Endometrioid cysts of the ovary, in contrast to functional cysts, have a different mechanism of development and in the vast majority of cases are bilateral. In gynecology, the endometrioid ovarian cyst refers to the frequently occurring manifestations of the genital form of endometriosis. in which the cells of the mucous membrane lining the inner surface of the uterus are found in the fallopian tubes, ovaries, vagina and abdominal cavity. The resulting endometriotic foci are functionally active and hormone dependent, so they are cyclically exposed to a menstrual-like reaction. The growth of the monthly bleeding endometrial tissue in the cortical ovarian layer leads to the formation of endometrioid ovarian cysts (“chocolate” cysts) filled with dark, brown contents that have not found an outlet.
The endometrioid ovarian cyst develops in women of reproductive age (30-50 years), usually against the background of internal endometriosis, can be combined with uterine fibroids and endometrial hyperplasia. The size of the endometrioid ovarian cyst can reach 10-12 cm. The histological sign of the endometrioid ovarian cyst is the absence of glands in its wall.
Causes of endometrioid ovarian cyst.
Despite the large number of theories of the origin of endometriosis, the exact causes of the disease are still unknown. According to the implant hypothesis, endometriosis and endometrioid ovarian cysts can occur during retrograde menstruation, when endometrial cells along with blood migrate and settle down in the tissues of the fallopian tubes, ovaries, abdominal cavity.
Skidding of endometrial scraps is also possible with surgical manipulations injuring the uterine mucosa: gynecological and obstetrical operations, diagnostic curettage. medoborte. diathermocoagulation of the cervix. It is also suggested that endometriotic foci may be the result of metaplasia of embryonic tissue remains, genetic defects (familial forms of endometriosis), or weakening of immune responses.
There is a relationship between the development of the endometrioid ovarian cyst and endocrine disorders in the body: a decrease in the level of progesterone, an increase in the level of estrogen (hyperestrogenia) and prolactin, dysfunction of the thyroid gland, adrenal cortex. Provoking moments in the development of endometriosis can act: any emotional stress; prolonged use of the IUD; endometritis. oophorites. impaired liver function, obesity. adverse ecology.
Symptoms of the endometrioid cyst of the ovary.
The severity of clinical manifestations of the endometrioid ovarian cyst depends on a number of factors: the extent of endometriosis, the presence of concomitant diseases, the psychological state of the patient, etc. In a number of cases, the formation of the endometrioid ovarian cyst is asymptomatic or manifests a violation of reproductive function (infertility). The endometrioid ovarian cyst can be accompanied by a pain syndrome in the lower abdomen and in the lumbar region, which increases during menstruation, with sexual intercourse. Sometimes the pain can be very severe, and with a large size and rupture of the capsule, a clinic of the “acute abdomen develops.
For the endometrioid ovarian cyst characterized by profuse menstrual, lengthening of the menstrual cycle with smearing secretions before and after menstruation. Perhaps the appearance of symptoms of intoxication: weakness, nausea, fever.
The proliferation of the endometrioid ovarian cyst can lead to local changes in ovarian tissue: oocyte degeneration, follicular cysts. the appearance of scars that disrupt the normal functions of the ovary. With the prolonged existence of the endometrioid ovarian cyst, a soldering process in the small pelvis may occur, with impaired functions of the intestine and bladder (constipation, flatulence, violation of urination). Endometrioid cyst of the ovary is a serious gynecological pathology, which can be complicated by suppuration, rupture of the cyst walls with outflow of its contents into the abdominal cavity and development of peritonitis.
Diagnosis of the endometrioid cyst of the ovary.
Gynecologic examination does not always reveal signs of endometriosis. In the endometrioid ovarian cyst, the presence of sedentary painful formation in the ovary and its increase before menstruation can be detected. Diagnosis of the endometrioid cyst of the ovary is determined by ultrasound of the pelvic organs with dopplerometry of the uterine-placental blood flow. MRI and laparoscopy.
Ultrasound with dopplerometry determines the absence of blood flow in the walls of the endometrioid ovarian cysts. When determining the level of the oncoprotein CA-125 in the blood, its concentration may be normal or slightly increased. In the presence of infertility, hysterosalpingography and hysteroscopy are performed. Diagnostic laparoscopy is the most accurate method of diagnosis of the endometrioid ovarian cyst. A biopsy and subsequent histological examination of the focus of endometriosis in ovarian tissue is necessary to determine the probability of malignancy.
Treatment of endometrioid ovarian cyst.
Treatment of the endometrioid ovarian cyst can be conservative (hormonal, nonspecific anti-inflammatory and analgesic therapy, administration of immunomodulators, vitamins, enzymes), surgical (organ-preserving removal of endometriotic foci by laparoscopic or laparotomic access) or combined. Complex treatment of endometriosis is aimed at eliminating symptoms, preventing the progression of the disease and treating infertility. The tactics of treating the endometrioid ovarian cyst depends on the stage, symptoms and duration of endometriosis, the age of the patient and the presence of problems with conception, concomitant genital and extragenital pathology.
With a small amount of the endometrioid ovarian cyst, prolonged hormonal therapy with low-dose monophasic COCs, norsteroids (levonorgestrel), prolonged MPA, androgen derivatives, synthetic GnRH agonists is possible. The pain syndrome, associated with the growth of the endometrioid ovarian cyst, is stopped by the use of NSAIDs, spasmolytic and sedative drugs. In case of ineffectiveness of conservative therapy in endometrioid ovarian cysts larger than 5 cm, combination of endometriosis and infertility, risk of complications and oncologic alertness, only surgical treatment is indicated.
Women of reproductive age who want to have children, try to avoid radical operations (oophorectomy, adnexectomy). Preferred methods of endometrial cyst surgery are enucleation of heterotopic formations or ovarian resection. Removal of foci of endometriosis and endometrioid cysts of the ovary is expedient to be carried out with preliminary and postoperative hormone therapy.
Preoperative hormone therapy allows to reduce foci of endometriosis, their blood supply and functional activity, inflammatory reaction of surrounding tissues. After surgical removal of the endometrioid ovarian cyst, appropriate hormonal treatment promotes regression of the remaining endometriotic foci and prevents recurrence of the pathology.
In the postoperative period, the appointment of physiotherapy with the purpose of correcting endocrine imbalance, the prevention of infiltrative and adhesive processes, the recurrence of endometrioid ovarian cysts (electrophoresis, ultrasound, phonophoresis, endonasal galvanization, CMT therapy, magnetotherapy, laser therapy, acupuncture, radon baths, etc.)
Prognosis with endometrioid ovarian cyst.
After removal of the endometrioid ovarian cyst, pain is reduced in most cases, normal menstrual and reproductive functions are restored. After treatment of the endometrioid ovarian cyst, a dynamic observation of the gynecologist with ultrasound – control and level of the CA-125 is recommended.