Paraovarial cyst is a tumor–like cavity formation formed from the appendage of the ovary. Disease can be asymptomatic or cause periodic abdominal and lower back pain; sometimes the cyst is accompanied by menstrual irregularities and infertility. Complications can be suppuration of a parovarial cyst, twisting of the leg, rupture of the capsule. Diagnostics using vaginal examination and ultrasound. Treatment consists in peeling the cyst while preserving the ovary and fallopian tube.
General information
Paraovarial cyst is located intraligamentarily, in the space bounded by the leaves of the broad uterine ligament, between the ovary and the fallopian tube. This is a single-chamber cavity formation that occurs when embryogenesis is disrupted from the tubules of a rudimentary formation – the parotid appendage (paraovarium). This diseaset is usually detected during puberty, at the age of up to 20 to 40 years, less often – at puberty. In gynecology, paraovarial cysts occur in 8-16% of all detected additional ovarian formations.
Characteristic
A paraovarial cyst is a smooth-walled formation of oval or rounded shape, of a tight-elastic consistency, located on the side or above the uterus. The walls of the paraovarial cyst are thin (1-2 mm) and transparent, inside they have a lining of single-row flat, cubic and cylindrical epithelium. A parovarial cyst contains a homogeneous, transparent, watery liquid with a large amount of protein and a low content of mucin.
An enlarged fallopian tube runs along the upper pole of the paraovarial cyst; the ovary is located at the posterior-lower surface. The blood supply to the cavity formation is carried out by the vessels of the mesentery, the fallopian tube and the own vessels of the cyst wall. The leg of the paraovarial cyst is formed by a leaf of a wide ligament, sometimes by its own ovarian ligament and fallopian tube.
The paraovarial cyst is sedentary, grows slowly and may have insignificant dimensions for a long time. An increase in the cyst occurs due to the accumulation of contents and stretching of its walls. The average size of symptomatic paraovarial cysts is 8-10 cm; in rare cases, the size of the cyst can reach the head of a newborn. Paraovarial cysts never malignate.
Inflammation of the ovary and uterine appendage (oophoritis, adnexitis), endocrine diseases (including hypothyroidism), early sexual development, repeated surgical termination of pregnancy, STIs, uncontrolled hormonal contraception, insolation (tanning in a solarium or under the sun), local hyperthermia (hot shared baths, warming up). The tendency to increase the paraovarial cyst is observed during pregnancy.
Symptoms
Disease of small size (0.5-2.5 cm in diameter) have no clinical symptoms. Symptoms usually appear when disease reaches a size of 5 cm or more. With the growth of the cyst, there are periodic aching or bursting pains in the side and sacrum that are not associated with menstruation and ovulation, which increase with activity and exertion and spontaneously stop.
Compression of the bladder or intestines causes dysuric disorders, constipation or frequent urge to defecate; dyspaurenia and abdominal enlargement may occur. In some cases, menstrual cycle disorders and infertility develop against the background of paraovarial cysts. With complicated variants of a paraovarial cyst (twist of the leg, rupture of the capsule), symptoms of an acute abdomen develop.
Diagnostics
The detection of a paraovarial cyst more often occurs during a planned ultrasound or gynecologist consultation, sometimes when performing diagnostic laparoscopy for infertility. With a bimanual gynecological examination, a unilateral painless tumor-like formation with smooth contours, elastic consistency, and limited mobility is palpated from the side or above the uterus.
In the process of transvaginal ultrasound, a rounded or ovoid thin-walled formation with a homogeneous anechoic content is determined, less often with a fine suspension inside. The echoscopic criterion is the visualization of an intact ovary. Pathology is differentiated with ectopic pregnancy, ovarian cyst, and true ovarian tumors.
Treatment
Unlike functional retention formations of the ovary (corpus luteum cysts, follicular cysts), this disease do not disappear on their own. An asymptomatic paraovarial cyst of small size can be left under dynamic observation. However, due to the fact that paraovarial cysts are diagnosed in patients of reproductive age, they are often complicated and not always correctly differentiated, surgical tactics – cyst enucleation is preferable in their relation. Also, planned removal of a paraovarial cyst is required before planning pregnancy or IVF.
Removal of a paraovarial cyst, as a rule, is performed during operative laparoscopy, less often – laparotomy. With an uncomplicated course of a paraovarial cyst, the anterior leaf of the broad uterine ligament is dissected during the operation, and the cyst is exfoliated from the intraligmental space. The ovary and fallopian tube are preserved during enucleation of a paraovarial cyst. After removal of the paraovarial cyst, due to the retraction properties, the deformed fallopian tube contracts and takes its former shape. In exceptional cases, it is possible to perform a targeted puncture with aspiration of serous contents and simultaneous injection of alcohol into it, which promotes obliteration of the cavity.
Complications
With intense physical exertion, sudden changes in body position, excessive insolation or local hyperthermic exposure, a paraovarial cyst can be complicated by twisting of the leg, suppuration of the contents, rupture of the capsule.
When the cyst leg is twisted, the uterine ligament, nerve and vascular trunks, and often the fallopian tube, are squeezed. In this case, necrosis of the paraovarial cyst develops, which is accompanied by a sharp deterioration in well-being: cramping pains throughout the abdomen, not relieved by taking analgesics; tension of the anterior abdominal wall, gas retention, tachycardia, falling blood pressure, pallor of the skin, sticky cold sweat.
Suppuration of a paraovarial cyst can be caused by lymphogenic or hematogenic drift of pathogenic microflora. This complication is manifested by fever from t ° to 38-39 ° C, intoxication, sharp spilled abdominal pain, vomiting. When a paraovarial cyst ruptures, there are general shock phenomena, sharp pains, signs of internal bleeding. All complications require emergency surgical intervention in the volumes dictated by the clinical situation (for example, oophorectomy, adnexectomy).
Forecast
Conception against the background is quite likely, however, with the increase in the uterus and its exit beyond the pelvis, the risks of twisting the cyst leg increase. Pregnancy management in patients with paraovarial cyst requires constant dynamic monitoring of the state of education.
After surgical treatment of a paraovarial cyst, there are no relapses, since the vestigial tissues from which the formation is formed are completely removed. Modern gynecology recommends planning a pregnancy no earlier than 3-4 menstrual cycles after the operation.
