Pseudomucinous ovarian cyst is a benign true ovarian neoplasm consisting of epithelial elements producing a mucus–like substance (pseudomucin). Pseudomucinous ovarian cyst is manifested by heaviness and abdominal pain, an increase in abdominal volume, disorders of defecation and urination. Diagnosis of ovarian cysts includes vaginal examination, ultrasound, laparoscopy. Tactics in relation to pseudomucinous ovarian cysts are exclusively surgical in the amount of removal of the neoplasm, ovariectomy, removal of appendages or supravaginal amputation of the uterus with appendages.
General information
Pseudomucinous cyst is the largest tumor of the ovaries; it develops with a violation of the embryonic differentiation of germ leaves from ectodermal elements, epithelium of Muller channels, vestigial mesonephros and integumentary ovarian epithelium. Pseudomucinous cyst is a predominantly unilateral epithelial ovarian tumor of a round or ovoid shape, of a tight elastic consistency, with an uneven surface. Most often, pseudomucinous ovarian cysts are multicameral: they consist of the main and daughter cystic cavities of various sizes, which are filled with viscous translucent contents (pseudomucin), sometimes with an admixture of blood. The cavities of pseudomucinous ovarian cysts are lined with a high prismatic single-layer epithelium similar to the epithelium of cervical cervical glands.
The wall of the pseudomucinous ovarian cyst is smooth on the outside, covered with a low cubic epithelium, under which there is a layer of connective tissue with blood vessels and lymphatic ducts; the inner surface of the capsule is smooth, sometimes with papillary growths. Disease has a leg, due to which the tumor is very mobile. It is capable of rapid growth in an everting type, can reach significant sizes (up to 30-50 cm) and eventually become malignated.
In gynecology, it is customary to distinguish secernating (not showing proliferative activity), proliferating (precancerous with intense proliferation, polymorphism and hyperchromatosis of the epithelium) and malignated (malignant) pseudomucinous ovarian cysts. Pseudomucinous ovarian cysts most often develop in women over the age of 40.
Symptoms
Pseudomucinous ovarian cyst can develop asymptomatically and even with a large size is not accompanied by any complaints. Sometimes patients pay attention to an increase in the volume of the abdomen or independently feel the tumor through the anterior abdominal wall.
With a small mobile pseudomucinous ovarian cyst, the menstrual cycle and the functions of neighboring organs are not disrupted; with a significant increase in the size and limited mobility of the tumor, heaviness and pain appear in the lower abdomen, in the lower back, difficulty or frequent urge to defecate and urinate. These disorders are caused by infringement of the capsule of pseudomucinous ovarian cyst, compression of the bladder and ureters, rectum, compression of the sacral nerve plexus, venous and lymphatic vessels. Pseudomucinous ovarian cyst can have adhesions with surrounding organs, combined with other tumors of the genitals (usually with uterine fibromyoma). Ascites with this type of ovarian cyst rarely occurs.
If the pseudomucinous ovarian cyst is too large, complaints of shortness of breath, palpitations, swelling of the lower extremities appear. Complications inherent in ovarian tumors may occur: twisting of the leg or rupture of the capsule, infringement, suppuration, hemorrhage in the tumor cavity, necrosis.
The twisting of the tumor leg often occurs as a result of sudden movements, lifting weights. With complete twisting of the leg of a pseudomucinous ovarian cyst, symptoms of acute abdominal pain occur: severe sharp pain, muscle tension of the anterior abdominal wall, vomiting, hyperthermia, tachycardia; with partial twisting, clinical symptoms are less pronounced. Rupture of the shell of a pseudomucinous ovarian cyst can develop as a result of trauma, lead to the outpouring of the contents of the tumor into the abdominal cavity.
Diagnostics
Disease can be diagnosed with a bimanual gynecological examination. In the area of the appendages of the uterus, a unilateral tuberous formation of a rounded shape, elastic consistency, mobile and painless, sometimes of considerable size is determined. With transabdominal or transvaginal ultrasound, a unilateral formation with multiple septa and mucus-like contents is visualized.
To exclude ovarian cancer, blood is examined for the cancer marker CA-125. Additionally, if there are indications, cystoscopy, survey urography, rectoscopy, irrigoscopy are performed; consultations of a urologist and a proctologist are conducted. In case of a doubtful diagnosis, diagnostic laparoscopy is indicated.
Treatment and prevention
The tactics for pseudomucinous ovarian cyst is surgical, the volume is determined by the age of the patient and the nature of the tumor: at a young age, it is possible to limit yourself to minimal surgical intervention – removal of the cyst (separately, within healthy tissues or together with the ovary) and its subsequent histological examination. When establishing the fact of malignancy of a pseudomucinous ovarian cyst, repeated extended laparotomy is performed with the removal of the ovaries (oophorectomy), supravaginal amputation of the uterus and resection of the large omentum.
In late reproductive age, removal of appendages is indicated, in postmenopause – simultaneously with removal of the uterus and resection of the large omentum. In case of twisting of the leg of a pseudomucinous ovarian cyst and symptoms of an acute abdomen, urgent surgical intervention is performed, the volume of which depends on the intraoperative picture.
Specific prevention of pseudomucinous ovarian cysts has not been developed. The exclusion of a complicated course and malignancy is possible with regular preventive examinations by a gynecologist, Doppler ultrasound and planned removal of a pseudomucinous ovarian cyst in case of its detection.