Corpus luteum cyst is a functional retention formation of ovarian tissue that forms on the site of an unregressed corpus luteum. The cyst of the ovarian corpus luteum is almost asymptomatic; in rare cases it is accompanied by minor pain in the lower abdomen, menstrual cycle disorders, complicated course. Diagnostics includes a gynecologist’s examination, ultrasound, Dopplerography, laparoscopy. Disease can regress independently during 3 menstrual cycles; with complications, cystectomy, resection or removal of the ovary is indicated.
The yellow body is a cyclically formed gland in the ovary, which occurs in place of the ovulated Graaf vesicle (follicle) and produces the hormone progesterone. The name of the gland was given by a lipochromic pigment present in its cells and giving them a yellowish color. The yellow body develops in the ovary during the second (luteal) phase of the menstrual cycle. In the flowering stage, the yellow body reaches a size of 1.5-2 cm and rises above the surface of the ovary with one pole. In the absence of fertilization, the yellow body undergoes involutive development at the end of the luteal phase and stops progesterone production. Upon the onset of pregnancy, the yellow body does not disappear, continues to increase and function for another 2-3 months and is called the yellow body of pregnancy.
The luteal cyst of the ovary is formed from a non-regressed corpus luteum, in which, due to circulatory disorders, fluid of a serous or hemorrhagic nature accumulates. The size is usually no more than 6-8 cm. Ovarian corpus luteum cyst occurs in 2-5% of women of reproductive age after the establishment of a two-phase menstrual cycle.
Clinical gynecology differentiates cysts of the corpus luteum that developed outside pregnancy (from an atresized follicle), as well as cysts of the corpus luteum that occur during pregnancy. The cyst of the yellow body of the ovary is more often one-sided, single-cavity; it has a capsule lined from the inside with granular luteal cells, filled with reddish-yellow contents. The independent disappearance of the ovarian corpus luteum cyst occurs during 2-3 menstrual cycles or in the second trimester of pregnancy.
The reasons for the formation are not completely clear. It is believed that the formation is caused by hormonal imbalance and impaired blood circulation and lymph outflow in the tissues of the ovary. The risk of luteal cyst formation increases against the background of taking drugs to stimulate ovulation in infertility or preparation for IVF (for example, clomiphene citrate) and emergency contraception drugs.
The possibility of this disease under the influence of severe physical and mental stress, harmful production conditions, eating disorders (monodiet), frequent oophoritis and salpingoophoritis, abortions is not excluded. All these factors can lead to endocrine imbalance, and, consequently, the formation of corpus luteum cyst.
Symptoms of ovarian corpus luteum cyst are poorly expressed. Luteal cysts often develop within 2-3 months, after which they spontaneously and suddenly undergo involution.
Corpus luteum cyst detected during pregnancy does not pose a threat to the woman and fetus. On the contrary, the absence of the corpus luteum of pregnancy in the early stages can cause spontaneous termination of pregnancy due to hormonal insufficiency. The reverse development during pregnancy also most often occurs spontaneously by 18-20 weeks of gestation: by this time, the formed placenta completely takes over the hormone-producing functions of the corpus luteum.
Sometimes corpus luteum cyst can cause minor soreness, a feeling of heaviness, swelling, abdominal discomfort on the developmental side. A luteal cyst producing progesterone can cause a delay in menstruation or, on the contrary, prolonged menstruation due to uneven rejection of the endometrium. Luteal ovarian cysts never malignate.
The most common symptoms develop with a complicated course of the ovarian corpus luteum cyst – twisting of the leg, hemorrhage into its cavity or ovarian apoplexy. In all these cases, there is a clinical picture of an acute abdomen – cramping acute pains having a diffuse character, vomiting, tension and sharp abdominal pain, positive peritoneal symptoms, gas and stool retention, disappearance of peristaltic noises, intoxication, etc.
Diagnosis of the ovarian corpus luteum cyst is carried out taking into account anamnesis, complaints, gynecological examination data, ultrasound, laparoscopy. Vaginal examination reveals a tight-elastic formation on the side of the uterus or behind it, which has limited mobility and sensitivity during palpation.
Echoscopically, the cyst of the corpus luteum is determined as an anechoic homogeneous formation of a round shape from 4 to 8 cm in diameter, with smooth clear contours, sometimes with a fine suspension inside. For accurate recognition of a luteal cyst, dynamic ultrasound is performed in the first (follicular) phase of the menstrual cycle. Color Dopplerography (CDG) is aimed at eliminating vascularization of the internal structures of the cyst and differentiating retention formation from true ovarian tumors.
As with other detected tumors and ovarian cysts, a study of the cancer marker CA-125 is shown. To exclude or confirm pregnancy, the determination of chorionic gonadotropin, a pregnancy test is carried out. In cases where the corpus luteum cyst is difficult to differentiate from other neoplasms (ovarian cysts, tecalyutein ovarian cysts with chorionepithelioma and vesicular drift, etc.) and ectopic pregnancy, diagnostic laparoscopy is required.
Patients with a small and clinically non-manifest ovarian corpus luteum cyst are shown gynecologist observation, ultrasound dynamic monitoring and CDG during 2-3 menstrual cycles. During this period, the cyst may undergo regression and disappear completely.
Symptomatic and recurrent ovarian corpus luteum cysts can also resolve under the influence of conservative anti-inflammatory therapy, selection and administration of hormonal contraceptives, balneotherapy (therapeutic baths and vaginal irrigation), peloidotherapy, laser therapy, SMT-phoresis, electrophoresis, ultraphonophoresis, magnetotherapy. For the period of treatment of the ovarian corpus luteum cyst, physical activity and sexual activity are limited in order to avoid twisting or rupture of the tumor-like formation. If the luteal cyst does not resolve within 4-6 weeks, the issue of its prompt removal is resolved.
Planned intervention for a corpus luteum cyst is most often limited to laparoscopic exfoliation of the cyst within unchanged ovarian tissues and suturing of its wall or ovarian resection. In case of complications (necrotic changes in ovarian tissues, bleeding, etc.), laparotomy with oophorectomy is indicated as an emergency.
Prevention and prognosis
Prevention of the formation of functional ovarian cysts is facilitated by timely and complete treatment of inflammation of the organs of the reproductive system, as well as correction of disturbed hormonal balance. Observation of a gynecologist-endocrinologist and ultrasound control when detecting corpus luteum cyst allows you to take the necessary measures in time and prevent complications. Corpus luteum cyst does not pose a threat to developing pregnancy. With spontaneous regression or planned removal of the ovarian corpus luteum cyst, the prognosis is favorable.