Cystadenoma of the ovary: serous, papillary, grubososochkovaya

Cystadenoma of the ovary is a benign tumor of epithelial tissue called the cystic formation. Ovarian cyst cystadenoma is not the same as it does not imply growth of epithelial and other pathological processes initiated. Accumulation of fluid in cysts associated with features of the functioning of epithelial ovarian cells.

According to statistics, every tenth of a gynecological patient, regardless of age by ultrasound show cysts in the ovary. Determine the nature of the process in the US with 100% is impossible, which is why doctors are wary of the various types of entities, assigning additional inspections.

Classification

Cystadenoma of the ovary according to the morphological (tissue) refers to the group classification epithelial tumors. These formations are formed from and on the structure of the coating ovarian epithelium are benign. In turn, these cysts are classified into:

• serous;
• mucinous.

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

The simplest is a serous ovarian cyst, which sometimes is called. More complex in structure is considered mucinous Education and dangerous cyst with papillae on the inner walls.

Formation of low-grade tumors are called border. This type mainly refers to the papillary cystadenoma.

The question of the boundary condition of ovarian cystadenoma is still being discussed. It is proved that a malignancy of adenomas results in p53 gene mutation, if such a mutation is absent, the cysts are not reborn. Some experts say the role of the genetic degeneration of cystadenoma, denying the existence of borderline tumors.

When malignancy cystadenoma right ovary and will often provide metastazirovnie by abdominal liver capsule and the right half of the diaphragm, and pleura.

According to the international classification ICD-10, code ovarian cystadenoma - D 27 signifying benign.

Epithelial ovarian cysts are more common in women over 40 years.

Young women cysts are almost always benign.

Smooth-walled serous cystadenoma of the ovary

Serous ovarian tumor of different unilateral disease. Usually, a simple smooth-walled cyst has the following characteristics:

• located mostly on the uterus;
• have a leg;
• easily dislodged by palpation;
• one camera, at least - 2-3;
• thick capsule reaches a thickness of 1-4 mm;
• and inner and outer surface smooth;
• serous contents anehogennoe on ultrasound - light and transparent;
• the likelihood of malignancy minimum;
• danger is compression of organs and tissues.

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

Serous papillary cystadenoma of the ovary

Papillary serous cystadenoma of the ovary papillary presence described protuberances on the inner or outer surface of the formation.

Papillary cystadenoma of the ovary is characterized by:

• bilateral lesions;
• located deep in the ligament;
• leg;
• the presence of adhesions in the abdominal cavity.

Grubososochkovaya cystadenoma ovary describes frequent malignancy of the process, therefore, is subject to immediate removal.

mucinous

Cystadenoma mucinous character is described as follows:

• Multi-chamber;
• presence of content with different echogenicity on ultrasound;
• uneven surface due to bulging chambers;
• partitions;
• with a smooth outer surface or with the growth of papillae on the capsule;
• have a leg;
• contents of tinged in yellow, brown, green, turbid;
• high probability of malignancy.

Tumors often accompanied by ascites - fluid accumulation in the abdominal cavity. Most of these cysts are diagnosed in older women.

predisposing factors

Unambiguous cause of cystadenoma was not found, however, there are several theories of its origin.

1. Hormonal imbalance. The epithelium of the ovary as a result of the monthly ovulatory proliferation eventually undergoes hyperplasia. A large number of pregnancies, as well as COCs reduce the likelihood of formation of cystadenoma.
2. Heredity. It is considered fundamental to the leading and, in particular, the family of ovarian cancer and breast cancer. Experts draw attention to the gene mutation BRCA1 and BRCA2.
3. Ovarian pathology: recurrent follicular and corpus luteum cysts, polycystic.
4. Menopausal age, when there are hormonal surges and violation of ovarian epithelial function.

Exposure to ionizing radiation is also considered as a factor of provocative cystadenoma.

symptoms

On average, when the brush size to 3 cm women do not celebrate the specific symptoms. Such education is differentiated with follicular cysts, corpus luteum cyst. The patient was observed to prescribe oral contraceptives. If the cyst is not reduced in size, prescribe more detailed examination, suspecting cystadenoma.

When adenoma reaches 5-7 cm size, a woman can bring certain complaints.

Clinical signs of ovarian cystadenoma are:

• aching pain in the lower back and in the abdomen;
• constipation;
• impaired urination process (acceleration, difficulty, false desires);
• an increase in the size of the stomach (often with mucinous cysts);
• sharp pain until he lost consciousness when the cyst torsion and necrosis.

Cystadenoma not exhibit hormonal activity.

Serous cyst of the right ovary tissue can compress the kidney and its ureter, leading to disruption of the flow of urine. Serous cyst of the left ovary is often manifested by constipation due to pressure on the part of the sigmoid intestine.

diagnosing

Diagnosis of cystic formation has a number of complexities and paramount differential diagnosis of ovarian cystadenoma with a simple cyst. Doctors are faced with such a situation in the young and middle-aged women with normal ovarian function.

Fertility means the sex glands produce estrogen, ovulation, and a two-phase cycle. When hormonal failures, immune disorders develop ovarian pathology such as endometrial, follicular cysts. That these states are differentiated from cystadenoma and cancer (cystadenocarcinoma). Therefore, an expert, who discovered the formation fluid must compare it with the menstrual cycle, a history of women and the presence of other diseases of the genital organs.

Diagnosis involves the use of the following techniques:

• palpation of appendages;
• ultrasound;
• determining the level of tumor markers;
• multislice CT and MRI;
• laparoscopy;
• biopsy;
• mammography;
• colonoscopy;
• gastroscopy.

Set cystadenoma ovary diagnostic methods determined in the first place, the age and menstrual function. The younger the woman, the less biased expert will refer to liquid form.

Traditional use of determining the level of CA-125 has some limitations in young women.

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

CA-125 is above 35 U / ml is a cause for suspicion of malignancy.

On ultrasound determine the following:

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

The "simpler" structure of the hand, the higher the probability of a benign process.

Unlike simple follicular formation, fibrous capsule of serous ovarian cysts thick and may have a smooth inner surface or papillary. Capsule cystadenoma is essentially a shell of the ovary with the extended portion of the wall.

Dimensions ovarian cystadenoma may be different: mucinous cysts may reach large sizes (20-30 cm or more), serous cysts usually have a size up to 6-7 cm.

Serous ovarian cyst on ultrasound photos, situated below shows typical anechoic formation having multiple cameras with smooth and thin walled, large fibrous capsule. At the same time, mucinous cyst contains solid components and the contents of the internal hypo anehogennoe.

Diagnosis of suspicious cystadenoma necessarily accompanied by a certain level and other tumor markers:

• oncofetal antigens - human chorionic gonadotropin, alpha-fetoprotein, necessary to eliminate germ cell tumors, the higher the value, the worse the prognosis;
• ROMA index calculation including determination of HE4 and CA-125 and calculation;
• CA-199;
• carcinoembryonic antigen;
• inhibin B (estrogenprodutsiruyuschih tumor marker).

The first three markers of young women.

After laboratory studies begin to instrumental methods:

• mammography;
• colonoscopy;
• EGD.

These methods of diagnosis cystadenoma needed to avoid metastasis.

Cystadenoma of the ovary after menopause should exclude sparing approach in diagnosis and treatment. It takes most detailed study using a variety of methods, including laparoscopy.

According to statistics, 70% of detected cancers detected already in the advanced stage, which is especially important for the age of women who have undergone menopause hormonal surges. The main reason for underdiagnosis - defective list of designated research.

Excess radicalism in appointments are not welcomed by the women of active reproductive phase. Surgical interventions on the ovaries may reduce ovarian reserve and the inability to conceive.

Determine the risk of malignancy liquid formation on the basis of conventional techniques very difficult to set, therefore, patients with suspicious cysts should be compulsorily sent for consultation to oncologist.

Complete diagnosis of ovarian cystadenoma is crucial in the prevention of cancer.

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

Modifier A (1 or 4):

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

The factor V (0, 1, or 4) assumes ultrasound features:

• multichamber cystic tumors;
• a solid component;
• two-way process;
• ascites (fluid accumulation in the abdomen);
• metastases.

If not stated features, 0 is selected if there is one attribute - confer one, more than one trait - 4 points.

Modifier C is a content of the tumor marker CA-125 in blood (U / ml).

When the index MI of less than 200, the formation of cystic considered potentially benign.

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

4 (postmenopause) * 4 (solid inclusion, multi-chamber) * 30 = 480, which means a high risk of malignancy and requires the removal of the ovaries.

If malignancy index is more than 200, the patient certainly sent for consultation to the oncologist. Border ovarian cystadenoma having a MI in the region 200 is also a reason for a more thorough inspection and alertness.

Treatment

All benign tumors of the ovary after the exclusion of follicular cysts are subject to surgical removal. And laparoscopic surgery is performed by laparotomy (open surgery). Laparoscopy is done to young women, and laparotomy - patients who have reached premenopausal age and older.

Treatment of cystic lesions in young women and representatives of menopausal age has significant differences. Women in the active reproductive phase of ovarian tissue are trying to preserve, considering its heritage. Some patients after surgery recommend pregnancy by assisted reproductive technology.

Age patients performed open surgery for optimal assessment of the nature of cancer.

Hormone therapy after surgery is not required.

Treatment during pregnancy

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

The growing uterus and the tumor putting pressure on the bladder, intestines, kidneys, leading to a worsening of the organs and the rise of the clinic. In case of emergency during pregnancy, laparoscopy is performed. In most cases - watch, and during or after delivery, which is performed surgically removed cyst.

Treatment of ovarian cystadenoma without surgery

Cystadenoma subject to surgical removal, as a conservative method of treatment does not exist. These cysts are not amenable to hormone therapy. Radical tactics of doctors due to the inability to completely eliminate the malignant process and predict future "behavior" of the cyst.

If a woman is contraindicated surgery, the cyst was observed by conducting ultrasound and determination of tumor markers in the blood. Eliminate all the possible heat treatments on the abdomen and the whole body.

Laparoscopy ovarian cystadenoma

Laparoscopy with video equipment is considered the leading treatment for cystadenoma.

Young female operate sparing laparoscopy, implying enucleation (husking) instead cyst excision.

According to responses of patients treated by laparoscopic ovarian cystadenoma characterized by rapid recovery period, a minor amount of complications and consequences, the lack of effect on reproductive function.

During laparoscopy diagnostic purposes is performed abdominal examination and biopsy. If the clinician suspected malignant process under examination, the observed specific algorithm:

• video;
• biopsy;
• in the case of formation of opening after a biopsy, the abdomen is washed with the contents taken for histology;
• biopsy of the opposite ovary, gland, lymph nodes;
• selection of peritoneal exudate (or flush) for histological examination.

In older women often have to resort to hysterectomy and two appendages with the aim of preventing cancer. During laparoscopy, a simple serous cystadenoma of the ovary at first glance, often have to switch to open surgery and work with potentially dangerous tumor.

prevention

cystadenoma ovary formed in women over age 40 in most cases. Reliable prevention methods exist, since not fully identified the causes of the formation. The most reliable way to prevent the development of cysts is considered to be an annual visit to the gynecologist and perform ultrasound, which can be detected adenoma and conduct minimally invasive laparoscopic removal by.