Ovarian cystadenoma: causes, treatment. Ovarian cystadenoma: types and methods of treatment

An ovarian cyst is very similar to a serous cystadenoma. These two medical concepts are the most common, which occur in approximately 70 women out of a hundred with ovarian tumors. Cases when pathology develops after fifty years are especially common. Among various diseases, diseases of the reproductive system are quite common.

Cystadenoma is formed from the epidermis and differs from a simple cyst in its tendency to malignant degeneration. Previously, when this pathology was detected, it was necessary to remove the ovaries, but modern medicine already has methods, diagnostics and treatments that make it possible to get rid of the tumor and at the same time preserve reproductive function. Removal of both ovaries and the uterus is usually performed for a malignant tumor with metastases.

Serous ovarian cystadenoma is a benign neoplasm arising from epithelial tissue. Having a capsule no larger than 3 cm in size, the pathology usually does not cause symptoms and does not in any way affect pregnancy and childbirth. Gradually, during development, the patient begins to experience aching, dull or cramp-like pain in the lower back and lower abdomen. You can also observe signs caused by compression of neighboring organs:

• frequent urination;
• swelling of the limbs;
• constipation, etc.

If a patient is diagnosed with this disease, surgical treatment can be performed using several types of operations.

Reasons for development

Medical research is not yet able to determine the exact causes due to which serous ovarian cystadenoma occurs. Based on the opinion of some learned gynecologists, ovarian neoplasms can arise from functional ovarian cysts, that is, formed from follicles. If such a cyst does not completely resolve, it becomes filled with serous contents. More often this disease is observed in women of reproductive age and in women during menopause. There are also other factors in the development of cystadenomas that are related to the reproductive system:

• Hormonal imbalances - disturbances in the female hormonal sphere can contribute to the development of cystadenoma. They are often observed in the presence of endocrine and somatic diseases, under stress, heavy physical and emotional stress.
• Early puberty is the appearance of menstruation between the ages of 10 and 12 years.
• Inflammatory processes in women - such diseases include endometritis and andexitis. They can develop in the case of promiscuous sexual life without the use of contraceptives, which can result in cystadenomas.
• Surgical manipulation of the pelvic organs - the occurrence of simple serous cystadenomas can often be found in women who have undergone surgical treatment of gynecological diseases, ectopic pregnancy, abortion or removal of appendages.
• Heredity - statistical studies prove that women who have had cases of serous ovarian cystadenoma in their family suffer from this disease more often.

Whatever the causes of serous cystadenoma, a woman should immediately be examined by a gynecologist if she suspects signs of this disease.

Classification

Papillary ovarian cystadenoma and other types of serous cystadenoma are often localized in the area of ​​the right ovary, since it is better supplied with blood than the left. However, sometimes it can also occur. Often there is a location on the left - papillary cystadenoma. Simple serous cystadenoma is:

• smooth-walled (simple);
• papillary (papillary);
• rough-papillary;
• mucinous.

Education in the ovary can be small or gigantic in size (from 4 to 15 cm). Simple smooth-walled cystadenoma usually affects only one ovary and has a smooth surface and a single chamber. Sometimes there are tumors that have several chambers with serous contents. Simple cystadenomas are usually diagnosed in women over 40 years of age. Borderline papillary cystadenoma is a transitional form from benign to malignant tumor.

Papillary serous cystadenoma

Serous papillary cystadenoma is the parietal growth of the tumor, which is the main difference from simple serous cystadenoma. In the appendage, papillary serous cystadenoma forms a cyst that is difficult to diagnose. A feature of papillary cystadenoma is the presence of papillae on the epithelial tissue.

Rough papillary serous cystadenoma

Less common is rough papillary cystadenoma, in the form of a chamber formation with the presence of dense whitish papillae. These papillae are formed from fibrous tissue and epithelial cells. The formation of rough papillae is an important diagnostic feature that is not found in non-tumor formations.

Mucinous cystadenoma of the ovary

This ovarian cystadenoma, by its nature, has much in common with the serous one, but differs in the mucous substance located in the cavity. The neoplasm is covered with cells that are similar to those that secrete uterine mucus. The structure of the tumor has chambers with partitions, which are easy to identify using ultrasound of the pelvic organs in gynecology. More often, such pathological foci form simultaneously on the left and right ovaries, and the size of the cyst can reach 30 centimeters. Therefore, treatment is usually carried out through surgery.

Symptoms

Signs of pathology development primarily depend on the size of the tumor. As the tumor grows, patients experience aching pain and discomfort in the area where the cyst is located. Lumbar pain is also possible. Patients may complain of a sensation of foreign objects in the abdominal area.

In the case of the papillary form of the disease, fluid accumulates in the cavities, which can lead to ascites, which promotes abdominal growth. If the patient has a significantly enlarged abdomen, this indicates advanced pathology, which can cause torsion of the leg and rupture of the capsule itself. In this case, cystic contents spill into the peritoneum.

The pain syndrome can radiate to the pubic area, accompanied by pressure on the bladder. Another sign is a disruption of the menstrual cycle, disruption of the urinary organs and constipation, as well as pain during urination and a feeling of heaviness in the abdomen.

Diagnostics

If a woman experiences symptoms of an ovarian cyst, testing should begin immediately. To make a diagnosis, the doctor carries out the following activities:

• blood analysis;
• gynecological examination;
• ultrasonography;
• computer or magnetic resonance imaging;
• tests for tumor markers.

If a malignant neoplasm is suspected, a biopsy may be performed, followed by histological examination of the sample taken.

Treatment

During the treatment of serous cystadenoma, surgery is necessary. It is not possible to get rid of the tumor without surgery. For small cystadenomas, laparoscopy is performed, during which the doctor makes a small incision in the abdominal wall and excises the tumor. Pregnancy after laparoscopy is possible after three or four months.

For large tumors, surgical treatment called laparotomy is performed. During this operation, a large incision is made in the abdomen, through which the tumor is removed along with part of the ovary or the entire appendage. When one appendage is removed, the recovery period lasts approximately a month. After six months, a woman can already plan a pregnancy, since the second ovary is functioning.

Sometimes it is necessary to remove both appendages or even the uterus along with the ovaries and omentum. In this case, the woman will no longer be able to have children and will have to take hormonal medications for the rest of her life in order to compensate for the lost functions of the reproductive system in producing hormones.

Consequences and complications

During the appearance of an ovarian cyst, various complications and consequences may occur. Complications of an ovarian cyst are:

• infertility;
• menstrual irregularities;
• hormonal imbalances;
• rupture of the capsule and torsion of the legs;
• necrosis;
• bleeding.

The bulk of all possible complications are caused by late detection of pathology. The appearance of the first symptoms of such a disease should necessarily alert every woman and send her to the nearest gynecologist for examination.

If the cyst is too large, the patient may undergo a colonoscopy or gastroscopy, since in this case damage to the intestine is possible. Avoiding such complications is possible only with timely detection of the disease.

Forecast

When discomfort occurs in the abdomen and reproductive organs, every woman should definitely consult a gynecologist for advice. An important factor in the treatment of cystadenoma is timely diagnosis, since as the tumor develops, its size will gradually increase, as a result of which the entire ovary, or even the uterus, may have to be removed. The prognosis for benign pathology is favorable. If the process becomes malignant, the prognosis depends on many factors, such as the stage of oncology, tumor size, and treatment performed.

Ovarian tumors are a very common disease of the female reproductive system. Serous cystadenoma and are identical concepts in medicine. Serous ovarian cyst is one of the most common ovarian tumors, the proportion of which is approximately 70%. It quite fits the definition of a “cyst” since it is a bubble called serous. Cystadenoma is formed from the epidermis, therefore it belongs to epithelial tumors; its cavity is lined with epithelium.

Education is classified as benign, and has a number of features in its structure and development:

1. It does not grow into neighboring tissues, it only pushes them apart or squeezes them.
2. Her cells are growing slowly.
3. Does not metastasize.

Depending on the nature of the formation, serous cystadenoma can be:

• Smooth-walled (simple). Simple ovarian cystadenoma mainly affects only one ovary and has a single chamber. But there are also multi-chambered ones with watery yellowish contents. The size of the tumor varies from 4 to 15 cm. Simple serous cystadenoma is most often diagnosed in patients over the age of 50 years. It does not interfere with normal childbearing if it does not exceed 3 cm.
• Papillary (papillary) or, as doctors sometimes call it, rough-papillary cystadenoma. Cystadenoma papillary or papillary cyst is considered the next stage of the disease, since the papillae appear only several years after the development of the tumor. A borderline papillary cyst is characterized by abundant and frequent papillary formations with fields of extensive dislocation. Papillary cystadenoma can be chambered and develops in both ovaries. With everting papillary cystadenoma, the growths are located outside the capsule. Inverting is characterized by the presence of papillae in the middle of the cyst. With a mixed form, the papillae are located inside and outside.
• Serous papillary cystadenomas develop into a malignant form with a 50% probability. There are single-chamber and. Inside they are filled with a transparent liquid of a brownish or dirty yellow hue. Papillary cystadenoma of the ovary is one of the most dangerous formations, since it tends to grow into nearby organs. As a result of this process, the functioning of the urinary tract and intestines is disrupted, diarrhea and problems with urination occur.
• very similar in nature to serous, but unlike the latter, it contains a mucous substance in the cavity. The tumor is covered with cells similar to the mucus-secreting cells of the uterus. The structure of the tumor is a cavity with chambers and partitions and is easily diagnosed using ultrasound. As a rule, this formation occurs simultaneously on both the right and left ovaries. The tumor can reach large sizes (up to 30 cm), and therefore must be surgically removed.

Smooth walled cystadenoma

Serous cystadenoma

Causes and symptoms

Until now, the causes of the cyst have not yet been fully elucidated. The most likely cause of development is a temporary disturbance in the level of hormones in the body. According to one assumption, serous ovarian cystadenoma develops from functional cysts. Typically, such tumors disappear a few months after their appearance. However, after a year, the functional tumor loses its ability to resolve and papillary cystadenoma develops.

Provoking factors include:

• Lack of regular sex life.
• Genetic predisposition.
• The presence of papilloma virus, sexually transmitted diseases.
• Abortion.
• Ectopic pregnancy.
• Previous operations on the ovaries.

Symptoms of a tumor are directly related to its size. First, nagging pain appears in the lower abdomen and lower back on the side where the cyst has developed. With its significant increase, a significant increase in the abdomen is observed, and the presence of a foreign body inside is felt. Papillary ovarian tumor is characterized by the appearance of ascites (accumulation of fluid in the abdominal cavity).

Diagnostic methods

Diagnosing the disease is quite easy.

For this purpose they prescribe:

1. Gynecological examination.
2. Ultrasound. On an ultrasound screen, a serous ovarian cyst looks like a round-shaped spot with clearly defined contours. After an ultrasound examination, surgical treatment can be prescribed.
3. Blood test for tumor markers. A feature of papillary cystadenoma is its malignant change, which occurs quite often. Therefore, patients diagnosed with this formation are recommended to donate blood for the presence of tumor markers before removing the tumor. Their meaning allows the doctor to choose the right operation.
4. CT or MRI. These studies are necessary to clarify the location and nature of the formation.
   Blood analysis. To detect either an inflammatory process or blood loss.
5. Pregnancy test. This method is necessary to exclude ectopic pregnancy.

Treatment of the disease

In the absence of urgent indications for surgical intervention, the tumor is subject to dynamic observation and drug treatment for several months. A functional cyst will disappear or significantly decrease in size in 1 to 3 months. If it is confirmed that the formation is not functional, has signs of progression, and for other special indications, surgical intervention is prescribed.

They try to treat simple serous cystadenoma with a diameter of less than 3 cm by enucleation.

If the size of the cyst exceeds 3 cm, then a dense capsule is formed from the surrounding tissues due to their compression. In this case, you will most likely have to remove the entire ovary.

Papillary serous cystadenoma is especially dangerous because it can degenerate into serous ovarian carcinoma (cancer). It all depends on the results of histological examination of the cyst. If the tumor is malignant, then the issue of removing the ovaries and sometimes even the uterus is decided.

They get rid of the tumor using the following types of surgery:

1. . Through several small incisions, the cystadenoma is removed.
2. Laparotomy. The tumor is removed through one large incision.

The main task when removing a cyst at a young age is to preserve the ovary. If the presence of a simple serous cystadenoma is confirmed, then surgical tactics are not justified, since it rarely develops into a malignant tumor. However, the absence of a risk of a tumor becoming malignant is not a reason to relax, since, as it grows, it can cause numerous other complications.

Possible forecast

Patients of childbearing age who have a cyst or cystadenoma of the left ovary or a cyst of the right ovary are interested in the possibility of future pregnancy after surgery. In the presence of a benign tumor, the ovary is not affected at all, and the ability to have children is completely preserved.

If one ovary was removed, then the possibility of becoming pregnant also remains.

It is important to note that there are cases where, when exposed to certain factors, a borderline or malignant tumor can form. Ovarian cystadenocarcinoma is a malignant tumor that belongs to the category of secondary cancer. Often such a tumor develops in serous cystadenomas. Mucinous cystadenoma, according to medical statistics, less often leads to the formation of such tumors.

If a large cyst with a bilateral location is detected, or if serous cystadenocarcinoma is diagnosed, both ovaries are removed, and the woman loses her ability to bear children. In general, with early diagnosis and properly selected treatment, the prognosis for this disease is favorable.

Ovarian cystadenoma is a fairly serious disease, which is characterized by the appearance of a tumor in the ovarian area. The pathological neoplasm has a clearly defined capsule. Unlike cysts, this pathology is capable of malignant degeneration.

Previously, in medical practice, this pathology was called, and required the removal of both ovaries. Over time, treatment methods have been developed aimed at preserving reproductive functions.

Cystadenomas have a negative impact on pregnancy, as they are a serious obstacle to conception. may also appear during pregnancy. The prognosis of the disease is disappointing. Such formations must be removed without fail.

Classification

In accordance with the structure of the epithelial lining and the contents of the capsule, cystadenoma can be of the following types:

• Serous is an ordinary cyst that has a dense epithelial membrane, usually round and single-chamber. Appear in 70% of cases and only on one ovary. Bilateral ovarian cystadenomas are quite rare and require a more qualified approach to treatment.
• Papillary - has parietal growths, which is its main difference from the serous type of neoplasm. When there is a large accumulation of tumors, they combine into tumors, which significantly complicates diagnosis. Papillary ovarian cystadenoma is characterized by the presence of papillae on the epithelium. The symptoms of the pathology are similar to those of cancer and.
• Mucinous is the most common form of the disease. In some cases, the formation reaches impressive sizes and can weigh about 15 kg. Mucinous cystadenoma of the ovary on ultrasound is distinguished by the presence of several chambers. The tumor, as a rule, contains mucosis, which is a dense secretion with a suspension. Thanks to these signs, recognizing it is not difficult.

Serous ovarian cystadenoma, in turn, is divided into simple and rough-papillary forms. A simple tumor is a benign formation that is covered with cubic epithelium. Rough papillary cystadenoma of the ovary is a morphological type of tumor, which is characterized by the presence of papillary vegetation that has a whitish color. A distinctive feature allows you to timely determine the nature of the pathological process and take the most effective measures for a given case.

A serous tumor can be potentially dangerous due to its tendency to malignancy. Mucinous formation is characterized by a borderline course, that is, borderline ovarian cystadenoma occurs in conjunction with flattening of the tumor capsule. It is distinguished from mucinous cancer by the absence of invasion of the tumor epithelium.

Reasons for development

Currently, the reasons for the appearance of cystadenoma in the ovarian region are not fully understood. There are several predisposing factors:

• hormonal and endocrine disorders;
• inflammatory and infectious processes;
• the presence of cysts.

The formation of a cyst can occur as a result of inflammation that occurs after surgery in the pelvic area, including childbirth and abortion. Sexual abstinence, indiscriminate sexual intercourse and frequent stressful situations are a predisposing factor in the presence of which the formation of ovarian cystadenoma occurs.

It should be noted that heavy lifting, as well as improper dieting, can have a negative impact on the female genital organs.

Symptoms of the disease

Signs of the pathological process depend directly on the size of the tumor. The growth of the cyst is accompanied by the appearance of aching pain. Typically, discomfort occurs in the area where ovarian cystadenoma is located. The development of lumbar pain syndrome cannot be ruled out.

When the formation reaches a significant size, the size of the abdomen increases. Women often feel a foreign object in the peritoneal area. In the papillary form, fluid accumulates, which can lead to the development of ascites. An enlarged abdomen indicates an advanced stage of the pathological process. In this case, torsion of the ovarian cystadenoma and rupture of the capsule may occur, which is accompanied by an outpouring of cystic contents into the peritoneum.

The pain may radiate to the pubic area and may also be accompanied by severe pressure on the bladder. A characteristic feature is disruption of the menstrual cycle, dysfunction of the urinary organs and the appearance of constipation.

Establishing diagnosis

Among the main diagnostic measures for ovarian cystadenoma are:

• Examination by a gynecologist - assessment of the size of the pathology, its consistency and degree of mobility, the presence of connections with neighboring organs is necessarily clarified.
• Ultrasound allows not only to determine the area of ​​localization and size of the cyst, but also to identify the degree of proliferation of the surface epithelium and density. The most reliable study will be that carried out a week after the menstrual cycle.
• CT and MRI - allows you to study in depth the structure of cystadenoma.
• A blood test is necessary to identify the tumor marker CA-125. Usually occur in the presence of a purulent abscess or an oncological process.
• FGDS and FCS are additional endoscopic investigational manipulations that allow you to examine the area of ​​the colon and stomach.

Therapeutic manipulations

Ovarian cystadenoma can only be removed surgically. Treatment without surgery is impossible in this case. Before surgery, a final diagnosis must be made to determine the size and type of tumor. For this, the patient is sent for an ultrasound of the abdominal cavity. A laboratory blood test is required to identify tumor marker proteins.

The timing and scope of the operation are determined individually for each patient. As a rule, the tumor is removed along with the ovary. In case of papillary form of the disease and ovarian cystadenoma, it is necessary to remove both sex glands along with the appendages. This approach allows us to exclude the process of malignancy.

For young patients who are planning a pregnancy, doctors try to preserve the ovary. Conceiving after surgery is quite possible. During the rehabilitation period, it is important to follow the recommendations of a specialist. You should visit a doctor at least once every 6 months, and in some cases more often.

Carrying out laparoscopy

Treatment of ovarian cystadenoma is an operation that is performed through small punctures made in the peritoneum using special equipment and instruments. This technique is very popular because it has a minimal traumatic effect on tissues and organs located in the peritoneal area, compared with a surgical procedure such as laparotomy.

Laparoscopy for ovarian cystadenoma has a number of advantages:

• minimal trauma;
• reduction of the rehabilitation period;
• exclusion of postoperative adhesions and scars.

Stages of implementation

Before surgery, the location of the cystadenoma is determined. To remove it, the capsule is punctured and the internal contents are sucked out. Next, the cystic membrane is separated from the soft tissue and removed.

As a rule, during laparoscopy, even when excising large formations, a small amount of soft tissue of the ovary is removed. This is due to the fact that as the cyst grows, it is filled with secretions, due to which the membrane stretches. Laparoscopy is performed along the edge of the formation, which allows for maximum preservation of healthy tissue.

Laparoscopic cyst removal (read more in detail) consists of the following steps:

• coagulation of vascular structures and stopping bleeding;
• connection of damaged soft tissues;
• sending the extracted material for histology.

In accordance with the form of education, the time of the operation is determined. Mostly the procedure does not exceed 40 minutes. At the same time, surgical procedures such as checking, separating adhesions, and removing fibroids are carried out. For complete restoration of the functioning of the ovary after the operation, at least one month passes.

When the pathological process becomes malignant, extirpation of the uterine body is mandatory, which involves removal of the appendages and amputation of the greater omentum. In this case, specialists resort to operations such as cystectomy, wedge resection, oophorectomy or adnexectomy.

Treatment during pregnancy

Serous cystadenoma can develop after conception, which requires special measures. If the size of the formation does not exceed 3 cm, no measures are taken - this does not interfere with the process of gestation.

Large cysts pose a danger to pregnancy. At the beginning of the 3rd trimester, the uterus descends into the peritoneum. In this case, as a rule, torsion of the cyst pedicle occurs. In this case, to alleviate the woman’s condition and prevent the development of fetal pathologies, surgical intervention is performed.

Papillary (rough papillary) serous cystadenoma- a morphological type of benign serous cystadenomas, observed less frequently than smooth-walled serous cystadenomas. Accounts for 7-8% of all ovarian tumors and 35% of all cystadenomas.
This is a single or multi-chamber cystic neoplasm; on the inner surface there are single or numerous dense papillary vegetations on a wide base, whitish in color.
The structural basis of the papillae is small cell fibrous tissue with a small number of epithelial cells, often with signs of hyalinosis. The integumentary epithelium is similar to the epithelium of smooth-walled cilioepithelial cystadenomas. Rough papillae are an important diagnostic feature, since similar structures are found in serous cystadenomas and are never observed in non-neoplastic ovarian cysts. Rough papillary growths with a high degree of probability make it possible to exclude the possibility of malignant tumor growth even during an external examination of the surgical material. Degenerative changes in the wall can be combined with the appearance of layered petrificates (psammotic bodies).
Papillary serous cystadenoma has the greatest clinical significance due to its pronounced malignant potential and high incidence of cancer development. The incidence of malignancy can reach 50%.
Unlike rough papillary cystadenoma, papillary serous cystadenoma includes papillae of soft consistency, often merging with each other and located unevenly on the walls of individual chambers. The papillae can form large nodes that invert tumors. Multiple papillae can fill the entire tumor capsule, sometimes growing through the capsule to the outer surface. The tumor takes on a “cauliflower” appearance, raising suspicion of malignant growth.
Papillary cystadenomas can spread over a long distance, disseminate throughout the peritoneum, and lead to ascites, more often with bilateral tumor localization. The occurrence of ascites is associated with the growth of papillae along the surface of the tumor and along the peritoneum and due to a violation of the resorptive ability of the peritoneum of the utero-rectal space. Everting papillary cystadenomas are much more often bilateral and the course of the disease is more severe. With this form, ascites is 2 times more common. All this allows us to consider an everting papillary tumor to be clinically more severe than an inverting one.
The most serious complication of papillary cystadenoma is its malignancy - transition to cancer. Papillary cystadenomas are often bilateral, with an intraligamentous location. The tumor has limited mobility, has a short stalk or grows intraligamentously.
Superficial serous papilloma (papillomatosis)- a rare type of serous tumor with papillary growths on the surface of the ovary. The neoplasm is often bilateral and develops from the surface epithelium. Superficial papilloma does not spread beyond the ovaries and has true papillary growths. One of the variants of papillomatosis is cluster-shaped papillomatosis (Klein tumor), when the ovary resembles a bunch of grapes.
Serous adenofibroma(cystadenofibroma) is relatively rare, often one-sided, round or ovoid in shape, up to 10 cm in diameter, with a dense consistency. On a section, the tissue of the node is grayish-white in color, dense, fibrous structure with small cavities. Rough papillary growths are possible. Upon microscopic examination, the epithelial lining of glandular structures is practically no different from the lining of other cilioepithelial neoplasms.
Borderline serous tumor has a more adequate name - a serous tumor, potentially malignant. Morphological types of serous tumors include all of the above forms of serous tumors, since they arise, as a rule, from benign ones.
Borderline papillary cystadenoma has more abundant papillary growths with the formation of extensive fields. Microscopically, nuclear atypia and increased mitotic activity are determined. The main diagnostic criterion is the absence of invasion into the stroma, but deep intussusceptions can be detected without invasion of the basement membrane and without pronounced signs of atypia and proliferation.
Mucinous cystadenoma (pseudomucinous cystadenoma) ranks second in frequency after cilioepithelial tumors and accounts for 1/3 of benign ovarian tumors. This is a benign epithelial tumor of the ovary.
The former term “pseudomucinous tumor” has been replaced by the synonym “mucinous cystadenoma”. The tumor is detected at all periods of life, more often in the postmenopausal period. The tumor is covered with low cubic epithelium. The underlying stroma in the wall of mucinous cystadenomas is formed by fibrous tissue of varying cellular density, the inner surface is lined with high prismatic epithelium with light cytoplasm, which in general is very similar to the epithelium of the cervical glands.
Mucinous cystadenomas almost always multi-chamber. The chambers are made of jelly-like content, which is mucin in the form of small droplets; mucus contains glycoproteins and heteroglycans. True mucinous cystadenomas are not characterized by papillary structures. The size of mucinous cystadenoma is usually significant; there are also giant ones, with a diameter of 30-50 cm. The outer and inner surfaces of the walls are smooth. The walls of a large tumor are thinned and can even become visible due to significant stretching. The contents of the chambers are mucous or jelly-like, yellowish, less often brown, hemorrhagic.
Mucinous adenofibromas and cystadenofibromas are very rare types of mucinous tumors. Their structure is similar to serous adenofibromas of the ovary, they differ only in the mucinous epithelium.
Borderline mucinous cystadenoma potentially malignant. Mucinous tumors of this type have the form of cysts and in appearance do not differ significantly from simple cystadenomas. Borderline mucinous cystadenomas are large multilocular formations with a smooth internal surface and a focally sutured capsule. The epithelium lining borderline cystadenomas is characterized by polymorphism and hyperchromatosis, as well as increased mitotic activity of the nuclei. Borderline mucinous cystadenoma differs from mucinous carcinoma in the absence of invasion of the tumor epithelium.
Pseudomyxoma of the ovary and peritoneum. This is a rare type of mucinous tumor arising from mucinous cystadenomas, cystadenocarcinomas, and also from diverticula of the appendix. The development of pseudomyxoma is associated either with a rupture of the wall of a mucinous ovarian tumor, or with germination and penetration of the entire thickness of the wall of the tumor chamber without a visible rupture. In most cases, the disease occurs in women over 50 years of age. There are no characteristic symptoms; the disease is almost not diagnosed before surgery. In fact, one should not talk about a malignant or benign variant of pseudomyxomas, since they are always secondary (of infiltrative or implantation origin).
Brenner's tumor(fibroepithelioma, mucoid fibroepithelioma) was first described in 1907 by Franz Brenner. It is a fibroepithelial tumor consisting of ovarian stroma.
Recently, the origin of the tumor from the integumentary coelomic epithelium of the ovary and from the hilus has been increasingly substantiated. In the region of the gate, they arise according to the location of the network and epoophoron. Benign Brenner tumor accounts for about 2% of all ovarian tumors. It occurs both in early childhood and over the age of 50 years. The tumor has a solid structure in the form of a dense node, the cut surface is grayish-white with small cysts.
The microscopic appearance of Brenner's tumor is represented by epithelial nests surrounded by strands of spindle cells. Cellular atypia and mitoses are absent. Brenner's tumor is often combined with other ovarian tumors, especially mucinous cystadenomas and cystic teratomas.
Epithelial components tend to undergo metal-asthetic changes. The possibility of developing proliferative forms of Brenner tumor cannot be ruled out.
The size of the tumor ranges from microscopic to the size of an adult’s head. The tumor is one-sided, often left-sided, round or oval in shape, with a smooth outer surface. The capsule is usually absent. The tumor often resembles ovarian fibroma in appearance and consistency.
Mostly the tumor is benign and is discovered accidentally during surgery. It is possible that proliferative forms of Brenner tumor may develop, which may become a transitional stage to malignancy.
Proliferating Brenner tumor(borderline Brenner tumor) is extremely rare and has a cystic structure with papillomatous structures. Macroscopically, there can be both cystic and cystic-solid structures. On the section, the cystic part of the tumor is represented by multiple chambers with liquid or mucous contents. The inner surface can be smooth or with tissue resembling papillary growths, loose in places.
Mixed epithelial tumors can be benign, borderline and malignant. Mixed epithelial tumors account for about 10% of all epithelial ovarian tumors. Two-component forms predominate; three-component forms are identified much less frequently. Most mixed tumors have a combination of serous and mucinous epithelial structures.
The macroscopic picture of mixed tumors is determined by the predominant tumor components. Mixed tumors are multilocular formations with different contents. There are serous, mucinous contents, less often areas of a solid structure, sometimes resembling fibroma or papillary growths.
Clinic of epithelial ovarian tumors. Benign ovarian tumors, regardless of their structure and clinical manifestations, have many similar features. Ovarian tumors often occur asymptomatically in women over 40-45 years of age. There are no specifically reliable clinical symptoms of any tumor. However, a more thorough questioning of the patient can reveal dull, aching pain of varying severity in the lower abdomen, lumbar and groin areas.
The pain often radiates to the lower extremities and the lumbosacral region and may be accompanied by dysuric phenomena, apparently caused by the pressure of the tumor on the bladder and an enlarged abdomen. Paroxysmal or acute pain is caused by torsion of the tumor stalk (partial or complete) or perforation of the tumor capsule. As a rule, pain is not associated with the menstrual cycle. They arise due to irritation and inflammation of the serous membranes, spasm of the smooth muscles of hollow organs, irritation of the nerve endings and plexuses of the vascular system of the pelvic organs, as well as due to tension of the tumor capsule, disruption of the blood supply to the tumor wall. Pain sensations depend on the individual characteristics of the central nervous system.
At papillary serous cystadenomas pain occurs earlier than with other forms of ovarian tumors. Apparently, this is due to the anatomical features of papillary ovarian tumors (intraligamentary location, bilateral process, papillary growths and adhesions in the pelvis).
With papillary cystadenomas, often bilateral, ascites is possible. The occurrence of ascites is associated with the growth of papillae along the surface of the tumor and along the peritoneum and due to a violation of the resorptive ability of the peritoneum of the utero-rectal space. With everting papillary serous cystadenomas (the papillae are located on the outer surface of the capsule), the course of the disease is more severe, and bilateral ovarian damage is much more common. With this form, ascites develops 2 times more often. All this allows us to consider an everting papillary tumor to be clinically more severe than an inverting tumor (location of the papillae on the inner surface of the capsule). The most serious complication of papillary cystadenoma remains malignancy.
With large tumors (mucinous) there is often a feeling of heaviness in the lower abdomen, it enlarges, and the function of neighboring organs is disrupted in the form of constipation and dysuria. Nonspecific symptoms - weakness, increased fatigue, shortness of breath are less common. Most patients have various extragenital diseases that can cause nonspecific symptoms. Reproductive function is impaired in every 5th examined woman (primary or secondary infertility).
The second most common complaint is menstrual irregularities. Menstrual dysfunction is possible from the moment of menarche or occurs later.
Recognizing pseudomyxoma before surgery is extremely difficult. There are no characteristic clinical signs on the basis of which a diagnosis could be made. The main complaint of patients is pain in the lower abdomen, often dull, less often paroxysmal.
The disease often begins gradually under the guise of chronic, recurrent appendicitis or an abdominal tumor of undetermined localization. Often patients consult a doctor due to rapid enlargement of the abdomen. The abdomen is round, spherical, its shape does not change when the patient’s body position changes. During percussion, there is a dullness of the percussion sound throughout the abdomen; palpation reveals doughiness, a characteristic “colloidal” crackle or “crunch”, since colloidal masses with pseudomyxoma do not overflow, as with ascites. Diffuse reactive peritonitis forms an extensive adhesive process, often disrupting the functions of the abdominal organs. Patients complain of loss of appetite, flatulence, and dyspepsia. The formation of intestinal fistulas, the appearance of edema, the development of cachexia, an increase in body temperature, and a change in the blood formula are possible. Death occurs due to increasing intoxication and cardiovascular failure.
Clinic of mixed epithelial tumors It does not differ significantly from single-component epithelial tumors.
Diagnosis of epithelial ovarian tumors. Despite technological advances, diagnostic thinking based on clinical examination remains important. Establishing a diagnosis begins with clarifying complaints, collecting anamnesis and bimanual gynecological and rectovaginal examinations. With a two-manual gynecological examination, it is possible to identify a tumor and determine its size, consistency, mobility, sensitivity, location in relation to the pelvic organs, and the nature of the tumor surface. It is possible to detect only a tumor that has reached a certain size when it increases the volume of the ovary. For small tumor sizes and/or giant tumors and atypical location of the tumor, bimanual examination is not very informative. It is especially difficult to diagnose ovarian tumors in obese women and in patients with adhesions in the abdominal cavity after laparotomies. It is not always possible to judge the nature of the tumor process based on palpation data. Bimanual examination gives only a general idea of ​​the pathological formation in the pelvis. A rectovaginal examination helps to exclude malignancy, during which one can determine the absence of “spikes” in the posterior fornix, overhang of the fornix with ascites, and invasion of the rectal mucosa.
During a two-manual vaginal-abdominal examination in patients with simple serous cystadenoma in the area of ​​the uterine appendages, a volumetric formation is determined posterior or lateral to the uterus, round, often ovoid in shape, tight-elastic consistency, with a smooth surface, with a diameter of 5 to 15 cm, painless, mobile on palpation .
Papillary cystadenomas more often they are bilateral, located on the side or posterior to the uterus, with a smooth and/or uneven (lumpy) surface, round or ovoid in shape, tight-elastic consistency, mobile or limitedly mobile, sensitive or painless on palpation. The diameter of the neoplasms ranges from 7 to 15 cm.
During a two-manual gynecological examination, mucinous cystadenoma is determined posterior to the uterus, has a lumpy surface, uneven, often tight-elastic consistency, round shape, limited mobility, diameter from 9 to 20 cm or more, sensitive to palpation. The mucinous tumor is often large (giant cystadenoma - 30 cm or more), occupying the entire pelvis and abdominal cavity. Gynecological examination is difficult; the body of the uterus and collateral appendages are difficult to differentiate.
During a two-manual vaginal-abdominal examination in patients with a verified diagnosis of Brenner’s tumor, a space-occupying formation of an ovoid or, more often, round shape, dense consistency, with a smooth surface, 5-7 cm in diameter, mobile, painless, is determined lateral and posterior to the uterus. Brenner's tumor often resembles subserous uterine fibroids.
Ultrasound occupies one of the leading places among methods for diagnosing pelvic tumors due to its relative simplicity, accessibility, non-invasiveness and high information content.
Sonographically smooth-walled serous cystadenoma has a diameter of 6-8 cm, a round shape, the thickness of the capsule is usually 0.1-0.2 cm. The inner surface of the tumor wall is smooth, the contents of cystadenomas are homogeneous and anechoic, septa can be visualized, often single. Sometimes a finely dispersed suspension is detected, which is easily displaced by percussion of the formation. The tumor is usually located posterior and to the side of the uterus (Fig. 10.1).

Rice. 10.1
have papillary growths unevenly located on the inner surface of the capsule in the form of parietal structures of various sizes and increased echogenicity. Multiple very small papillae give the wall a rough or spongy appearance. Sometimes lime is deposited in the papillae, which has increased echogenicity on scanograms. In some tumors, papillary growths fill the entire cavity, creating the appearance of a solid area. Papillae can grow onto the outer surface of the tumor. The thickness of the capsule of papillary serous cystadenoma is 0.2-0.3 cm.
Papillary serous cystadenomas are defined as bilateral round, less often oval formations with a diameter of 7-12 cm, single-chamber and/or double-chamber. They are located lateral or posterior to the uterus, sometimes thin linear septa are visualized (Fig. 10.2).

Rice. 10.2
Mucinous cystadenoma has multiple septa 2-3 mm thick, often in certain areas of cystic cavities. Suspension is visualized only in relatively large formations. Mucinous cystadenoma is often large, up to 30 cm in diameter, almost always multilocular, located mainly on the side and behind the uterus, round or ovoid in shape. In the cavity there is a fine, non-displaceable suspension of medium or high echogenicity. The contents of some chambers may be homogeneous (Fig. 10.3).

Rice. 10.3
Brenner's tumor, mixed, undifferentiated tumors give a nonspecific image in the form of formations of a heterogeneous solid or cystic-solid structure.
Color Doppler mapping (CDC) helps to more accurately differentiate benign and malignant ovarian tumors. Based on the blood flow velocity curves in the ovarian artery, the pulsation index and the resistance index, tumor malignancy can be suspected, especially in the early stages, since malignant tumors have active vascularization, and the absence of vascularization zones is more typical for benign neoplasms.
With color Doppler ultrasound, benign epithelial ovarian tumors are characterized by moderate vascularization in the capsule, septa and echogenic inclusions. The resistance index does not exceed 0.4 (Fig. 10.4, 10.5, 10.6).

Rice. 10.4

Rice. 10.5

Rice. 10.6
Recently, X-ray computed tomography (XCT) and magnetic resonance imaging (MRI) have been used to diagnose ovarian tumors.
Endoscopic research methods (laparoscopy) widely used for the diagnosis and treatment of ovarian tumors. Although laparoscopy does not always make it possible to determine the internal structure and nature of the formation, it can be used to diagnose small ovarian tumors that do not lead to volumetric transformation of the ovaries, “non-palpable ovaries.”
The endoscopic picture of a simple serous cystadenoma (Fig. 10.7) reflects a volumetric formation of a round or ovoid shape with a smooth shiny surface of a whitish color with a diameter of 5 to 10 cm. A simple serous cystadenoma often resembles a follicular cyst, but unlike a retention formation, it has a whitish-gray color to bluish, which is apparently due to the uneven thickness of the capsule. A vascular pattern is determined on the surface of the capsule. The contents of serous cystadenoma are transparent, with a yellowish tint.

Rice. 10.7
Papillary cystadenoma at surgery it is determined (Fig. 10.8) as an ovoid or round tumor with a dense, opaque whitish capsule. On the outer surface of papillary cystadenoma there are papillary growths. The papillae can be single in the form of “plaques” protruding above the surface, or in the form of clusters and located in various parts of the ovary. With pronounced dissemination of papillary growths, the tumor resembles “cauliflower”. In this regard, it is necessary to inspect the entire capsule. Papillary cystadenoma can be bilateral, in advanced cases it is accompanied by ascites. Intraligamentary location and distribution of papillae throughout the peritoneum are possible. The contents of papillary cystadenoma are transparent, sometimes acquiring a brown or dirty yellow color.

Rice. 10.8
Endoscopic picture of mucinous cystadenoma often characterized by a large value. The surface of mucinous cystadenoma (Fig. 10.9) is uneven, the structure is multilocular. The boundaries between the cameras are visible. The tumor is irregular in shape, with a dense, opaque capsule, whitish in color, sometimes with a bluish tint. Bright, branching, unevenly thickened large vessels are clearly visible on the capsule. The inner surface of the tumor is smooth, the contents are jelly-like (pseudomucin).

Rice. 10.9
Laparoscopic intraoperative diagnosis of ovarian tumors is of great value. The accuracy of laparoscopic diagnosis of tumors is 96.5%. The use of laparoscopic access is not indicated in patients with ovarian tumors, so it is necessary to exclude a malignant process before surgery. If malignant growth is detected during laparoscopy, it is advisable to proceed to laparotomy. During laparoscopic removal of a cystadenoma with malignant degeneration, disruption of the integrity of the tumor capsule and contamination of the peritoneum may occur; difficulties may also arise during omentectomy (removal of the omentum).
In the diagnosis of malignant ovarian tumors, a large place is given to the determination of biological substances specific to these tumors by biochemical and immunological methods. Of greatest interest are the numerous tumor-associated markers - tumor-associated antigens (CA-125, CA-19.9, CA-72.4).
The concentration of these antigens in the blood allows us to judge the processes in the ovary. CA-125 is found in 78 - 100% of patients with ovarian cancer, especially in serous tumors. Its level exceeds the norm (35 IU/ml) only in 1% of women without ovarian tumor pathology and in 6% of patients with benign tumors. Tumor markers are used for dynamic monitoring of patients with malignant ovarian tumors (before, during and after treatment).
In case of bilateral ovarian damage, to exclude a metastatic tumor (Krukenberg), an X-ray examination of the gastrointestinal tract should be performed, and, if necessary, endoscopic methods (gastroscopy, colonoscopy) should be used.
The prevalence of the process is clarified by urological examination (cystoscopy, excretory urography). In exceptional cases, lymph and angiography are used.
Additional research methods in patients with space-occupying ovarian formations allow not only to determine the surgical approach, but also to form an opinion about the nature of the space-occupying formation, which determines the choice of surgical treatment method (laparoscopy - laparotomy).
Treatment of epithelial tumors operational. The scope and access of surgical intervention depend on the patient’s age, the size and malignancy of the formation, as well as on concomitant diseases.
The extent of surgical treatment helps determine an urgent histological examination. At simple serous cystadenoma at a young age, it is permissible to remove the tumor, leaving healthy ovarian tissue. In older women, the uterine appendages are removed from the affected side. At simple serous cystadenoma of borderline type in women of reproductive age, the tumor is removed from the affected side with a biopsy of the collateral ovary and omentectomy.
In premenopausal patients, supravaginal uterine amputation and/or hysterectomy and omentectomy are performed.
Papillary cystadenoma, due to the severity of proliferative processes, requires more radical surgery. If one ovary is affected, if the papillary growths are located only on the inner surface of the capsule, in a young woman it is permissible to remove the appendages of the affected side and biopsy the other ovary. If both ovaries are affected, supravaginal amputation of the uterus with both appendages is performed.
If papillary growths are found on the surface of the capsule, supravaginal amputation of the uterus with appendages or extirpation of the uterus and removal of the omentum is performed at any age.
Laparoscopic access can be used in patients of reproductive age with unilateral ovarian lesions without tumor capsule germination using an evacuating bag-container.
At border papillary cystadenoma of unilateral localization in young patients interested in preserving reproductive function, removal of the uterine appendages of the affected side, resection of the other ovary and omentectomy are acceptable.
In perimenopausal patients, extirpation of the uterus with appendages on both sides is performed and the omentum is removed.
Treatment of mucinous cystadenoma surgical: removal of the appendages of the affected ovary in patients of reproductive age. In the pre- and postmenopausal period, it is necessary to remove the appendages on both sides along with the uterus.
Small mucinous cystadenomas can be removed by surgical laparoscopy using an evacuation pouch.
For large tumors, it is necessary to first evacuate the contents with an electric suction through a small hole.
Regardless of the morphological affiliation of the tumor, before the end of the operation it is necessary to cut it and examine the inner surface of the tumor.
Inspection of the abdominal organs (appendix, stomach, intestines, liver), examination and palpation of the omentum, para-aortic lymph nodes, as with tumors of all types, are also indicated.
For pseudomyxoma, immediate radical surgery is indicated- resection of the omentum and parietal peritoneum with implants, as well as liberation of the abdominal cavity from gelatinous masses. The scope of surgical intervention is determined by the patient’s condition and the involvement of the abdominal organs in the process. Despite the fact that it is almost completely impossible to free the abdominal cavity from gelatinous masses, recovery can sometimes occur after surgery. Even in advanced cases of the disease, one should try to operate, since without surgical intervention the patients are doomed.
The prognosis for pseudomyxoma is unfavorable. Frequent relapses are possible, in which repeated surgery is indicated. Despite the morphological benignity of the tumor, patients die from progressive exhaustion, since it is not possible to completely free the abdominal cavity from the erupted gelatinous masses.
Treatment of Brenner's tumor is surgical. In young patients, removal of the uterine appendages of the affected side is indicated. In perimenopause, supravaginal amputation of the uterus and appendages is performed. In case of a proliferating tumor, supravaginal amputation of the uterus with appendages and total removal of the omentum are indicated.

Neoplasms in the area of ​​the uterine appendages are diverse - in most cases, only after surgery, based on the results of histological examination, can malignant degeneration be excluded. Ovarian cystadenoma belongs to epithelial tumors, some of which can cause oncological pathology with an unfavorable prognosis, therefore, at the stage of preparation for surgery, the doctor always approaches the examination from the standpoint of oncological alertness.

Options for benign neoplasms

Depending on the structure and cellular structure, epithelial tumors are divided into the following main types:

1. Serous cystadenoma;
2. Mucinous cystoma;
3. Endometrioid ovarian disease;
4. Clear cell tumor;
5. Brenner's tumor;
6. Mixed variant of the neoplasm.

It is not always possible to accurately determine the type of tumor at the stage of preoperative preparation: most often, during surgery, when performing an express biopsy, the doctor will be able to accurately determine the histological variant of the cystoma.

Serous tumors

The most common type is serous ovarian cystadenoma. The inner surface of the cystoma is lined with normal ovarian epithelium, which produces a liquid secretion. The main diagnostic criteria to suggest the histotype of a benign neoplasm are:

• smooth-walled;
• one-sided;
• single-chamber;
• small in size (no more than 30 cm in diameter);
• liquid contents without dense inclusions.

Having received the result of the ultrasound scan, and based on the clinical manifestations, the doctor will suggest a surgical treatment option - only by removing the tumor can we confidently say that the process is benign. The scope of the operation in the absence of suspicion of cancer is always organ-preserving: it is quite enough to remove the cyst or perform a partial resection of the organ.

Mucinous neoplasms

The second most common epithelial cystadenoma of the ovary is mucinous cystoma. The inner surface of the tumor is lined with columnar cells, which are similar to the cervical epithelium of the cervix, which produces thick mucus. The main features of mucinous ovarian cystadenoma are:

• lumpy surface;
• multi-chamber;
• medium and large in size (can reach 50 cm in diameter);
• thick mucus-like contents.
• smooth walls of the inner surface.

The old name of the tumor is pseudomucinous cystadenoma of the ovary. The benign quality of the neoplasm is confirmed histologically, which allows the doctor to use low-traumatic types of operations.

Endometriosis, Brenner fibroma, clear cell and mixed cystomas are much less common. The main task of the doctor at the stage of examination and preparation for surgery is to guess the histotype of the tumor as accurately as possible in order to choose the optimal treatment tactics.

Borderline cystomas

A common variant of tumor growth is a precancerous condition, in which the first signs of obligatory malignant degeneration appear. Borderline cystomas include:

1. Serous papillary cystadenoma;
2. Superficial papillary tumor of the ovary;
3. Borderline papillary cystadenoma.

The earlier any of the precancerous histotypes are identified, the better the prognosis for the treatment of ovarian cystadenoma: given the huge risk of ovarian cancer, for any papillary cystadenoma it is necessary to carry out surgical intervention with the obligatory use of the principles of oncological vigilance.

Serous papillary tumor

The most prognostically favorable variant of precancer, serous papillary cystadenoma of the ovary is much less likely to degenerate compared to other types of borderline papillary neoplasms. The likelihood of this histotype of cystoma can be assumed based on the following characteristics:

• single-chamber (less often – double-chamber);
• medium size (up to 30 cm);
• the presence of a small number of papillae on the inner surface of the cyst.

With a transvaginal ultrasound scan, the doctor will see single rough papillae inside the cystoma, which is the first and important sign of a borderline cancer condition. The risk of degeneration is not great, but the approach to treatment tactics is clear - the tumor must be removed taking into account the expected malignant growth.

Papillary cystadenoma of the ovary

The situation is much more serious and dangerous when, as a result of examination, multiple papillary growths are revealed on the surface of the cystoma. This is a sign of active growth with proliferation of cellular elements. Signs of a precancerous condition include:

• a large number of small papillae, which tend to merge and form structures similar to cauliflower;
• wide distribution over the surface of the cystoma;
• rapid increase in the size of the cystic neoplasm;
• multilocular tumor.

The worst option is the detection of papillary growths on neighboring organs and the abdominal covering of the abdomen. This indicates the metastatic spread of precancer, which sharply worsens the prognosis for curing papillary ovarian cystadenoma.

Borderline tumor

It is often impossible to detect the moment of malignant degeneration - borderline papillary cystadenoma can become ovarian cancer in a short period of time. A borderline precancerous condition is characterized by:

• extensive sizes of papillary growths;
• rapid growth of cystoma;
• the appearance of fluid in the abdomen (ascites).

It is important to prepare and perform radical surgery as soon as possible to reduce the risk of malignancy. However, even with histological confirmation of a pre-tumor condition, the doctor will carry out postoperative treatment using methods of therapy for ovarian oncology.

Malignant neoplasms

Ovarian cancer has many histological types. The classification of epithelial tumors includes the following main options:

1. Serous cystadenocarcinoma;
2. Superficial papillary adenocarcinoma;
3. Mucinous malignant tumor.

Rarely occurring types (endometrioid, clear cell, transitional cell, squamous and mixed) are usually a surgical finding - after surgery for ovarian cystadenocarcinoma, the histologist finds specific cancer cells in the removed tissue and issues a conclusion to the attending physician about the presence of an atypical histotype of cancer.

Serous type ovarian adenocarcinoma

As in the case of a benign cyst, this type of tumor is the most common (up to 60% of all types of epithelial ovarian cancer). Serous ovarian cystadenocarcinoma may be no different from a regular serous type cystoma, therefore, in each specific case, it is necessary to perform a rapid tissue biopsy during surgery to remove a cystic neoplasm in the ovary. Often, only histology can distinguish cystadenoma from adenocarcinoma. An assessment of cell differentiation is mandatory - there are 3 options:

• highly differentiated;
• moderately differentiated;
• low differentiated.

The best prognosis for cystadenocarcinoma with highly differentiated tumor cellular structures.

Superficial papillary adenocarcinoma

The presence of growths on the outer surface of the cystoma is always a high risk of papillary ovarian cystadenocarcinoma. It is extremely important not to delay surgery for ovarian cystadenoma, even if examination does not reveal papillae on the surface of the cyst: sometimes papillary growths can only be detected during surgery. The risk of papillary cancer is very high if you have the following symptoms:

• a large number of papillary structures;
• extensive growth;
• the presence of metastases in the second ovary;
• metastatic damage to neighboring tissues and organs.

It is necessary to undergo surgery to radically remove the cyst with mandatory combination antitumor therapy.

Mucinous malignant cystoma

Malignancy based on pseudomucinous cystadenoma of the ovary occurs in 15% of women, so the presence of a multilocular cyst filled with mucus is a risk factor for oncology. Important signs of possible malignant degeneration include:

• the appearance of pain syndrome;
• dysfunction of the pelvic organs;
• formation of ascites.

During examination, it is not always possible to distinguish cancer from mucinous cystadenoma of the ovary, so the doctor will assume oncology when performing surgery for a pseudomucinous neoplasm.

Treatment tactics

Any variant of ovarian cystadenoma requires surgical intervention. You cannot postpone or refuse surgery in order to create conditions for the progression of the cystoma. The transition from a benign to a borderline and malignant state can take a short period of time (from several weeks to 2-3 months), therefore the main and most effective treatment for ovarian cystadenoma is surgery to remove the tumor. The histological result is of great importance for the choice of treatment tactics in the postoperative period - depending on the type of tumor, the doctor will offer the following options:

• medical supervision for up to 2 years with periodic examinations;
• a single course of chemotherapy;
• combination therapy with drugs and radiation exposure.

It is necessary to accurately and accurately follow the specialist's instructions in order to prevent recurrence of the ovarian tumor and improve the prognosis for life, especially against the background of detection of ovarian cancer.