Benign ovarian tumor are a group of pathological additional formations of ovarian tissue resulting from disruption of cellular proliferation and differentiation processes. The development may be accompanied by abdominal pain, menstrual and reproductive dysfunction, dysuria, defecation disorder, and an increase in the size of the abdomen. Diagnosis is based on data from vaginal examination, ultrasound, determination of tumor markers, MRI, laparoscopy, and other studies. Treatment is operative in order to restore specific female functions and exclude malignancy.
Benign ovarian tumor are an acute problem of gynecology, since they often develop in women of childbearing age, causing a decrease in reproductive potential. Among all ovarian formations, benign tumors account for about 80%, but many of them are prone to malignancy. Timely detection and removal of ovarian tumors is extremely important in terms of ovarian cancer prevention.
The question of the causality remains debatable. Various theories consider the hormonal, viral, and genetic nature of ovarian tumors as etiological moments. It is believed that the development is preceded by a state of hyperestrogenism, causing diffuse, and then focal hyperplasia and cell proliferation. Embryonic disorders play a role in the development of germinogenic formations and tumors of the genital tract.
Risk groups for the development include women with a high infectious index and premorbid background; late menarche and impaired menstrual function; early menopause; frequent inflammation of the ovaries and uterine appendages (oophoritis, adnexitis), primary infertility, uterine fibroids, primary amenorrhea, abortions. Benign ovarian tumor are often associated with hereditary endocrinopathies – diabetes mellitus, thyroid diseases, HPV and herpes virus type II.
According to the clinical and morphological classification of benign ovarian tumor, there are:
- epithelial tumors (superficial epithelialnostromal). Disease of epithelial type are represented by serous, mucinous, endometrioid, light-cell (mesonephroid), mixed epithelial tumors and Brenner tumors. Most often among them, operative gynecology encounters cystadenoma and adenoma.
- tumors of the genital cord and stromal. The main type of stromal tumors is ovarian fibroma.
- germinogenic tumors. Germinogenic tumors include teratomas, dermoid cysts, etc.
Hormone-inactive and hormone-producing benign ovarian tumor are differentiated based on hormonal activity. The latter of them can be feminizing and verilizing.
Early and relatively permanent symptoms include pulling, mainly unilateral pain with localization in the lower abdomen, not associated with menstruation. Pollakiuria and flatulence may be observed as a result of the pressure of the tumor on the bladder and intestines. Against this background, patients often note an increase in the size of the abdomen.
As they grow, benign ovarian tumor usually form a leg, which includes ligaments of the artery, lymphatic vessels, nerves. In this regard, the clinic often manifests with symptoms of an acute abdomen caused by twisting of the tumor leg, compression of blood vessels, ischemia and necrosis. A quarter of patients have menstrual cycle disorders, infertility. With ovarian fibroids, anemia, ascites and hydrothorax can develop, which regress after the removal of tumors.
Feminizing tumors contribute to premature puberty of girls, endometrial hyperplasia, dysfunctional uterine bleeding in reproductive age, bloody discharge in postmenopause. Virilizing benign ovarian tumor are accompanied by signs of masculinization: amenorrhea, hypotrophy of the mammary glands, infertility, coarsening of the voice, hirsutism, hypertrophy of the clitoris, baldness.
Benign ovarian tumor are recognized taking into account anamnesis data and instrumental examinations. Gynecological examination determines the presence of a tumor, its localization, size, consistency, mobility, sensitivity, the nature of the surface, the relationship with the pelvic organs. Rectovaginal examination makes it possible to exclude the germination of the tumor into adjacent organs.
Transabdominal ultrasound and transvaginal echography in 96% of cases make it possible to differentiate benign ovarian tumor from uterine fibroids, inflammatory processes in the appendages. In atypical cases, computer and/or magnetic resonance imaging is indicated.
When any tumor processes are detected in the ovaries, tumor markers are determined (CA-19-9, CA-125, etc.). In case of menstrual cycle disorders or postmenopausal bleeding, separate diagnostic curettage and hysteroscopy are resorted to. To exclude metastatic tumors in the ovaries, gastroscopy, cystoscopy, excretory urography, irrigoscopy, colonoscopy, rectoromanoscopy are performed according to indications.
Diagnostic laparoscopy has 100% diagnostic accuracy and often develops into a therapeutic one. True benign ovarian tumor differentiate with retention ovarian cysts (the latter usually disappear within 1-3 menstrual cycles on their own or after the appointment of COC).
The detection of a benign ovarian tumor is an unambiguous indication for its removal. Surgical tactics in relation to benign ovarian tumor are determined by the age, reproductive status of the woman and the histotype of the formation. Usually, the intervention consists in removing the affected ovary (oophorectomy) or adnexectomy. In patients of reproductive age, it is permissible to perform a wedge-shaped resection of the ovary with an emergency histological diagnosis and revision of the other ovary.
In perimenopause, as well as with bilateral localization of benign ovarian tumor or suspected malignancy, the removal of appendages is performed together with the removal of the uterus (pangisterectomy). The access of choice is currently laparoscopic, which reduces surgical trauma, the risk of developing adhesions and thromboembolism, accelerates rehabilitation and improves reproductive prognosis.
It is proved that long-term use of monophasic COCs has a preventive effect against benign ovarian tumor. To exclude unwanted hormonal changes, it is important that the selection of contraception is carried out only by a gynecologist. In addition, it was noted that in patients with realized generative function, benign ovarian tumor develop less frequently. Therefore, women are strongly discouraged from terminating pregnancy, especially the first one.
It is also known that women who have undergone hysterectomy or tubal ligation have a lower risk of developing ovarian tumors, although this protective mechanism remains unclear. A certain importance in the prevention of benign ovarian tumor is given to the sufficient use of plant fiber, selenium and vitamin A. As screening measures for benign ovarian tumor, regular gynecological examinations and pelvic ultrasound are distinguished.