Reasons for the formation of papillary cystadenoma. Papillary ovarian cystoma

Content

Ovarian cystadenoma is a benign tumor of epithelial tissue and is called a cystic formation. An ovarian cyst is not identical to a cystadenoma, since it does not imply the proliferation of the epithelium, but is initiated by other pathological processes. The accumulation of fluid in a cystic formation is associated with the peculiarities of the functioning of ovarian epithelial cells.

According to statistics, in every tenth gynecological patient, regardless of age, an ultrasound examination reveals a cystic formation in the ovary. It is impossible to determine the nature of the process with a 100% guarantee using ultrasound, which is why doctors are wary of various types of formations, prescribing additional examinations.

Classification

According to the morphological (tissue) classification, ovarian cystadenoma belongs to the group of epithelial tumors. These formations are formed from the integumentary epithelium of the ovaries and are benign in their structure. In turn, these cystic formations are classified into:

• serous;
• mucinous.

Mucinous and serous cysts are divided into smooth-walled and papillary forms.

The simplest is the serous ovarian cyst, which is sometimes called that. Mucinous formations are considered more complex in structure, while cysts that have papillae on the inner walls are considered dangerous.

Low-grade tumors are called borderline tumors. This type is more related to papillary cystadenoma.

The issue of the borderline state of ovarian cystadenomas is still being discussed. It has been proven that a mutation of the p53 gene leads to malignancy of adenomas; if such a mutation is absent, then the cystic formation will not degenerate. Some experts note the genetic role of degeneration of cystadenomas, denying the presence of borderline tumors.

When malignant, cystadenoma of the right ovary more often and quickly metastasizes through the abdominal cavity into the liver capsule and the right half of the diaphragm and pleura.

According to the international classification ICD-10, the code for ovarian cystadenoma is D 27, meaning benign formations.

Epithelial cystic formations of the ovaries most often occur in women over 40 years of age.

In young women, cystic formations are almost always benign.

Smooth-walled serous cystadenoma of the ovary

Serous ovarian tumor is characterized by unilateral lesions. Typically, a simple smooth-walled cyst has the following characteristics:

• most often located above the uterus;
• have a leg;
• easily move during palpation;
• one camera, less often – 2-3;
• the capsule is dense, reaches a thickness of 1-4 mm;
• both the inner and outer surfaces are smooth;
• serous contents are anechoic on ultrasound - light and transparent;
• the likelihood of malignancy is minimal;
• the danger lies in compression of organs and tissues.

Thus, serous cystadenoma of the left ovary often leads to constipation and intestinal problems, compressing the sigmoid colon. Localization of the cyst on the right can lead to pressure on the ureter and kidney, since it is located below the left one.

Serous papillary cystadenoma of the ovary

Serous papillary cystadenoma of the ovary is described by the presence of papillary projections on the internal or external surface of the formation.

Papillary cystadenoma of the ovary is characterized by:

• bilateral lesion;
• location in the thickness of the ligaments;
• leg;
• the presence of adhesions in the abdominal cavity.

Rough papillary cystadenoma of the ovary is characterized by frequent malignancy of the process, and therefore must be immediately removed.

Mucinous

Mucinous cystadenoma is described as follows:

• multi-chamber;
• the presence of contents with different echogenicity according to ultrasound;
• uneven surface due to bulging chambers;
• partitions;
• with a smooth outer surface or with proliferation of papillae on the capsule;
• have a leg;
• the contents are yellow, brown, green, cloudy;
• high probability of malignancy.

The tumor is often accompanied by ascites, an accumulation of fluid in the abdominal cavity. Most often, such cystic formations are diagnosed in older women.

Predisposing factors

A clear cause of cystadenoma has not been identified, however, there are several theories of its occurrence.

1. Hormonal imbalance. As a result of monthly ovulatory proliferation, the ovarian epithelium undergoes hyperplasia over time. A large number of pregnancies, as well as taking COCs, reduce the likelihood of cystadenoma formation.
2. Heredity. It is considered the leading and fundamental factor, in particular, familial ovarian and breast cancer. Experts pay attention to mutations in the BRCA1 and BRCA2 genes.
3. Ovarian pathologies: recurrent follicular and corpus luteum cysts, polycystic disease.
4. Menopausal age, when hormonal fluctuations and disruption of the functioning of the ovarian epithelium are observed.

Exposure to ionizing radiation is also considered as a precipitating factor in the development of cystadenoma.

Symptoms

On average, when the cyst reaches a size of 3 cm, women do not notice any specific symptoms. Such formations are differentiated from a follicular cyst, a corpus luteum cyst. The patient is observed and oral contraceptives are prescribed. If the cyst does not decrease in size, more detailed examinations are prescribed, suspecting cystadenoma.

When the adenoma reaches a size of 5-7 cm, a woman may present certain complaints.

Clinical signs of ovarian cystadenoma are:

• aching pain in the lower back and lower abdomen;
• constipation;
• disturbance of the urination process (frequency, difficulty, false urge);
• an increase in the size of the abdomen (more often with mucinous cysts);
• acute pain up to loss of consciousness due to cyst torsion and necrosis.

Cystadenomas do not have hormonal activity.

A serous cyst of the right ovary can compress the tissues of the kidney and its ureter, leading to disruption of the outflow of urine. A serous cyst of the left ovary often manifests itself as constipation due to pressure on the sigmoid part of the intestine.

Diagnosis

Diagnosis of cystic formation has a number of difficulties, and differential diagnosis of ovarian cystadenoma with a simple cyst is of paramount importance. Doctors encounter this situation in young and middle-aged women with normal ovarian function.

Fertility involves the production of estrogen by the gonads, ovulation and a two-phase cycle. With hormonal imbalances and immune disorders, ovarian pathologies such as endometrioid and follicular cysts develop. It is these conditions that are differentiated from cystadenoma and cancer (cystadenocarcinoma). Therefore, a specialist who discovers a liquid formation must compare it with the menstrual cycle, the woman’s medical history and the presence of other diseases of the genital organs.

Diagnostics involves the use of the following methods:

• palpation of appendages;
• determination of tumor marker levels;
• multislice CT and MRI;
• laparoscopy;
• biopsy;
• mammography;
• colonoscopy;
• gastroscopy.

The set of methods for diagnosing ovarian cystadenoma is determined, first of all, by age and menstrual function. The younger the woman, the less biased the specialist will be towards fluid formation.

The traditional use of CA-125 testing has some limitations in young women.

This tumor marker may be elevated in the second phase of the cycle, during breastfeeding, during pregnancy, as well as with endometriosis, fibroids, pelvic inflammatory diseases, hepatitis, cholecystitis. In addition, in women with stage 1-2 ovarian cancer, this indicator is increased only in 50% of cases, which means the need for an integrated approach to diagnosis.

CA-125 above 35 U/ml is a reason to suspect a malignant process.

The ultrasound determines the following:

• the presence of chambers and additional cavities in cystadenoma;
• soft tissue contents (cystic-solid, solid structure);
• presence of inclusions in the cavity;
• thickness of the cystadenoma capsule;
• involvement of the opposite ovary in the process;
• size of education;
• structure of the inner surface of the cavity wall.

The “simpler” the structure of the cyst, the higher the likelihood of a benign process.

Unlike a simple follicular formation, the fibrous capsule of a serous ovarian cyst is thick and may have a smooth inner surface or a papillary surface. The cystadenoma capsule is essentially the shell of the ovary with a stretched part of the wall.

The size of ovarian cystadenoma can be different: mucinous cystic formation can reach large sizes (20-30 cm or more), serous cysts most often measure up to 6-7 cm.

The serous ovarian cyst in the ultrasound photo below demonstrates typical anechoic formations, having several chambers with smooth and thin walls, a thick fibrous capsule. At the same time, the mucinous cyst contains solid components, the internal contents are hypo and anechoic.

Diagnosis of suspicious cystadenoma is necessarily accompanied by determination of levels of other tumor markers:

• oncofetal antigens - human chorionic gonadotropin, alpha-fetoprotein, necessary to exclude germ cell tumors; the higher the values, the worse the prognosis;
• calculation of the ROMA index, including determination of HE4 and CA-125 and calculation;
• SA-199;
• carcinoembryonic antigen;
• inhibin B (a marker of estrogen-producing tumors).

The first three markers are determined in young women.

After laboratory studies, they begin instrumental methods:

• mammography;
• colonoscopy;
• FGDS.

These methods for diagnosing cystadenoma are necessary to exclude metastasis.

Ovarian cystadenoma in menopause should exclude a gentle approach to diagnosis and treatment. The most detailed examination using various methods, including laparoscopy, is required.

According to statistics, 70% of detected cancer is detected at an advanced stage, which is especially important for older women who have experienced hormonal changes during menopause. The main reason for underdiagnosis is an incomplete list of prescribed studies.

Excessive radicalism in prescriptions is not welcome in women of the active reproductive phase. Surgery on the ovaries can lead to a decrease in ovarian reserve and the inability to conceive.

It is very difficult to determine the risk of malignancy of a liquid formation based on a traditional set of techniques, therefore patients with suspicious cysts must be referred for consultation to an oncologist.

A complete diagnosis of ovarian cystadenomas is crucial in cancer prevention.

For screening and early detection of ovarian cancer, specialists use the calculation of the MI index (malignancy index) using the formula: A*B*C.

Multiplier A (1 or 4):

• reproductive age and premenopausal period – 1 point;
• postmenopause – 4 points.

Multiplier B (0, 1 or 4) implies ultrasonic features:

• multilocular cystic tumor;
• solid component;
• two-way process;
• ascites (accumulation of fluid in the abdominal cavity);
• metastases.

If there are no specified signs, choose 0; if 1 sign is present, one is awarded; more than one sign is awarded 4 points.

Multiplier C means the content of the tumor marker CA-125 in the blood (IU/ml).

When the MI is less than 200, the cystic formation is considered potentially benign.

For example, a postmenopausal woman was diagnosed with a multilocular cystic formation with a solid component in the cavity, and the CA-125 value was 30 units. Total:

4 (postmenopause)*4 (solid inclusion, multilocular) *30=480, which means a high risk of malignancy and requires removal of the ovaries.

If the malignancy index is more than 200, the patient will undoubtedly be sent for a consultation with an oncologist. Borderline ovarian cystadenoma, which has an MI in the region of 200, is also a reason for a more thorough examination and alertness.

Treatment

All benign ovarian tumors, after excluding follicular cysts, are subject to surgical removal. The operation is performed laparoscopically and laparotomically (open intervention). Laparoscopy is performed on young women, and laparotomy is performed on patients who have reached premenopausal age and older.

Treatment of cystic formations in young women and women of menopausal age has significant differences. For women in the active reproductive phase, they try to preserve ovarian tissue as much as possible, considering it an asset. Some patients are recommended to become pregnant after surgery through the use of assisted reproductive technologies.

Older patients undergo open surgery to optimally assess the nature of the tumor process.

Hormonal treatment is not required after surgery.

Treatment during pregnancy

If a cystic formation is detected in a pregnant woman, she is subject to careful monitoring. The main danger during gestation is considered to be torsion of the leg, necrosis, rupture and the need for urgent surgery.

The growing uterus and tumor put pressure on the bladder, intestines, and kidneys, which leads to worsening organ function and worsening symptoms. In emergency cases, laparoscopy is performed during pregnancy. In most cases, they are observed, and during or after childbirth, which is carried out surgically, the cyst is removed.

Treatment of ovarian cystadenoma without surgery

Cystadenomas must be surgically removed, since there is no conservative method of treatment for them. These cystic formations do not respond to hormonal therapy. The radical tactics of doctors are due to the impossibility of completely excluding the malignant process and predicting the subsequent “behavior” of the cyst.

If surgery is contraindicated for a woman, the cyst is observed by performing an ultrasound and determining tumor markers in the blood. All possible thermal procedures on the abdominal area and the whole body are excluded.

Laparoscopy of ovarian cystadenoma

Laparoscopy using video equipment is considered the leading method of treatment for cystadenomas.

Young women undergo gentle laparoscopy, which involves enucleation (enucleation) rather than excision of the cyst.

According to patient reviews, laparoscopic treatment of ovarian cystadenoma is characterized by a quick recovery period, a small number of complications and consequences, and no effect on reproductive function.

During laparoscopy, an examination of the abdominal cavity and a biopsy are performed for diagnostic purposes. If the doctor suspects a malignant process during examination, then a certain algorithm is followed:

• video recording;
• biopsy;
• in case of opening of the formation after a biopsy, the abdominal cavity is washed, the contents are taken for histology;
• biopsy of the opposite ovary, omentum, lymph nodes;
• selection of peritoneal exudate (or washout) for histological examination.

In older women, it is often necessary to resort to extirpation of the uterus and both appendages in order to prevent cancer. During laparoscopy of a simple serous ovarian cystadenoma, at first glance, it is often necessary to switch to open surgery and work as if it were a potentially dangerous tumor.

Prevention

Cystadenoma forms in women over 40 years of age in the vast majority of cases. There are no reliable methods of prevention, since the causes of formation have not been fully determined. The most reliable way to prevent the development of cysts is considered to be an annual visit to the gynecologist and an ultrasound scan, which can detect the adenoma and perform minimally invasive removal laparoscopically.

Ovarian cystadenoma is a benign tumor and is called in some sources a true ovarian cyst. Anatomically, this formation is a bubble of epithelial tissue filled with liquid or mucous substance, capable of reaching 50 cm in diameter in the most advanced cases.

In addition, the tumor may be smooth or covered with tissue projections called papillae. Benign tumor implies:

• The inability of cystadenoma to penetrate adjacent tissues; it can only compress or displace them.
• Slow, stable and non-spike growth of tumor tissue.
• The neoplasm is not capable of forming metastases, and therefore does not spread to other systems, organs, and so on.

The reasons for the appearance of this disease have not yet been established, as well as the reasons for the appearance of many other neoplasms. But there is a list of risk factors that increase the likelihood of this formation:

• hormonal disorders;
• menstrual irregularities;
• infectious and inflammatory diseases;
• frequent stressful situations, etc.

In addition to the above risk factors, there are a large number of other factors that can also trigger the appearance of ovarian cystadenoma, albeit with a much lower probability. Among them are:

• long-term sexual abstinence;
• ectopic pregnancies, unprofessional abortions and childbirth;
• sexually transmitted diseases, disruption of normal ovarian functions and diseases of the genital organs;
• a sharp increase in physical activity;
• hereditary predisposition.

Although some researchers are inclined to believe that the main cause of ovarian cystadenoma is hormonal imbalance, this hypothesis has not been confirmed by statistics.

Note. Hormonal imbalance usually, if not the cause of tumor development, appears after dangerous tissue has to be removed.

The image clearly shows why ovarian cystadenoma is easy to diagnose using ultrasound - the difference in the size of the ovaries in the presence of a neoplasm is obvious

Types of ovarian cystadenomas

There are several types of cystadenomas, which differ in the mechanics of formation, size, morphological and histological features, as well as health hazards. These varieties are:

• Serous ovarian cystadenoma (its special subtype - papillary ovarian cystadenoma - differs in appearance and functionality).
• Mucinous cystadenoma of the ovary.

Treatment for these types of cysts varies, which is why correct diagnosis and accurate laboratory test results are so important.

In addition to belonging to one of the varieties, the lesion can be left-sided or right-sided, or bilateral. The clinical manifestations of cystadenoma of the right or left ovary are identical.

Serous cystadenoma of the ovary

Note. This type is more common than all others: 70% of women with ovarian cystadenoma are affected by this type of disease. Serous ovarian cystadenoma often occurs in women after 50 years of age; it is very rare in women under 30.

This type of disease best fits the most common description of ovarian cystadenoma - the neoplasm is a bubble of smooth epithelial tissue filled with a clear yellowish liquid. The shape of the cyst is round and consists of one chamber. The dynamics of development are poorly predictable, sizes vary from 5 mm to 35 cm in diameter. With all this, this variety very rarely turns out to be malignant and does not interfere with bearing or conceiving children. Sometimes serous ovarian cystadenoma is called a smooth-walled cilioepithelial cyst, or serous cyst.

This is what serous ovarian cystadenoma looks like under a microscope. The black line is dense epithelial tissue that is not capable of unpredictable growth, due to which serous ovarian cystadenoma very rarely turns into cancer.

Note. The main theory of the occurrence of serous cystadenomas is as follows: they develop from functional cysts if the latter do not resolve on their own. Functional cysts disappear due to a special layer of cells, which becomes thinner over time or even disappears in some places. And it is in these places that new growths appear.

Rough papillary serous cystadenoma of the ovary

Rough papillary cystadenoma of the ovary in some cases develops from a serous cyst after several years of its existence. Its key differences are the presence of growths (papillae) inside and outside the capsule, as well as consistency and color.

Rough papillary cystadenoma of the ovary is much more often bilateral and usually has several chambers. The symptoms of the disease are similar to those of cancer and teratoma. However, it is very easy to distinguish rough-papillary cystadenoma from serous one - just do an ultrasound. Due to the small, but still present, likelihood of malignant degeneration, you should be tested for tumor markers.

Some experts distinguish rough-papillary cystadenoma as a separate type of cyst, while others consider it a subtype of papillary cystadenoma.

Note. Despite the fact that this type is less common than serous cystadenomas, rough papillary cystadenomas of the ovary account for more than a third of all cases of cystadenomas and about 10% of all ovarian tumors.

Papillary serous cystadenoma of the ovary

This variety has a 50% chance of developing into a malignant tumor. The difference from rough papillary cystadenoma is the ability of the epithelial tissue of papillary cystadenoma not only to grow, but also to form stable structures and metastasize. In the most advanced clinical cases, multiple papillae cover the inner and outer surface of the capsules, forming nodes and changing the shape of the bladder. There are everting and inverting types of overgrowth of papillae; in the first, the papillae grow outside, and in the second, inside.

Note. Formations with everting papillae are much more likely to be bilateral, and are also twice as likely to cause ascites.

Mucinous cystadenoma of the ovary

Mucinous cystadenoma of the ovary is almost always multilocular, occurs after menopause, and is filled with mucus called mucin.

The image perfectly illustrates the main feature of mucinous ovarian cystadenoma - a multilocular tumor, the cavities of which are filled with a substance of jelly-like or mucous consistency, which can have different shades

The shell of the neoplasm is smooth, elastic, can slowly stretch and, at particularly large sizes, even be translucent. The sizes can reach 30-50 cm in diameter, and on average, tumors of this subtype have a significant volume, which is why they are easy to detect using ultrasound. The mucus inside the tumor can vary in consistency (from mucus to a jelly-like substance) and color (from light yellow to brown), and may also contain blood.

Note. Mucinous ovarian cystadenoma differs from a real cancer tumor primarily in the inability of the epithelium to invade adjacent tissues, that is, the absence of metastases.

Diagnosis and treatment of cystadenomas

Diagnosis is carried out using ultrasound, histological examination and laboratory tests for tumor markers - substances that help determine the ability of unwanted tissues to metastasize.

Once the presence of oncology has been established, histological examination will help determine the exact subtype of the formation, and malignancy or benignity is determined using tumor markers.

Treatment combines surgical and medical approaches: the cystadenoma must be removed, and medications can compensate for hormonal imbalance after surgery.

Previously, the ovary was often removed with a cyst, which significantly reduced the patient’s ability to become pregnant. Now doctors have learned to perform laparoscopy - a minimally invasive operation that does not require large incisions and sometimes even completely avoids injury to the patient’s ovaries and other genital organs. Thus, after removal of an ovarian cystadenoma, pregnancy is quite likely.

One of the common diseases that is detected during a woman’s childbearing years is a tumor on the ovary, the so-called cystadenoma. This formation is a cavity surrounded by dense membranes and filled with liquid.

Timely diagnosis and removal of the formation on the ovary helps prevent relapse.

Cystadenoma most often has a round shape with clear edges and, as is typical for such a formation, it develops in one ovary. In medicine there is also a classic expression - ovarian cyst. And, depending on the condition of the wall, it is divided into simple serous cystadenoma (has smooth and straight surfaces) and papillary (also called papillary due to the presence of small dense processes similar to warts).

Causes and symptoms of ovarian cysts

The etiology of neoplasms appearing in the ovaries is not yet well understood, but the main cause of their occurrence is hormonal disorders.

The main reasons include:

• hormonal imbalances in the body;
• stress, deep and strong feelings;
• psycho-emotional and physical stress;
• rare sexual intercourse or prolonged abstinence;
• genital herpes virus or human papillomavirus present in the body;
• diseases of the genital area of ​​chronic etiology;
• previous sexually transmitted diseases, as well as the stage of their exacerbation;
• ectopic pregnancy, abortion;
• previous ovarian surgeries;
• hereditary predisposition.

Usually the presence of a cyst is not felt at all and obvious symptoms are not visible. It is most often diagnosed during a routine ultrasound examination. The main cause for concern may be irregular periods or mild pain in the lower abdomen, on the right or left, that is, on the side where the cyst is located.

Irregular periods or mild pain in the lower abdomen should definitely be a cause for concern.

Obvious symptoms in the presence of a large cyst:

• nagging pain in the abdomen;
• periodic exacerbations of pain in the middle of the cycle, which are accompanied by bleeding;
• disrupted menstrual cycle;
• pain during physical activity and during sexual intercourse;
• periodic nausea and vomiting;
• frequent urge to go to the toilet, pain during urination or bowel movements.

Types of cystadenomas

Papillary cystadenoma is a category of serous tumor, manifested by a feeling of heaviness and pain, menstrual irregularities, and infertility. Some types of such tumors can degenerate into adenocarcinoma. This disease can be diagnosed using invaginal ultrasound and laparoscopy.

The disease can be diagnosed using invaginal ultrasound or laparoscopy.

The development of papillary cysts is very often observed in bilateral ovarian lesions and the special location of the tumor itself. Depending on the location of the papillae, the following forms are noted:

• inverting - in the middle of the cyst;
• everting - on the outer surface of the capsule;
• mixed - inside and outside the cyst.

The growth and enlargement of the papillae often spread throughout the peritoneum, but this is not an indicator of the malignancy of the tumor.

In most cases, the size of papillary cystadenomas does not exceed 10 cm in diameter. Every second such cyst can degenerate into cancer.

The disease does not manifest itself in any way at the initial stage. In some forms, serous ascites is formed, which entails an increase in the size of the abdomen and adhesions, which subsequently leads to infertility. In the case of severe, advanced manifestations, with tumor necrosis, rupture of the cyst, intra-abdominal bleeding and peritonitis occur.

Papillary cystadenoma can be detected after diagnostic studies and histological tests. During an ultrasound, the actual size of the cyst, the thickness of the capsule, the size and presence of chambers and papillae are determined.

In some cases, for a more accurate diagnosis, an additional CT or MRI of the pelvic organs is performed. The final diagnosis is made after laparoscopy, biopsy and histology.

The development of papillary cysts is very often observed in bilateral ovarian lesions and the special location of the tumor itself.

In the situation of bilateral cystadenoma, regardless of age, both ovaries are removed. During menopause or with borderline tumors, the uterus and appendages can be amputated, after which the affected tissue is submitted for histological examination.

Timely diagnosis and removal of the formation on the ovary helps prevent relapse. But to eliminate cancer risks, constant monitoring by a gynecologist is necessary.

Serous cystadenoma

The most common tumor is a serous cyst. It can develop to large sizes, which manifests itself in the form of pain in the abdomen, heaviness and discomfort. This benign tumor very rarely develops into ovarian cancer. Most often, a serous cyst appears after 40 years of age, but there are cases of this problem developing at an earlier age.

1. Serous cyst: main symptoms
2. Dull pain in the groin, pubic area, and lumbar region.
3. Frequent urge to urinate.
4. The size of the abdomen increases.
5. Constant discomfort, heaviness, bloating in the abdomen.
6. Difficulty defecating.
7. Disruptions of the menstrual cycle.

Problems with conception, infertility.

In most cases, the size of papillary cystadenomas does not exceed 10 cm in diameter.

Treatment of serous cystadenoma is surgical. The volume and method of surgery usually depend on the following factors:

• age of the patient;
• condition of the ovaries;
• size, type, location of the tumor;
• possible parallel pathologies.

The estimated volume of the operation may also vary. They provide for complete or partial removal of reproductive organs:

• excision of the tumor followed by restoration of the organ;
• removal of a tumor from the affected ovary;
• cutting out one or two ovaries;
• amputation or extirpation of the uterus.

After surgery, the cyst undergoes histological examination. If the tumor is benign, only the affected appendage is removed. If the formation is on both sides, resection of the ovaries is required, after which the ability to subsequently conceive is preserved.

After surgery, cystadenoma is subjected to histological examination.

Complete removal of the uterus or ovary is indicated when the cyst is malignant and there is a possible risk of metastases. In addition, if histology and biopsy tests are disappointing, chemotherapy is prescribed after surgery.

The cyst is very dangerous, since its presence can lead to ovarian cancer. Timely diagnosis and removal of tumors will save you from many problems in the future.

Features of borderline papillary cystadenoma

In a borderline papillary tumor there are abundant and frequent papillary formations with the presence of fields of extensive dislocation. The main diagnostic indicator is the absence of invasions, but along with this, intussusceptions without any special signs of atypia are determined.

When a borderline papillary cyst is detected on the ovary in young women who are interested in having children in the future, removal of the uterine appendages with the affected areas, as well as resection of the second ovary, is used. Women of premenopausal age undergo extirpation of the uterus with ovaries and omentum.

Today there are many factors influencing diseases of the female reproductive system. Treatment with antibacterial drugs, oral contraceptives without a doctor's prescription, promiscuity, cooling, and stress have a negative impact on health. The article will focus on papillary ovarian cysts, a type of epithelial neoplasm.

A papillary ovarian cyst is a benign tumor, an “irregularity” in the gynecological process, in which a serous tumor is formed in the ovarian tissue, the epithelial tissue of which is lined with papillae. The cyst is similar to a capsule with liquid, which is surrounded by a dense membrane. The shape of the cystadenoma is round, the edges are clear, the development of the neoplasm occurs in one ovary. The disease is called an ovarian cyst. The disease affects women of reproductive age. In girls 11-15 years old and menopausal women, the disease rarely develops. 7 out of 100 women develop papillary cystoma, 34% develop epithelial tumors. 50-70% - the cyst turns from benign to a malignant tumor. Deviations of the reproductive system - uterine fibroids, ovarian cysts, cancer of the smooth muscle hollow organ, endometriosis - are combined with papillary cystoma.

• feeling of heaviness;
• pain in the lower abdomen;
• disturbance of the urination process;
• menstruation disorders;
• infertility;
• accumulation of exudate or transudate

A papillary cyst is diagnosed by ultrasound, MRI, the CA-125 marker is determined, and laparoscopy. The danger of adenocarcinoma is growing, so the affected ovary, appendages and uterus are removed.

Distinctive features of benign education:

1. Does not disappear after taking medications.
2. The serous cyst is multi-chambered, irregularly rounded, with a short stalk, formed by connective tissue, arteries, fibers, and lymphatic vessels.
3. Papillary cystadenoma is diagnosed on both sides.
4. The cyst is filled with brown or yellow fluid.
5. The papillary enlargements look like cauliflower.
6. Papillary ovarian cyst does not exceed 10 cm in size.

Systematization of benign tumors

Cystadenomas are:

1. Unilateral - the development of a neoplasm on one ovary.
2. Bilateral - the tumor grows on both sex glands.

Formations on epithelial tissue grow:

1. An inverting cyst, which occurs in 30% of cases, is characterized by damage to the internal walls.
2. Non-inverting neoplasm appears in 10%, visible from the outside.
3. The papillae spread along the inner and outer sides - mixed tumors, the diagnosis of which reaches 60%.

Non-inverting and mixed forms are considered the most dangerous. The development of diseases occurs quickly, turning into cancer. For adenomas of these types, a bilateral location is typical. If a cyst is diagnosed on the right ovary, the growth is also detected on the other side. On the left, the tumor grows at a slow pace and is detected later. The right ovary is considered a large feeding artery; there is an intensive supply of fluid circulating in the circulatory system.

Three degrees of danger for the development of cystadenoma have been established:

• benign course of the disease;
• increasing cystoma;
• low-grade papillary cyst.

The proliferation and growth of papillae often extends into the abdominal cavity, but this is not always considered cancer.

Factors causing the disease

Scientists have not found the origin of diseases that form on the ovaries, but they have put forward three hypotheses.

1. Excessive activity of the hypothalamus and pituitary gland develops with chronic hyperestrogenism.
2. Frequent release of a mature egg from the ovary, the causes of which are early puberty, late menopause, lack of an “interesting position”, sudden interruption of breastfeeding.
3. Heredity with the presence of benign and malignant formations on the ovaries and breast cancer in women in the family.

Causes of papillary neoplasms:

• hormonal disbalance;
• stress, depression, anxiety and excitement;
• lack of sex;
• emotional and psychological stress;
• HPV, herpes II;
• sexual chronic diseases;
• sexually transmitted diseases;
• pregnancy complication, miscarriage;
• surgical interventions on paired female reproductive glands;
• hereditary factor

Symptoms

In the initial period of the disease, no signs were identified. With a non-inverting neoplasm and a mixed papillary cyst, serous ascites occurs, the abdomen enlarges, and adhesions appear, which threatens the impossibility of conceiving a child. Hemoperitoneum and inflammation of the parietal and visceral layers of the peritoneum occur when the vital activity of cells ceases and apoplexy occurs.

With active capsule growth:

• “pulls” the stomach;
• painful sensations with blood in the second half of the cycle;
• the monthly cycle is disrupted;
• pain during intimate relationships;
• periodically feels sick, vomits;
• problems with bowel movements;
• urinary complications

Diagnosis of the disease

Small or medium-sized bodies are found during a medical examination using an ultrasound examination or when taking cytology. Ultrasound determines the size of the cystoma, the thickness of the membrane, borders and papillae. The conclusion is made on the basis of laparoscopic, biopsy and histological studies. To be examined more widely, it is necessary to conduct CT and MRI diagnostics. Random menstruation or pain in the lower abdomen, depending on where the cyst is located - on the right or left - is a reason to consult a doctor.

Excluding oncology:

• take blood for CA-125 protein, an increase in concentration indicates a malignant change;
• perform laparoscopic examination

The final justification for the development of oncology is made using material obtained by biopsy.

Treatment of the problem

Papillary cystadenoma is removed surgically. Physiotherapy and medication are useless.

Timely diagnosis and elimination of the papillary cyst makes it possible to remain with the ovaries and become pregnant.

Proposed operations:

1. If the tumor is benign, the cyst is excised without affecting the ovarian tissue.
2. The cyst is removed by resection of the ovary.
3. In the case of a bilateral tumor and there is suspicion of cancer, both ovaries are excised.
4. The affected gonad is amputated along with the uterus.

Carrying out manipulation is logical during menopause or in the absence of other outcomes of the operation.

If a pregnant woman is diagnosed with a rough-papillary cyst, the operation is postponed until the birth of the child. If active growth is detected and oncology is suspected, surgery is performed immediately after the fetal organs have formed. Cyst rupture and pedicle torsion are urgent indications for surgery to avoid the patient’s death.

Serous cyst

Serous cystadenoma is a common tumor that develops to a size of more than 10 cm and is manifested by pain in the lower abdomen, heaviness and discomfort. Adenoma rarely turns into cancer. The manifestation of a serous cyst is observed in the menopause, but lesions occur in women under the age of 40 years.

Symptoms of the disease:

• pain in the lower back, groin, pubic area;
• frequent urination;
• enlarged belly;
• heaviness, discomfort in the peritoneum;
• difficulty with bowel movements;
• irregular menstrual cycle;
• inability to conceive a child

Diagnosis of the neoplasm is carried out by ultrasound. The tumor is monitored for up to six months, unless there is an indication for urgent surgery. A benign formation has the ability to resolve or shrink.

To do this, the doctor prescribes hormonal or anti-inflammatory medications.

Serous cystadenoma is treated surgically. Depending on how old the patient is and other pathologies, surgical intervention is used to remove organs partially or completely.

1. The tumor is removed with further reconstruction
2. Removing a tumor with a damaged organ
3. One or both ovaries are removed
4. Amputation or resection of the uterus

After the operation, the cyst is examined histologically. The affected appendages are removed if there is no oncological process. By removing part of the ovary, a woman has the opportunity to produce offspring.

Hysterectomy or oophorectomy is necessary if there is a risk of developing cancer and metastases. Chemotherapy is prescribed if histological studies are positive. A pathological cavity leads to the formation of ovarian cancer. It is important to diagnose and remove the tumor in time.

Borderline papillary cyst

A tumor with abundant and frequent papillary formations located in numerous places. A girl of childbearing age who wishes to subsequently have children has her appendages removed and another hollow organ resected. During menopause, a woman has her uterus, ovaries and omentum removed.

To avoid gynecological problems, a woman needs to visit a gynecologist once a year. A patient with a papillary ovarian cyst needs to see a doctor every 3 months and follow the doctor’s instructions to avoid complications and relapses.

– a type of serous tumor of ovarian tissue that has a pronounced capsule, an internal lining formed by papillary growths of the epithelium, and liquid contents. Papillary ovarian cystoma is manifested by a feeling of heaviness and pain in the lower abdomen, dysuric phenomena, menstrual disorders, infertility, and ascites. Some types of tumors of this type can degenerate into adenocarcinoma. Papillary ovarian cystoma is diagnosed using vaginal examination, ultrasound, MRI, determination of the CA-125 marker, and laparoscopy. For reasons of oncological alertness, the presence of papillary ovarian cystoma requires removal of the affected ovary or uterus with appendages.

General information

It develops more often during reproductive age, somewhat less frequently during menopause, and practically does not occur until puberty. The frequency of papillary cysts in gynecology is about 7% of all ovarian tumors and almost 34% of epithelial type tumors. Papillary ovarian cystomas are prone to blastomatous degeneration in 50-70% of cases, therefore they are considered as a precancerous disease. The presence of papillary ovarian cystoma in 40% of patients is combined with other tumor processes of the reproductive organs - ovarian cyst, uterine fibroids, endometriosis, uterine cancer.

Causes of development of papillary ovarian cystoma

On the question of the causes of papillary ovarian cystoma, modern gynecology has several hypotheses. According to one theory, papillary ovarian cystomas, like other tumor formations of ovarian tissue, develop against the background of chronic hyperestrogenism caused by hyperactivity of the hypothalamic-pituitary system. Another theory is based on arguments about “constant ovulation” caused by early menarche, late menopause, a small number of pregnancies, refusal of lactation, etc. According to the theory of genetic predisposition, the presence of ovarian tumors in female family members is important in the development of papillary ovarian cysts and breast cancer.

Classification of papillary ovarian cysts

Morphologically, papillary ovarian cystoma is characterized by papillary growths of the epithelium on its internal and sometimes external surface. According to the localization of papillary growths, papillary ovarian cystoma can be inverting (30%), everting (10%) and mixed (60%). Inverting cystoma is characterized by individual papillae or massive papillary growths lining only the inner surface of the tumor wall. In an everting cystoma, papillary growths cover only the outer surface of the wall. With papillary ovarian cystoma of mixed type, the papillae are located both outside and inside the capsule.

In terms of oncological alertness, the histological form of papillary ovarian cystoma is extremely important. There are papillary ovarian cystomas without signs of malignancy, proliferating (precancerous) and malignant (malignant). Papillary ovarian cystoma often has a multi-chamber structure, an irregularly rounded shape, convex walls, and a short stalk. Inside the cystoma chambers there is a yellowish-brown liquid medium.

The walls of the chambers contain unevenly spaced papillary growths, the number of which can vary, and the shape resembles coral or cauliflower. Small and multiple papillae give the cystoma wall a velvety appearance. When epithelial papillae grow through the cystoma wall, seeding of the parietal peritoneum of the pelvis, second ovary, diaphragm and neighboring organs occurs. Therefore, everting and mixed papillary cystomas are considered potentially malignant and more likely to develop into ovarian cancer.

Papillary ovarian cysts are characterized by bilateral localization with simultaneous development of tumors and intraligamentary growth. Large ovarian papillary cystomas develop extremely rarely.

Symptoms of papillary ovarian cystoma

At the early stage of the disease, symptoms are not expressed. The clinical picture of papillary ovarian cystoma manifests itself with the appearance of sensations of heaviness and pain in the lower abdomen; pain often radiates to the lower limbs and lower back. Early development of dysuric phenomena, defecation disorders, and general weakness is noted. Some women may experience menstrual irregularities such as amenorrhea or menorrhagia.

With everting and mixed forms of cysts, serous ascites develops; the hemorrhagic nature of ascitic fluid indicates the presence of a malignant cystoma. Ascites is accompanied by an increase in the size of the abdomen. The adhesive process in the pelvis often leads to infertility.

Diagnosis of papillary ovarian cystoma

Papillary ovarian cystoma is recognized by vaginal examination, ultrasound, diagnostic laparoscopy, and histological analysis. During a bimanual gynecological examination, a unilateral or bilateral painless ovoid formation is palpated, pushing the uterus towards the pubic symphysis. The consistency of the cystoma is tight-elastic, sometimes uneven. Everting and mixed cystomas, covered with papillary processes, have a finely tuberous surface. The interligamentous location causes limited mobility of papillary ovarian cysts.

During a gynecological ultrasound, the size of the cystoma, the thickness of the capsule are accurately determined, and the presence of chambers and papillary growths is clarified. When palpating the abdomen, as well as using

In premenopause and menopause, as well as in case of borderline or malignant cystomas, supravaginal amputation of the uterus with appendages or panhysterectomy is performed. To clarify the morphological form of the cystoma and determine the extent of intervention during surgery, the tumor tissue undergoes urgent histological examination.

Intraoperative detection of ascites and dissemination of papillae along the tumor surface and peritoneum does not directly indicate the malignancy of the cystoma and cannot serve as a reason for refusing surgery. After removal of the papillary ovarian cystoma, the foci of dissemination regress, and ascites does not recur.

Prognosis for papillary ovarian cystoma

Timely diagnosis and removal of papillary ovarian cystoma practically eliminates the possibility of their recurrence in the form of ovarian cancer. However, to exclude oncological risks after surgery, patients are subject to observation by a gynecologist. If treatment is refused, papillary ovarian cystoma can take an unfavorable course with the development of ascites, complications (torsion of the pedicle, rupture of the capsule), and malignancy.