Tecalyutein ovarian cyst is a retention formation of ovarian tissue, represented by atresized follicles with a layer of tecalyutein cells. The appearance of a tecalyutein cyst, as a rule, is associated with trophoblastic disease or drug hyperstimulation of ovulation. A tecalyutein ovarian cyst can cause discomfort in the pelvic region; with a rupture or twisting of the leg, the development of an acute abdominal clinic. Diagnosis of tecalyutein cysts is based on anamnesis data, the results of gynecological and ultrasound examination. Tecalyutein ovarian cysts usually do not require treatment and regress spontaneously after the end of gestation or removal of the trophoblast. Surgical tactics are required when the cyst is preserved and its complicated course.
General information
In gynecology, tecalyutein cysts account for 2 to 10% of all ovarian cystic formations. Tecalyutein ovarian cysts are usually multiple, with symmetrical bilateral localization. Macroscopically, a tecalyutein cyst looks like a thin-walled multicameral formation filled with light or pale yellow liquid contents. When examining a cyst under a microscope, atresized follicles containing luteinized cells are determined. The sizes of tecalyutein ovarian cysts vary from 6 to 30-40 cm .
Causes
The development of tecalyutein ovarian cysts is always caused by exposure to high concentrations of chorionic gonadotropin (HCG), which causes hyperstimulation of follicles. Less often, the cause is luteal hyperreaction associated with increased sensitivity of follicles to HCG. High levels of HCG are found in trophoblastic disease (vesicular drift or chorionepithelioma), therefore, 25-60% of patients with trophoblast diseases are diagnosed with tecalyutein ovarian cysts.
Sometimes the formation of tecalyutein ovarian cysts occurs during a normally occurring multiple pregnancy, gestation against the background of diabetes mellitus, hypertension, late pregnancy toxicosis, Rh incompatibility. The presence of tecalyutein ovarian cysts can be detected even in newborns; giant (up to 8-12 cm in diameter) cysts can squeeze neighboring organs, causing intestinal obstruction.
In addition, tecalyutein ovarian cysts are also found outside pregnancy, for example, when prescribing gonadotropins, clostylbegite (clomiphene) to stimulate superovulation in in vitro fertilization programs. Such tecalyutein ovarian cysts are usually single, unilateral and single-chamber.
Symptoms
Tecalyutein ovarian cysts often do not manifest clinically in any way. Large cysts can cause feelings of bursting or pressure in the lower abdomen. During pregnancy or trophoblastic disease, softening and an increase in the size of the uterus is observed. Tecalyutein ovarian cysts, as a rule, do not complicate the course of pregnancy: the size of the uterus corresponds to the gestation period, the movement and heartbeat of the fetus is not disturbed. In women with a tecalyutein ovarian cyst caused by taking drugs to stimulate ovulation, the uterus has a normal size and dense consistency.
The presence of ascites is uncharacteristic for tecalyutein ovarian cysts. Complications of cysts (capsule rupture, leg twist, necrosis, bleeding) are extremely rare. In these cases, the picture of an acute abdomen comes to the fore – sudden pain syndrome, hypotension, tachycardia, vomiting, pallor of the skin.
Diagnosis
All patients with tecalyutein ovarian cysts are characterized by a history of pregnancy, complications associated with it, or taking medications to induce ovulation. During gynecological examination, cysts are defined as additional formations of one or both ovaries, with a diameter of 6 to 20 cm or more, painless on palpation. The presence of pregnancy or trophoblast pathology is accompanied by a positive result of specific tests.
Ultrasound of the small pelvis reveals echoscopic signs typical of tecalyutein ovarian cysts: multi-chamber structure, homogeneous contents without additional inclusions, symmetry of location, etc. In unclear cases, diagnostic laparoscopy or laparotomy is resorted to.
Intraoperative diagnosis of tecalyutein cysts is not difficult: when examining the ovary, a cluster-shaped, tense, thin-walled formation is determined. On the incision, the inner surface of the cyst is yellow, a yellowish liquid is released from the chambers. When diagnosing a tecalyutein cyst, it is differentiated from ovarian cysts, corpus luteum cysts, ovarian cancer.
Treatment
When excluding data for neoplastic ovarian lesions (absence of ascites, bleeding, dissemination, etc.), a conservative and expectant tactic is chosen with dynamic ultrasound examination of the patient after childbirth or during subsequent menstrual cycles. Usually, after the resolution of pregnancy or evacuation of trophoblast tissues, with the normalization of HCG levels, tecalyutein ovarian cysts spontaneously disappear within 2-4 months. It is possible to perform puncture sclerotherapy of tecalyutein ovarian cysts under the control of ultrasound. In case of rupture or twisting of the cyst leg, laparoscopic wedge-shaped resection of the ovaries is performed.
