Ovarian cyst is a tumor–like formation of the ovary of a benign nature. It is a cavity on the leg filled with liquid contents and tends to increase its size due to the accumulation of secretions. There are ovarian cysts (follicular, corpus luteum cysts, endometrioid, etc.) and supra-ovarian appendage (paraovarial). It often proceeds asymptomatically, may manifest discomfort and pain in the lower abdomen, menstrual dysfunction, dysuric disorders (with compression of the bladder). It is complicated by twisting of the cyst leg, rupture of the capsule, leading to a picture of acute abdomen and peritonitis.
The term “cyst” (Greek. “kytis” – a bag, a bubble) is used in medicine to denote pathological cavities in organs consisting of a capsule and liquid contents and increasing their size as secretions accumulate. Cysts are the most common type of benign formations and can occur in almost all tissues and organs: teeth, kidneys, liver, mammary glands, pancreas, thyroid gland, male and female genitalia, etc.
The concept of “ovarian cyst” hides a large group of tumor-like neoplasms that differ from each other in structure, causes, course and treatment approaches. Ovarian cysts are benign neoplasms of the gland tissues, usually develop for a long time, their size can vary from a few millimeters in diameter to 20 centimeters or more.
Ovarian cysts are a widespread disease and are more common in women in the childbearing period: in 30% of cases they are diagnosed in women with a regular menstrual cycle and in 50% – with a disturbed one. During menopause, ovarian cysts occur in 6% of women.
Ovarian cysts can develop under the influence of a number of causes, the most common of which are:
- hormonal dysfunction (early menstruation, impaired follicle maturation and ovulation)
- inflammatory processes (oophoritis, adnexitis)
- endocrine diseases: hypothyroidism (decreased thyroid function) and others
- surgical termination of pregnancy: abortions and mini-abortions
Depending on the nature of the origin of the formation and its contents, the following types of ovarian cyst are distinguished:
- Follicular. Follicular cysts refer to formations of a functional nature that form in the ovarian tissue itself and are directly related to cyclic changes occurring in it. They are formed on the site of an unexploded follicle.
- Cyst of the yellow body. It is formed on the site of the unregressed yellow body of the follicle. The pathological cavity in this type of ovarian cyst is formed from the membranes of the corpus luteum. Like the follicular cyst of the ovary, the cyst of the corpus luteum does not reach a significant size and can disappear independently as the secretions dissolve in them and the cystic cavity subsides.
- Paraovarial. Paraovarial cysts originate from supra-ovarian appendages without involving ovarian tissue in the process. Such ovarian cysts can reach gigantic sizes.
- Endometrioid. Endometrioid cysts are formed from particles of the uterine mucosa (endometrium) with its pathological focal growth on the ovaries and other organs (endometriosis). The contents of endometrioid ovarian cysts are old blood.
- Dermoid. Dermoid cysts are congenital formations formed from embryonic rudiments. They contain fat, hair, bones, cartilage, teeth and other fragments of body tissues.
- Mucinous. Mucinous ovarian cysts are often multicameral, they are filled with thick mucus (mucin), which is produced by the inner mucosa of the cyst. Endometrioid and mucinous ovarian cysts are more prone to degeneration into malignant neoplasms.
Symptoms of ovarian cyst
Most of the ovarian cysts do not have pronounced clinical manifestations for a long time and are often detected during preventive gynecological examinations. In some cases (increase in size, complicated course, hormonal secretion, etc.), ovarian cysts can manifest themselves with the following symptoms:
- pain in the lower abdomen
Pain may occur due to possible complications: twisting of the leg, rupture of the membrane, bleeding or suppuration of the ovarian cyst. Constant aching pains are caused by pressure on neighboring organs due to a significant increase in the size of the ovarian cyst.
- enlargement and asymmetry of the abdomen
An increase in the circumference of the abdomen or its asymmetry may be associated with both the large size of the ovarian cyst and ascites (accumulation of fluid in the abdominal cavity).
- symptoms of compression of organs and vessels
, a growing ovarian cyst can squeeze the bladder or lower intestine, which is manifested by dysuric disorders and constipation. Compression of venous vascular bundles can cause varicose veins of the lower extremities.
- menstrual cycle disorders
Hormonally active ovarian cysts cause menstrual irregularities – irregular, heavy or prolonged menstruation, abnormal uterine bleeding. When male sex hormones are secreted by tumors, hyperandrogenization of the body may occur, accompanied by coarsening of the voice, male-type hair growth on the body and face (hirsutism), an increase in the clitoris.
Some types of ovarian cysts can disappear on their own, some require a course of anti-inflammatory or hormonal treatment, and in some cases surgical intervention is required to prevent the development of formidable complications. Ovarian cyst is a potential danger of malignancy, especially the risk of ovarian cancer from mucinous and endometrioid cysts is high. Therefore, in order to prevent the development of cancer, priority in the treatment of ovarian cysts is given to their surgical removal.
Ovarian cyst is most often a mobile formation on the leg. The twist of the cyst leg is accompanied by a violation of its blood supply, necrosis and the phenomena of peritonitis (inflammation of the peritoneum), which is clinically manifested by the picture of an “acute abdomen”: sharp abdominal pain, an increase in body temperature to 39 ° C, vomiting, tension of the abdominal wall muscles. It is possible to twist the cyst together with the fallopian tube and ovary. In these cases, an emergency surgical operation is required, during which the issue of the amount of necessary surgical intervention is resolved.
With some types of ovarian cysts (especially with endometrioid), there is a high probability of rupture of the capsule and the contents pouring into the abdominal cavity. Another complication of an ovarian cyst is infection and suppuration of the formation. In these cases, emergency surgical measures are also required. Ovarian cysts can cause female infertility or complicated pregnancy. Endometrioid ovarian cysts often cause the development of adhesions in the pelvis.
Diagnosis of an ovarian cyst is carried out on the basis of the following methods:
- collection of anamnesis and complaints of the patient
- bimanual (two-handed) gynecological examination, which allows to identify pathological formations in the ovaries, their mobility and soreness
- transabdominal or transvaginal ultrasound diagnostics, which gives an echoscopic picture of the state of the pelvic organs. To date, ultrasound is the most reliable and safe method of diagnosing an ovarian cyst and dynamically monitoring its development
- by puncture of the posterior vaginal arch, which allows detecting the presence of effusion or blood in the abdominal cavity (more often with complicated ovarian cysts)
- diagnostic laparoscopy, which also allows removal of the ovarian cyst, followed by histological examination and final determination of the type
- of tumor, determination of the cancer marker CA-125 in the blood, the increased content of which in menopause always indicates malignancy of the ovarian cyst. In the reproductive phase, its increase is also observed with inflammation of the appendages, endometriosis, simple ovarian cysts
- computer or magnetic resonance imaging (CT or MRI), providing information about the location, size, structure, contents of the ovarian cyst and its relation to the adjacent organs
- a pregnancy test that excludes ectopic pregnancy.
The choice of treatment tactics depends on the nature of education, the severity of clinical symptoms, the patient’s age, the need to preserve reproductive function, and the risk of developing a malignant process. Expectant tactics and conservative treatment are possible with the functional nature and uncomplicated course of the ovarian cyst. In these cases, monophasic or two-phase oral contraceptives are usually prescribed for 2-3 menstrual cycles, a course of vitamins A, B1, B6, E, C, K, homeopathic treatment.
In some cases, dietary therapy, therapeutic gymnastics, acupuncture, treatment with mineral waters (balneotherapy) are indicated. In the absence of a positive effect from conservative therapy or with an increase in the size of the ovarian cyst, surgical intervention is indicated – removal of the formation within healthy ovarian tissues and its histological examination.
The advantages of elective surgical treatment of an ovarian cyst before the occurrence of an emergency situation are quite obvious. In solving the issue of the scope and access of surgical intervention, operative gynecology currently adheres to organ-preserving and low-traumatic techniques. Usually, planned operations to remove an ovarian cyst are performed by laparoscopic access and preserve organ tissues as much as possible.
Laparoscopy is usually not used if it is reliably known about the malignancy of the process in the ovaries. In this case, an extended laparotomy (abdominal surgery) is performed with an emergency histological examination of the tumor. With ovarian cysts , the following types of operations are performed:
- Cystectomy is the removal of a cyst and the preservation of healthy promising ovarian tissue. In this case, the capsule of the ovarian cyst is exfoliated from its bed with a thorough hemostasis. The ovarian tissues are preserved, and after recovery, the organ continues to function normally.
- Wedge–shaped ovarian resection is the excision of the ovarian cyst together with the surrounding tissue.
- Removal of the entire ovary (oophorectomy), often together with tubectomy (i.e. complete removal of appendages – adnexectomy).
Biopsy of ovarian tissue. It is carried out to take ovarian tissue material for histological examination if a cancerous tumor is suspected.
Dermoid, mucinous, and endometrioid ovarian cysts are subject only to surgical removal. It is also necessary to remove the ovarian cyst before the planned pregnancy due to the high risk of twisting its legs or increasing the tumor in size. Early diagnosis of an ovarian cyst and elective surgery can significantly reduce the amount of surgery, recovery time and avoid the terrible consequences of the disease.
With ovarian cysts at a young age, when it is necessary to preserve reproductive function, a cystectomy or resection of the organ is performed with the preservation of healthy unchanged tissues. In the menopausal period, in order to prevent oncological processes, the uterus with appendages is removed – an extended hysterectomy (pangisterectomy). After surgical removal of the ovarian cyst, a course of restorative treatment is prescribed.
Prognosis and prevention
Ovarian cysts of a functional nature can form repeatedly during life, as long as menstrual function persists. Properly selected hormone therapy helps to avoid relapses. It is also possible to resume endometrioid ovarian cysts, but this depends on the correct operation and further treatment. Removed dermoid ovarian cysts do not form again. After removal or conservative treatment of an ovarian cyst, pregnancy may occur.
In order to avoid the risk of complications, ovarian cysts must be diagnosed and treated in a timely manner to preserve the reproductive function. This is possible only with a competent, conscious attitude to your health and regular (2 times a year) preventive examinations by a gynecologist.