What are Tumor-like Uterine Appendages?
Retention formations of the ovary (cysts) are the most frequent volumetric pathology of the ovaries and are divided into follicular cysts (83%), corpus luteum cysts (5%), endometrioid (10%), paraovarial (10%), theca-luteal (2%) .
Cysts are not capable of proliferation; they are formed as a result of the retention of excess fluid in the preformed cavities and cause a significant increase in the ovary. Cysts can form from the follicle, corpus luteum, paraovarian (epioophoron), endometrioid hsterotopia implanted on the surface of the ovary.
Causes of Tumor-like Formations of the Uterine Appendages
Cysts are observed mainly in the reproductive period, but are possible at any age, even in newborns. The frequency of cysts in postmenopausal women will be 15%.
Follicular cysts arise from the preovulatory follicle as a result of cystic transformation of the non-ovulating follicle during anovulatory menstrual cycle as a result of hormonal disorders. Experimental data indicate that follicular cysts occur in connection with a primary decrease in ovarian estrogen function and subsequent persistent impairment of the pituitary gonadotropic function (increased FSH secretion with decreased LH secretion).
Follicular cysts develop mainly in reproductive age, in rare cases, mogugs occur in postmenopausal women. Sometimes they are detected in fetuses and newborns. The formal sign of the transition of the physiological process of follicular maturation into a pathological follicular cyst is the diameter of the fluid formation of more than 30 mm. Fluid accumulates in the cavity of the cyst, either as a result of transudation from blood vessels, or as a result of continued secretion by granulosa epithelium. It is believed that the follicular epithelium does not participate in the accumulation of fluid.
Morphologically, a follicular cyst is a thin-walled fluid formation, the wall of which consists of several layers of the follicular epithelium. Outside of the follicular epithelium is fibrous connective tissue. As the cyst enlarges, the follicular epithelium undergoes dystrophic changes, becomes thinner, desquamated, and undergoes atrophy. The cyst wall can only consist of connective tissue lined with flat or cubic cells from the inside. In most cases, these cysts are single chamber. However, several cysts may occur in the ovary at the same time, which, gradually increasing, merge with each other, in connection with which the impression of a multi-chamber formation is created. Follicular cysts occur only with a single-phase menstrual cycle.
Follicular cysts occur in women with endocrine-metabolic disorders that contribute to the development of hyperestrogenia and chronic apovulation.
Macroscopically, follicular cysts are small (with a diameter of 50-60 mm), smooth and thin-walled formations. Follicular cysts contain a clear, light yellow liquid.
Symptoms of Tumor-like Formations of the Uterine Appendages
Clinically, follicular cysts in most cases do not show anything. In some cases, there is a delay in menstruation, pain in the lower abdomen of various intensities is possible. Pain usually appears during the period of cyst formation.
Relatively rare complications include torsion of the cyst legs, rupture of the cyst wall or hemorrhage into the cavity of the formation. Clinically, these complications are manifested by severe pain in the lower abdomen, accompanied by nausea, vomiting. Torsion of the legs of the cyst leads to an increase in education as a result of impaired venous circulation, swelling of the tissue and hemorrhage.
Diagnosis of Tumor-like Formations of the Uterus Appendages
During a gynecological examination, the follicular cyst is palpated laterally or anterior to the uterus, elastic consistency, more often one-sided, round, with a smooth surface, 6-8 cm in diameter, mobile, slightly painful. Bilateral follicular cysts are often the result of ovarian hyperstimulation in the treatment of infertility.
The diagnosis is established on the basis of the clinical picture and dynamic ultrasound with CDK and laparoscopy.
Follicular cysts on echograms are single-chamber rounded formations located mainly on the side or back of the uterus. The inner surface of the cyst is even, smooth, its wall is racing, about 1 – 2 mm, the contents are homogeneous, anechoic (echo-negative). Often, in patients of active reproductive age, a portion of intact ovarian tissue is visualized on the side of the follicular cyst. Behind the formation there is always an acoustic amplification effect. The diameter of the cysts varies from 2.5 to 8 cm.
Dynamic ultrasound makes it possible to differentiate a follicular cyst with smooth-walled serous cystadenoma.
With CDC in the follicular cyst, single sections of blood flow are found that are located exclusively on the periphery of the formation, with a low speed and medium resistance (IR – 0.4 and higher).
Treatment of Tumor-like Formations of Uterine Appendages
With an uncomplicated cyst, patient observation for 6-8 weeks and conservative anti-inflammatory or hormonal therapy are indicated. Follicular cysts undergo gradual regression and usually disappear within 1-2, less often 3 menstrual cycles.
Spontaneous recovery is possible only with active granulosa epithelium in the follicular cyst. The severity of this layer is inversely proportional to the size of the cyst and the duration of its persistence. If conservative treatment is ineffective or complications occur, surgical treatment is indicated. With follicular cysts, it is possible to use laparoscopic access, in which the cyst is husked if the preserved ovarian tissue is not changed, or the tumor formation is removed.
After surgical treatment, therapy aimed at normalizing menstrual function is recommended – cyclic vitamin therapy (folic acid, ascorbic acid, vitamin E), drugs of the nootropic group (nootropil or piracetam) and estrogen-gestagen drugs for 3 months. At perimenopausal age, the uterine appendages on the side of the cyst are removed.