Ovarian fibroid is a connective tissue, hormonally inactive ovarian tumor of benign nature. Symptoms develop when the tumor reaches a significant size and is manifested by ascites, anemia, less often hydrothorax (Meigs syndrome). Gynecological examination, ultrasound, CT are used in the diagnosis; a clarifying diagnosis of ovarian fibroid is made based on the results of histological examination of tumor tissues. Treatment is operative – removal of the tumor, sometimes together with the affected appendage of the uterus.
D27 Benign ovarian neoplasm
In practical gynecology, fibroid occurs in 10% of cases among benign ovarian neoplasms. Disease are not registered before puberty. The tumor can occur starting from puberty, but most often develops during premenopause and menopause (40-60 years). The size of the tumor can vary from 3 to 15 cm, the neoplasm has a unilateral localization.
The causes are not precisely established, but the risk factor may be an unfavorable premorbid background of the patient, including:
- endocrine pathology (violation of menstrual and reproductive functions);
- reduced immune protection;
- inflammation of the appendages and ovaries (adnexitis, oophoritis).
Ovarian fibroid is a rounded or ovoid formation with a smooth or knobby surface, the size of which can reach 10-12 cm. In the presence of pseudo-cavities, the consistency of ovarian fibroid can be tightly elastic, with pronounced edema – soft, with the deposition of calcium salts – hard. Ovarian fibroid, as a rule, is one-sided and mobile, since it has a leg.
Ovarian fibroid on the slice is white or white-gray in color, usually poor in blood vessels; with the prolonged existence of a tumor in its center, foci of ischemia with necrosis, hemorrhages, degenerative changes with a brownish-red hue may be observed. Histologically, the tumor consists of bundles of spindle-shaped connective tissue cells intertwining with each other in different directions, with edema, the cells have a stellate shape.
There are two forms of this pathology: delimited (the tumor has a distinct capsule separating it from the ovarian tissue) and diffuse (the ovary is completely affected). Ovarian fibroid tissues are most often edematous and may contain cysts. Ovarian fibroid is a slow-growing tumor, but with dystrophic changes in the tissues, its growth can accelerate. Increased mitotic activity of the tumor is considered a borderline condition with low malignant potential.
Fibroid of small size usually does not affect the function of the ovary, does not prevent the onset and gestation of pregnancy. Hypercellular (cellular) disease can recur, especially if its capsule is damaged during surgery.
Symptoms of ovarian fibroid
With small fibroid sizes (up to 3 cm) and preservation of ovarian function, clinical manifestations may be absent for a long time. With the growth of the tumor, signs of Meigs syndrome develop (ascites, anemia, pleurisy), manifested by bloating, pain, shortness of breath, general weakness and fatigue, tachycardia.
Ascites is a frequent symptom of ovarian fibroid, occurs when transudate is released from the tumor into the abdominal cavity. Hydrothorax is caused by the ingress of ascitic fluid through the gaps of the diaphragm from the abdominal cavity into the pleural. In some cases, ovarian fibroid may be accompanied by polyserositis and cachexia (as a rule, with malignant degeneration of the tumor). The severity of the disease is largely determined by the compression of neighboring organs with fluid, especially with polyserositis.
The menstrual cycle is usually not disturbed. When disease is combined with other diseases of the genitals, the clinical picture is characterized by a combination of their symptoms: for example, in the presence of uterine fibroma, menometrorrhagia may be attached.
Complications of ovarian fibroid include leg twisting, necrosis, hemorrhage, tumor suppuration, and the likelihood of malignancy. Pronounced symptoms of irritation of the peritoneum appear with hemorrhages and necrosis in the ovarian fibroid, as well as with twisting of the tumor leg.
Ovarian fibroid is asymptomatic for a long period and can be detected accidentally during examination or surgery for another disease. Diagnosis is possible on the basis of available clinical manifestations, examination by a gynecologist with mandatory two-handed examination; laboratory diagnostics (general blood test, cancer markers CA-125, NOT 4); instrumental methods (ultrasound, MRI, CT of pelvic organs) and histological examination of the tissue of the removed tumor.
- During gynecological examination, it is possible to determine the presence of a formation on the side or back of the uterus, with a smooth or knobby surface, dense, sometimes rocky consistency, mobile and painless.
- Diagnostic ultrasound with CFM reveals a rounded or oval formation with clear, even contours, mainly with a homogeneous echopositive structure, medium (reduced) echogenicity, sometimes with echonegative inclusions. With CFM, the vessels are usually not visualized, which determines the avascularity of ovarian fibroid. In the diagnosis of ovarian fibroid, MRI and CT are equivalent in sensitivity and specificity to ultrasound.
- It is possible to perform pleural puncture and abdominal puncture with cytological examination of the resulting transudate.
- The determining factor in the diagnosis of ovarian fibroid is the histological examination of the tissue of the removed tumor after performing diagnostic laparoscopy.
Differential diagnosis is performed with a subserous myomatous node of the uterus, ovarian cysts, metastatic ovarian cancer, ovarian follicular cyst, corpus luteum cyst.
Conservative (medical) treatment is not carried out, surgical removal of the tumor is mandatory. The volume of surgical intervention and the nature of access are determined by the size of the tumor, the age of the patient, the condition of the other ovary and uterus, the existing concomitant pathology.
In young women with a small size, ovarian fibroids are limited to laparoscopic removal (exfoliation) of the tumor itself with the preservation of menstrual and generative functions. In premenopausal women, oophorectomy or removal of appendages is advisable; with bilateral ovarian damage, they try to leave part of one of them.
Prognosis and prevention
The prognosis is favorable, the probability of malignancy is 1%. Pregnancy can be planned only after the end of the course of rehabilitation treatment. There are no specific ways to prevent ovarian fibroid; it is necessary to visit a gynecologist at least once a year and conduct ultrasound of the pelvic organs in order to detect this disease in a timely manner.