surgical interventions on the pelvic organs.

Symptoms of serous ovarian cystoma

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

Diagnosis of serous ovarian cystoma

• Gynecological examination. Makes it possible to detect a tumor formation near the right or left ovary.
• Ultrasonography. 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 ovarian tumors. Most often, the entire cyst is sent for histological examination after it is removed.

Treatment of serous ovarian cystoma

• If the tumor is small, it is completely removed. Sometimes - with part of the ovary.
• If the cyst is large enough, 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 affected side.

Serous ovarian cystoma and pregnancy

Large tumor sizes pose a danger to the pregnant woman and the fetus. At 12 weeks, when the uterus begins to rise from the pelvic cavity into the abdominal cavity, an increase in torsion of the cyst pedicle occurs. This is an emergency condition that requires immediate surgery and can cause miscarriage.

Large serous ovarian cystomas must be removed before pregnancy.

Papillary ovarian cystoma

Papillary ovarian cyst, according to the World Health Organization (WHO) classification, is a precancerous condition. It becomes malignant in 40–50% of cases.

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

Mucinous ovarian cystoma

Mucinous ovarian cysts are detected at different ages. They are most often found in women aged 50 years.

Typically, a mucinous cyst has a round or oval shape and an uneven, bumpy surface. Inside there are several chambers filled with mucus. The tumor grows very quickly and reaches enormous sizes.

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

Symptoms and diagnostic features of mucinous ovarian cystoma

Symptoms and examination for mucinous ovarian cysts are practically no different from those for serous cysts.

Treatment of ovarian mucinous cystoma

Possible tactics of surgical treatment:

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

Pregnancy with mucinous ovarian cystoma

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

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

Corpus luteum cyst of the ovary

The corpus luteum is a collection of endocrine cells that remains at the site of the burst follicle (see above “anatomy of the ovary”). For some time it releases the hormone progesterone into the bloodstream, and then, by the time of the next ovulation, it atrophies.

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

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

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

Causes of corpus luteum cyst

Factors that contribute to the development of ovarian corpus luteum cyst:

• taking medications that simulate the release of an egg from the follicle in case of infertility;
• taking medications to prepare for in vitro fertilization, in particular clomiphene citrate;
• taking emergency contraception medications;
• long-term 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

Symptoms of luteal ovarian cyst

• slight pain in the lower abdomen on the affected side;
• feeling of heaviness, fullness, discomfort in the abdomen;
• delays in menstruation;
• prolonged periods due to uneven shedding of the uterine lining.

Diagnosis of corpus luteum cyst

Treatment of ovarian luteal cysts

Corpus luteum cyst of the ovary and pregnancy

On the contrary, the absence of the corpus luteum during pregnancy is a risk factor for miscarriage.

Treatment of ovarian corpus luteum cyst with folk remedies

Raisin tincture

Take 300 grams of raisins. Pour in 1 liter of vodka. Leave for a week. Take one tablespoon three times a day 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 out the juice. Take a tablespoon three times a day before meals. Once the juice is squeezed, it should be stored in the refrigerator and used within three days. After this, 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 the fire, add chopped egg yolk to it. Remove from heat and let steep 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.

Walnut-based folk remedy against functional ovarian cysts

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

Can a girl develop an ovarian cyst?

• heredity – 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;
• use of various hormonal drugs ;
• thyroid diseases ;
• heavy physical activity ;
• excess weight and obesity – a large amount of fat in the body contributes to imbalances in female sex hormones;
• .

1. Follicular cyst.
2. Corpus luteum cysts.

In most cases, girls develop functional cysts, but this does not mean that they do not develop other types of cysts.

Features of manifestations of ovarian cysts in teenage girls:
1. May be asymptomatic ovarian cyst, if its size is less than 7 cm.
2. The most typical symptoms are:

• pain in the lower abdomen , aggravated by physical activity;
• menstrual irregularities;
• painful periods and premenstrual syndrome;
• from the vagina are possible bloody issues , not related to menstruation.

Treatment of ovarian cysts in girls.

Considering the very young age, the main principle of treatment of ovarian cysts in girls is maximum preservation of the ovary and 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 maternal 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. It is possible to prescribe hormonal or homeopathic medications.
• If the cyst increases in size during observation , then surgery is necessary. In this case, if possible, they try to remove the cyst while preserving the gonad.
• When cyst complications occur (inflammation, rupture, torsion of the cyst leg), as well as in case of continuous uterine bleeding, surgery is inevitable and is performed according to health reasons. 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 its appendages is removed.

In most cases, ovarian cysts in adolescents proceed favorably and do not lead to removal of the gonad, which does not affect the girl’s reproductive function in the future. During observation of the cyst and after surgery, observation by a gynecologist and a gentle regime of physical activity are necessary.

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

Schematic representation of possible sites of localization of a paraovarian cyst.

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

Reasons for the development of paraovarian cyst:

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

Treatment of ovarian cysts during pregnancy:

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

Does an ovarian cyst resolve with treatment without surgery?

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

Types of ovarian cysts that can resolve without surgery:

• small ovarian follicular cyst (up to 4 cm);
• small corpus luteum cyst (up to 5 cm);
• ovarian retention cysts;

• dermoid cyst;
• endometriotic cyst;
• paraovarian cyst;
• cystoadenoma;
• serous ovarian cyst;
• ovarian cancer tumors.