Serous ovarian cystadenoma is a true benign tumor originating from the epithelial tissue of the organ. With small sizes (up to 3 cm), the disease is asymptomatic. As the neoplasm grows, the patient experiences dull, aching or cramping pains in the lower abdomen and lower back, as well as signs of compression of neighboring organs (frequent urination, constipation, swelling of the legs, etc.). Bimanual examination, ultrasound, CT and MRI of pelvic organs, blood test for cancer markers are used for diagnosis. The only effective method of treating serous cystadenoma is surgery to remove the neoplasm, ovary, appendages or uterus with appendages.
General information
Serous cystadenoma (serous cyst, simple, cilioepithelial or smooth—walled cystadenoma) is a tight-elastic benign neoplasm of the ovary located to the side or posterior to the uterus. Usually the tumor develops at the age of 30-50 years. In more than 80% of patients, the diameter of the tumor is from 5 to 16 cm, but in some late-diagnosed cases, its dimensions reached 30-32 cm. The frequency of simple cystadenoma is 11% of all ovarian neoplasms and 45% of serous (cilioepithelial) tumors. As a rule, a neoplasm occurs on one side. In 72% of cases, it is single—chamber, in 10% of patients — two-chamber and in 18% – multi-chamber.
Causes
To date, there is no scientifically confirmed theory of the occurrence of a simple cyst. According to some gynecologists, such a neoplasm is formed from functional ovarian cysts — follicular and corpus luteum, which did not completely resolve and began to fill with serous contents. Predisposing factors to the development of simple ovarian cystadenoma are:
- Hormonal disorders that prevent the normal maturation of the egg. An imbalance in the female hormonal sphere can be observed with the extinction of reproductive function, concomitant somatic and endocrine diseases, stress, significant physical and emotional overload, extreme diets, prolonged sexual abstinence.
- Early puberty with the appearance of the first menstruation at the age of 10-12 years.
- Inflammatory female diseases (endometritis, adnexitis, etc.). Diseases caused by STI pathogens in disordered sexual life without barrier contraception are especially dangerous.
- Operations on the pelvic organs. Simple serous cystadenomas are somewhat more common in patients who have undergone ectopic pregnancy, abortions, surgical treatment of gynecological diseases.
- Burdened heredity. According to some observations, in women whose mothers suffered from serous neoplasms of the ovaries, cystadenoma is detected more often.
Pathogenesis
Serous cyst, as a rule, is formed in one of the ovaries. At first, it is a small smooth—walled single-chamber (less often – multi-chamber) neoplasm. Its dense connective tissue walls are lined from the inside with a single-layer cubic or cylindrical ciliated epithelium with secretory activity. As the cystadenoma grows, serous contents accumulate inside — a watery transparent liquid of light yellow color. As a result, the growing tumor-like formation squeezes the surrounding organs and nerve fibers, which leads to the appearance of pain syndrome. When the inflammatory process is attached, the smooth shiny surface of the cyst becomes opaque and becomes covered with adhesions.
Symptoms
Clinical symptoms with small (up to 3 cm) smooth-walled cysts are usually not observed, they become a random find during gynecological examination or ultrasound of the pelvic organs. As the neoplasm increases, the patient has symptoms associated with the pressure of the cyst on neighboring organs. The most typical pain syndrome. It usually has the character of dull, aching, less often cramping pains that occur in the groin area, behind the pubis or in the lower back. In addition, a woman may experience pressure on the bladder, rectum, feel the presence of a foreign body.
With large cysts, it is possible to disrupt the functions of adjacent organs due to their compression, which is manifested by frequent urination, discomfort in the intestines, constipation, nausea, swelling of the lower extremities. In cases where the tumor reaches a size of 6-10 cm or more, it can lead to an increase in the abdomen or its visible asymmetry. The menstrual cycle in serous cystadenomas is usually not disturbed. However, if the neoplasm is large enough and puts pressure on the ovary and/or uterus, the nature of menstruation changes — they become more abundant or too scarce and are accompanied by painful sensations. Extremely rarely, with uncomplicated simple cysts, there is a general reaction of the body in the form of fatigue, weakness, lethargy, reduced efficiency, irritability.
Complications
The main danger of untimely detection and inadequate treatment of serous ovarian cystadenoma is compression of neighboring organs with a violation of their functions and the occurrence of acute conditions. The most serious complications of a cyst requiring urgent surgical treatment are twisting of the leg (if present) with necrosis of the neoplasm and rupture of the capsule (ovarian apoplexy) with its contents entering the abdominal cavity and bleeding. A complicated course of the disease may be indicated by an increase in temperature, a sharp increase in pain, the occurrence of severe nausea or vomiting, severe malaise with headaches, dizziness and loss of consciousness, sharp pallor, bloody discharge from the vagina. Sometimes there is a relapse of the disease after organ-preserving surgery and malignant degeneration of the tumor.
Diagnostics
To confirm or clarify the diagnosis of the disease, conduct differential diagnosis and choose the optimal treatment method, patients with suspected serous cystadenoma are prescribed a comprehensive gynecological examination. It includes:
- Examination by an obstetrician-gynecologist. A bimanual examination in the area of the uterine appendages usually reveals a tight-elastic, mobile, painless formation with a smooth surface that is not associated with neighboring organs.
- Pelvic ultrasound. Allows to identify a homogeneous hypoechoic tumor with a dense smooth capsule of 3 cm in size. With small cystadenomas, transvaginal access is used, with large ones — transabdominal.
- Computer or magnetic resonance imaging. During the tomographic examination, a three-dimensional model of the cystadenoma and adjacent organs is created to conduct a more thorough differential diagnosis and exclude tumor germination.
- Blood test for cancer markers. The study of tumor antigens (CA-125, CA 19-9, CA 72-4) makes it possible to exclude the development of an oncological process or a purulent abscess in the ovary and other pelvic organs.
- Color Dopplerography. The diagnostic method is additional and in doubtful cases allows differentiating a benign ovarian tumor from a malignant one based on the intensity of blood flow.
Simple serous cystadenoma must be distinguished from other benign ovarian neoplasms, primarily functional cysts, papillary and pseudomucinous cysts. To exclude metastasis to the ovary of one of the forms of stomach cancer, patients are necessarily prescribed fibrogastroduodenoscopy. Fibrocolonoscopy makes it possible to assess the degree of involvement of the sigmoid and rectum in the process. An alternative solution if it is impossible to conduct an endoscopic examination of the stomach, rectum and sigmoid colon is a radiography of the gastrointestinal tract.
Also, in the course of differential diagnosis, malignant ovarian lesion, tubovarial abscess, ectopic pregnancy, pathology of adjacent organs — acute appendicitis, kidney dystopia and other malformations of the urinary system, diverticulosis of the sigmoid colon, bone and extraorgan pelvic tumors are excluded. In such cases, in addition to laboratory and instrumental examination, consultations of related specialists are prescribed — a surgeon, oncologist, gastroenterologist, oncologist, urologist.
Treatment
The main method of treating a simple serous cyst is surgical removal of the tumor. There is no reliable data on the effectiveness of medicinal and non-medicinal methods of treating this disease in gynecology. When choosing a specific type of surgery, the patient’s age, the presence or planning of pregnancy, and the size of the tumor are taken into account. The main goals of treatment of patients of reproductive age are the maximum preservation of healthy ovarian tissue and prevention of tubal—peritoneal infertility (TPB). Radical operations aimed at preventing the recurrence of cystadenoma and preserving the quality of life are recommended for women during perimenopause.
The indication for the planned operation is the presence of a tumor-like formation with a diameter of 6 cm, which persists for 4-6 months. The gynecologist makes a decision on the timing of the removal of a smaller neoplasm individually, taking into account the results of dynamic observation. In an emergency, surgical intervention is performed if there is a suspicion of twisting of the leg or rupture of the cyst capsule. Usually, elective surgery is performed laparoscopically. The main types of surgical interventions for smooth- walled serous cystadenoma are:
- Cystectomy (cyst removal) or wedge-shaped resection (excision of damaged tissue in the form of a wedge) with preservation of the ovary, revision of the contralateral ovary and emergency histological diagnosis. Organ-preserving operations are recommended for young women planning pregnancy with a cystadenoma no more than 3 cm in diameter.
- Unilateral ovariectomy or adnexectomy. The intervention involves the removal of the entire ovary or ovary with a fallopian tube on the side of the lesion and is considered the optimal solution for women of reproductive age with a neoplasm larger than 3 cm.
- Bilateral adnexectomy or hysterectomy with appendages. The recommended method of surgical treatment in women during perimenopause and in patients with bilateral ovarian lesions. Its advantage is a significant reduction in the risk of developing cancer.
Prognosis and prevention
With timely detection and surgical treatment, the prognosis of the disease is favorable: serous cystadenoma rarely recurs and becomes malignant. Women of reproductive age who have undergone organ-preserving interventions, unilateral ovariectomy or adnexectomy are recommended to plan pregnancy no earlier than 2 months after surgery. Full recovery after laparoscopic conservative removal of serous smooth-walled ovarian cystadenoma occurs in 10-14 days, after radical operations, the recovery period lasts up to 6-8 weeks. Patients are shown dispensary observation by a gynecologist. According to the observations of American specialists, the use of combined oral contraceptives of monophasic action has a preventive effect on the development of benign ovarian cystadenomas.