What is ovarian cystadenoma and how dangerous it is. Types of ovarian cystadenoma, their treatment, features and origin

Ovarian cystadenoma is a benign tumor-like formation filled with serous fluid. The disease is found mainly in women of late reproductive age and in the premenopausal period. The cyst is asymptomatic, but has a tendency to malignancy. When identifying a cystadenoma, it is extremely important to find out that it is not cancer and carry out comprehensive treatment according to the identified pathology.

A benign serous formation is often mistaken for a simple ovarian cyst. Often, an accurate diagnosis can be made only after surgery and histological examination. It is important to remember that, unlike simple functional cysts, cystadenoma does not respond to hormonal therapy and is not able to regress on its own. Once established, education will grow. The only treatment option is surgery.

Let's take a closer look at how to distinguish cystadenoma from other ovarian diseases and what to do when it appears.

Reasons for the development of pathology

The exact mechanisms of the formation of the disease have not yet been studied. There is an opinion that cystadenoma occurs against the background of a simple follicular ovarian cyst that has not regressed in due time. Not all gynecologists share this point of view. Most doctors believe that the serous formation is formed by other mechanisms and has nothing to do with a persistent follicular cyst.

Other possible causes of cystadenoma:

• Hormonal disbalance. The influence of excess estrogen synthesis against the background of a relative progesterone deficiency is assumed. The effect of thyroid and adrenal hormones on the formation of pathology is being studied;
• Infectious and inflammatory diseases of the pelvic organs. It has been noted that cystadenoma often occurs against the background of chronic salpingoophoritis (inflammation of the uterine appendages);

Some experts believe that one of the causes of cystadenoma is the development of an inflammatory process in the uterine appendages (salpingoophoritis).

• Previous abortions and spontaneous miscarriages. After termination of pregnancy, a woman’s hormonal background changes, and conditions arise for the development of ovarian cysts and tumors;
• Surgical interventions on the pelvic and abdominal organs. Cystadenoma on the right is often detected after appendectomy, on the left - after intestinal resection;
• Endocrine pathology. The influence of diseases of the thyroid gland and adrenal glands, metabolic disorders is being studied;
• Prolonged stress, severe emotional experiences;
• Uncontrolled use of hormonal drugs;
• Heredity. According to the observations of doctors, cystadenoma is often detected in several generations.

Cystadenoma – what is it like?

In the International Classification of Diseases (ICD-10), the disease is coded N83.2 - other and unspecified benign ovarian cysts. When a malignant tumor is detected, the code C56 is assigned.

In gynecology, it is customary to distinguish several types of cystadenoma:

Simple serous

Characteristics:

• Predominantly single-chamber formation. Multilocular serous cystadenomas are extremely rare;
• Smooth-walled cavity - there are no outgrowths inside;
• It is usually detected only on one side; bilateral formations are less common;
• Average size – from 3 to 20 cm;
• Lined with epithelium, similar to the cells of the mucous membrane of the fallopian tube.

Simple serous cystadenoma in section.

A simple cystadenoma in gynecology is called a serous ovarian cyst, but many doctors classify it as a true tumor. On the one hand, this formation grows due to an increase in the volume of serous fluid and gradual stretching of the capsule - like all cysts. On the other hand, the cells that line the cavity can proliferate - as in all tumors. Such a dual structure of the formation forces one to treat it with particular caution and does not allow the doctor to postpone surgical treatment for a long time.

Simple serous cystadenoma is considered a benign tumor. It does not degenerate into cancer, but can develop into a papillary tumor. In this situation, each serous ovarian cyst is considered potentially dangerous in terms of malignancy and requires special attention from a doctor.

It is important to know

A simple serous cyst is often disguised as a follicular formation. Unlike a functional cyst, a cystadenoma cannot disappear spontaneously, and the woman inevitably undergoes surgery. The final diagnosis is made only after tumor removal and histological examination.

Papillary (rough papillary)

Characteristic features:

• A cystic cavity consisting of one or more chambers;
• The inside is covered with multiple papillae on a broad base;
• Most often one-sided.

Papillary cystadenoma is the next stage of development of a simple serous cyst. Papillary growths form after a year or more of the tumor's existence. This formation is prone to malignancy and in 50% of cases degenerates into cancer. When malignancy spreads over a large area and leads to the appearance of ascites. The accumulation of fluid in the abdominal cavity occurs due to the proliferation of papillae and a decrease in the absorption capacity of the peritoneum.

Papillary border

Distinctive features:

• Single-chamber or multi-chamber formation;
• More often detected on both sides;
• The inside of the cavity is lined with a large number of soft papillae;
• Not capable of invasive growth.

Borderline cystadenoma has features of both benign and malignant tumors. In approximately half of the cases, it becomes malignant with the development of metastases to neighboring organs.

Cystadenofibroma

Character traits:

• Unilateral or bilateral formation;
• It is characterized by slow growth and rarely reaches a size of more than 10 cm;
• Has a clear round shape;
• Contains a large amount of fibrous tissue;
• May lead to fibrous degeneration of the ovary;
• It is detected mainly during menopause.

Cystadenofibroma is a serous tumor of the ovary. It can be benign or borderline. Capable of malignancy in 10% of cases.

Mucinous cystadenoma

Characteristic features:

• Almost always multi-chamber;
• In most cases (up to 90%) it is unilateral;
• The wall of the cavity is lined with epithelium, similar in structure to the cells of the glands of the cervix;
• The inside of the wall may be smooth (simple mucinous cyst) or contain papillae (papillary mucinous cyst);
• Inside the cavity there is mucin - a mixture of heteroglycans and glycoproteins;
• Reaches large sizes - up to 30 cm in diameter.

Inside the many capsules of the mucinous cyst there is a viscous mucous content - mucin.

A mucinous cyst is considered benign by default, but in 15% of cases it can become malignant.

Features of the development of pathology

At the initial stages of its existence, cystadenoma is a smooth-walled cyst with thin walls. Usually this is a single-chamber formation. Much less often, a cyst becomes multi-chambered from the very beginning. Education grows slowly, so it goes unnoticed for a long time. In the first year, the disease is detected only by ultrasound.

The growth of simple serous cystadenoma occurs due to the accumulation of secretions inside the cavity. The contents of the cyst are a transparent gray-yellow liquid. Over time, the epithelial lining of the formation changes. Papillae form, and a simple serous cyst turns into a papillary cyst. The addition of the inflammatory process leads to the fact that the once smooth shiny surface of the tumor becomes dull and covered with adhesions.

Leading symptoms of cystadenoma

Serous formation of the right or left ovary remains asymptomatic for a long time. Cystadenoma does not have hormonal activity and does not affect the menstrual cycle. A cyst less than 3 cm in diameter is not accompanied by any complaints and is detected by chance during an examination for another disease.

As education grows, the following symptoms arise:

• Pain in the projection of the affected ovary. If the tumor is localized on one side, discomfort will be felt in the groin area on the left or right. With bilateral damage, a dull aching pain is localized in the lower abdomen. Unpleasant sensations radiate to the lower back, can go to the sacrum, down to the limbs;
• The feeling of a foreign body in the perineum or rectum is noted with a low location of the cystadenoma;
• Increased urination occurs when the cyst puts pressure on the bladder;

One of the signs of cystadenoma is a frequent urge to urinate.

• Chronic constipation indicates the location of the cystadenoma near the intestinal loops;
• Asymmetrical enlargement of the abdomen occurs with large formations - from 10-12 cm.

For your information

Pain, discomfort during urination and defecation occur with various tumors of the uterus, appendages, bladder and intestines. You should consult a doctor as soon as possible to find the cause of this condition.

Dangerous consequences of neoplasm

A simple serous ovarian cyst is not yet an oncology, but against the background of this pathology the risk of developing cancer increases significantly. When mucinous or papillary cystadenoma is detected, the probability of malignancy increases to 30-50%.

Risk factors:

• Burdened heredity. If there have been cases of borderline or malignant ovarian tumors in the family, the risk of developing cancer increases significantly;
• Menopause. Any ovarian tumor discovered after the decline of reproductive function is considered potentially malignant and requires mandatory removal. And if in the premenopausal period the doctor may still suggest enucleation of the cyst or resection of the ovary, then in postmenopause the entire organ is usually removed;

During menopause, if a tumor is detected in the ovary, the woman will be asked to remove the entire organ so as not to risk her health in the future.

• Relapse of the disease. Repeated detection of a similar cyst on the same ovary is a reason for a targeted examination.

It is important to distinguish benign cystadenoma from a dangerous pathology - cystadenocarcinoma. This is a malignant ovarian tumor arising from epithelial tissues. There are two types of the disease:

• Serous cystadenocarcinoma. Arises from the epithelial lining of serous cysts and tumors. It is observed mainly during menopause and is detected in women 40-65 years old. Often occurs against the background of infertility, inflammatory changes in the uterine appendages. It is characterized by rapid growth and spread to neighboring organs: peritoneum, omentum, bladder and intestines;
• Mucinous cystadenocarcinoma. Formed from the epithelium of mucinous formations. Leads to disruption of intestinal function with the development of constipation and diarrhea, and the rapid appearance of ascites.

Malignant ovarian tumors are difficult to recognize in the early stages. There are no distinctive symptoms. The appearance of abdominal pain is noted, but only with large sizes of the formation. Signs of tumor intoxication (unmotivated weight loss, severe weakness, low-grade fever) do not always occur or are not noticed by the woman. Often, cystadenocarcinoma is detected in the presence of metastases.

Life expectancy for a malignant tumor varies and depends on the stage at which cystadenocarcinoma was detected. Analysis of medical records shows that the five-year survival rate is about 30%. If the pathology is detected at an early stage, the survival rate reaches 85%.

Complications and their characteristic symptoms

Long-term cystadenomas can lead to the development of the following conditions:

• Inflammation of the cyst with spread of infection to surrounding tissues. Accompanied by increased body temperature and cramping pain in the lower abdomen;

If cystadenoma is not treated in time, this can lead to serious inflammatory processes, which are accompanied by pain in the lower abdomen and high fever.

• Torsion of the tumor stalk. Occurs during physical activity, after sex. Leads to the appearance of sharp, severe pain in the lower abdomen. Threatens ovarian necrosis and peritonitis;
• Rupture of the capsule of the formation with hemorrhage into the ovary. Occurs against a background of fever and increased pain. Without treatment it leads to peritonitis and sepsis;
• Compression of the pelvic organs. It is noted against the background of large cystadenomas - from 10 cm in diameter. Leads to dysfunction of the bladder and rectum.

Treatment of complications that arise is only surgical. The extent of the operation is determined after revision of the pelvic cavity. If you consult a doctor in a timely manner, you can save the ovary. In advanced cases, removal of the organ along with the complicated cyst is indicated.

Diagnostic scheme for suspected cystadenoma

If you experience pain in the lower abdomen or other characteristic symptoms of ovarian pathology, you should consult a doctor. The doctor will conduct a general and gynecological examination of the patient. During the examination, the doctor pays attention to the symmetry of the abdomen and notes pain upon palpation. Simple serous formations do not cause any discomfort during examination. The appearance of pain and discomfort indicates the development of complications.

During a gynecological examination, attention is focused on the condition of the uterus and appendages. The ovaries can be enlarged due to a cyst. In the projection of the organ, an elastic round formation is palpated, mobile and painless. With a bimanual examination, the gynecologist can only determine the presence of a tumor, but additional research will be needed to determine its type.

Blood test for tumor markers

In the diagnosis of ovarian tumors, the following indicators are important:

• CA-125. Normally present in endometrial tissue. Does not penetrate the bloodstream. It increases during menstruation, with endometriosis and cancer. With malignant neoplasms of the ovary, it increases 5 times or more. Used as a screening for any gonadal tumors and cysts;

Donating blood for the CA-125 tumor marker will allow timely recognition of the nature of the tumor in the ovary.

• CA-19-9. Normally synthesized by cells of the digestive tract. It has low specificity and is therefore not used as a screening method. Prescribed for suspected metastases. When the tumor spreads, the marker grows to more than 10,000 U/ml. Used after surgery to detect relapse of the disease.

In benign pathology, tumor markers remain within normal limits. The increase in indicators speaks in favor of ovarian cancer.

Ultrasonography

The ultrasound picture differs for different types of tumor. Simple serous cystadenoma is visible on ultrasound as an anechoic single-chamber or multi-chamber formation. The partitions between the cells are thin and smooth. The photo shows this formation:

The photo below shows a multilocular simple cystadenoma (3D image):

Mucinous cystadenoma can be multilocular. In the lumen of large cells there are small ones. The walls of the formation are smooth and thin, the contents are anechoic or hypoechoic. The changes are clearly visible in the photo:

Cystadenofibroma in the ultrasound image below is presented as a multi-chamber anechoic formation with smooth walls:

Serous cystadenocarcinoma is visible on ultrasound as a multilocular formation with thick and uneven septa. Solid inclusions with active blood flow are determined inside (by Doppler). The photo below demonstrates this pathology:

Magnetic resonance imaging

MRI is used in difficult cases when it is impossible to distinguish a benign tumor from a malignant one by other means. The technique allows us to detect not only ovarian cancer, but also possible metastases to the peritoneum and lymph nodes.

Often, MRI does not provide an accurate diagnosis, and then the patient is referred for diagnostic laparoscopy. The type of tumor can be determined unambiguously only after histological examination.

Treatment approaches

Any ovarian cystadenoma is an indication for surgical treatment. Conservative therapy is not carried out. The development of complications can only be prevented by timely removal of the tumor. Laparoscopic excision of the cystadenoma (sometimes together with the ovary) is indicated.

Surgical treatment options:

• Cystectomy is the excision of only the cyst within healthy tissue. Possible with small size of the formation and intact ovary;
• Ovarian resection – removal of the tumor along with part of the organ;
• Ovariectomy – removal of the entire ovary. It is carried out if the formation has completely replaced the functional tissue of the gonads, and the ovary has become a cyst capsule.

It is important to know

Removing one ovary does not affect reproductive function. According to reviews, even after oophorectomy, women manage to conceive and carry a child. If both ovaries are removed, hormone replacement therapy is indicated until natural menopause occurs. Pregnancy in this case is only possible using a donor egg.

After removing one of the ovaries, a woman may well become pregnant and bear a healthy baby.

The extent of the operation is also determined by the type of cystadenoma. If the doctor suspects a benign formation, he will try to leave the ovary. The following facts speak in favor of organ-preserving surgery:

• The woman's age is less than 50 years. It is important that the patient has not yet entered menopause. During menopause, the risk of developing cancer increases significantly, and leaving non-functional ovaries does not make sense;
• Tumor markers are within normal limits;
• Absence of ascites and other probable signs of a malignant tumor;
• The diameter of the formation is no more than 10-12 cm;
• Ultrasound reveals a single-chamber smooth-walled cyst without inclusions (presumably simple serous cystadenoma);
• Doppler measurements do not determine blood flow inside the tumor;
• Diagnostic laparoscopy shows no signs of peritoneal damage.

At the slightest suspicion of a borderline or malignant tumor, the operation is performed in compliance with all the rules of ablastics. Before removal, the ovary is placed in a special container. All manipulations are carried out inside the container, and even if the cyst opens, its contents will not enter the pelvic cavity. This approach avoids the spread of the tumor if it turns out to be malignant.

The prognosis for ovarian cystadenoma directly depends on the time of its detection. The earlier a tumor is detected, the easier it is to cope with its consequences and the higher the chances of a favorable outcome.

Cystadenoma and pregnancy: main aspects

When planning pregnancy against the background of pathology, it is important to know:

• Cystadenoma does not affect the menstrual cycle and does not interfere with the conception of a child;
• A tumor-like formation up to 3 cm in size does not interfere with pregnancy and childbirth;
• A cavity larger than 3 cm in diameter can cause miscarriage or premature birth.

If a cystadenoma larger than 3 cm is detected, gynecologists advise removing the tumor before conceiving a child. You can plan a pregnancy 6 months after laparoscopic surgery and a year after abdominal surgery.

If a woman is diagnosed with a cystadenoma larger than 3 centimeters, then before planning a pregnancy, the tumor should be surgically removed.

Questions for a gynecologist

A few words about what worries women who come to see a doctor:

Is it possible to treat cystadenoma with folk remedies?

No, this tumor is not amenable to alternative therapy. Decoctions and infusions of herbs, as well as herbal tampons and other methods will not help. There is no other effective remedy other than surgery.

Can cystadenoma be treated with hormones?

No, a serous tumor cannot be treated with conservative therapy. Medicines are not used in treatment.

If the tumor is not removed, will it develop into cancer?

Not always. Some forms of cystadenoma do not cause malignancy, but the risk always remains. Any cystadenoma or unclear cyst should be considered as a potentially malignant tumor.

Can a surgeon make a mistake and mistake a benign tumor for cancer or vice versa?

Yes, this happens. During the operation, the removed lesion is sent to the laboratory for urgent histological examination. This method is imperfect, and sometimes the diagnosis turns out to be erroneous. In this regard, special attention is paid to preoperative diagnostics - ultrasound, MRI and determination of tumor markers in the blood.

Do I need to see a doctor after surgery?

After removal of the cystadenoma, a control ultrasound is performed after 1, 3 and 6 months. If the tumor turns out to be malignant, monitoring of tumor markers is indicated. These measures allow you to detect a relapse in time and avoid the development of complications.

Diagnosis: ovarian cystadenoma... What to do? Expert answers

Diagnosis and treatment of borderline ovarian tumors

Papillary ovarian cyst is a type that belongs to true benign tumors - cystomas - cavity formations with internal exudate.

Unlike a simple smooth-walled serous cystoma, unevenly spaced outgrowths in the form of papillae are formed on the shell of the capsule of papillary cystadenoma, which is why experts often call it a papillary or rough-papillary cyst.

Papillary cystoma is considered as the next stage of a smooth serous cyst, since epithelial growths in the form of papillae appear several years after the appearance of a simple serous tumor.

Peculiarities:

1. Occurs in 7 out of 100 patients with tumors of various types.
2. Never resolves with medication.
3. In 50 out of 100 patients, papillary cystadenoma becomes malignant.
4. In 40 women out of a hundred, a tumor of this type is combined with other cysts and tumors, including, as well as endometriosis.
5. In most cases, papillary cystadenoma is diagnosed on both sides.
6. Its structure is characterized by multi-chamber, irregular rounded shape, short leg, formed from tissues of ligaments, arteries, nerve fibers, lymph vessels.
7. The cystoma cavity is filled with brownish-yellow exudate.
8. Papillary growths are shaped like the surface of cauliflower.
9. This type of cystoma rarely reaches a large size.
10. Appears in women over 30 years of age.

Based on the location of the growth of the papillae, it is classified as:

• inverting, with characteristic damage to the inner wall (30%);
• everting, in which the papillae are formed externally (10%);
• mixed, when growths are detected on both sides of the cystic capsule (60%).

The likelihood of oncology is determined by distinguishing three degrees of development of cystadenoma:

• benign education;
• proliferating (growing) papillary cystadenoma, which is considered as a precancerous (borderline) condition;
• malignancy of cystadenoma (transition of the process to malignancy).

Cystadenomas of everting and mixed forms are most prone to degeneration into a cancerous tumor when they grow into the papillae and spread to the abdominal wall, second gonad, diaphragm and adjacent organs.

This type of cystoma is characterized by bilateral localization. Therefore, when a cystadenoma of the right ovary is diagnosed, a formation is also detected on the left. But in most cases, papillary cystoma of the left ovary appears a little later and grows more slowly. This is explained by the fact that the right gonad, due to its anatomical features (large feeding artery), is more intensively supplied with blood, therefore the cystoma of the right ovary forms faster.

Symptoms of papillary cystadenoma

At the initial stage of papillary cyst development, symptoms are mild or absent. As soon as the formation reaches a certain size, the following manifestations occur:

1. Heaviness, distension and pain in the lower abdomen, radiating to the groin, leg, sacrum and lower back. Pain often increases with movement, heavy lifting, and active sexual intercourse.
2. The development of dysuria is urinary disturbances with frequent urge to urinate. As the cyst grows, compression of the ureters can lead to urinary retention.
3. Severe weakness, increased heart rate.
4. Constipation caused by compression of the rectum.
5. Swelling of the legs due to compression of large veins and lymphatic vessels.
6. Accumulation of fluid in the peritoneal cavity and the development of ascites. In this regard, there is an increase in volume and asymmetry of the abdomen.
7. Development of adhesions between ligaments, fallopian tubes, and gonads.

At the beginning of the disease, the monthly cycle remains normal, then menstrual disorders begin in the form of absence of menstruation (amenorrhea) or abnormally prolonged bleeding (menorrhagia).

Consequences

What are the consequences of the growth of a papillary cystoma if it is not removed? This disease can lead to the following complications:

• transition of pathology into a cancerous tumor;
• ascites, in which the presence of blood in the serous fluid in the abdominal cavity is characteristic of a malignant process;
• development of adhesions;
• dysfunction of the gonads, uterine appendages, intestines, bladder;
• infertility.

Papillary cystoma can cause life-threatening conditions, which include:

1. Twisting of the pedicle, which interrupts the blood supply to the tumor tissue, causing its death (necrosis).
2. Rupture of the cystoma walls with the development of hemorrhage into the peritoneum and its acute inflammation (peritonitis).
3. Suppuration of the tumor with the spread of pyogenic bacteria to neighboring organs and tissues.

With torsion of the pedicle and perforation of the cystic membrane, the symptoms become pronounced and manifest themselves:

• acute, often unbearable abdominal pain with protective tension in the abdominal muscles;
• a sharp rise in temperature and drop in pressure;
• nausea, increased heart rate and breathing;
• perspiration, a feeling of panic;
• excitability followed by lethargy and loss of consciousness.

If such symptoms occur, only immediate surgery can prevent death.

Causes

There are several hypotheses about the reasons that provoke the development of papillary cystoma.

Among them are:

• excessive activity of the hypothalamus and pituitary gland, leading to excess production of estrogen;
• dysfunction of the ovaries due to disruption of hormonal status;
• conditions associated with the early arrival of menstruation (menarche) in growing girls (10 – 11 years old), late menopause or early menopause, absence of pregnancies, refusal of breastfeeding;
• genetic predisposition and the presence of cysts, cystic structures, tumors and fibroadenomatosis of the mammary glands in female relatives;
• sexual infections, papilloma virus and herpes;
• chronically ongoing inflammatory processes in the reproductive organs (adnexitis, endometritis, oophoritis), development of uterine and ectopic endometriosis;
• multiple terminations of pregnancy, miscarriages, complicated childbirth;
• impaired blood supply and movement of lymphatic fluid in the pelvic area.

Diagnostics

Papillary ovarian cystoma is diagnosed through several examinations, including a gynecological examination, ultrasound, laparoscopy, blood testing for tumor markers, histological analysis and tomography.

During a medical examination, a round, with limited mobility, small-lumpy, less often smooth (in the case of an inverting form), formation on one or two gonads is determined. Palpation of the peritoneum reveals the development of ascites.

Using an ultrasound, the doctor accurately determines the type and size of the cystadenoma, wall thickness, number of chambers, length of the pedicle, prevalence of papillary growths, and accumulation of fluid in the peritoneal cavity.

Computed tomography and magnetic resonance imaging are required for a more in-depth examination and to identify connections between the cystoma and other organs.

To exclude the development of gonadal cancer, the following is carried out:

• blood sampling to determine the concentration of the CA-125 protein, an increase in which, together with other signs, may indicate oncology;
• diagnostic laparoscopy (through small incisions on the abdominal wall using microinstruments).

Final confirmation of a probable cancerous process in the ovaries is made only after tissue is taken for a biopsy during surgery and the biopsy is examined.

Treatment

In case of detection of papillary cystadenoma, only surgical tactics are chosen, since the use of drugs and physical procedures in the development of such a cystic tumor is useless.

The volume of tissue removed and the type of operation are related to:

• as the patient ages;
• condition of the ovaries;
• size and location of cystadenoma;
• the presence or absence of signs of cancer;
• probable concomitant diseases.

The expected scope of surgical intervention includes:

1. Excision of cystadenoma without or with partial involvement of ovarian tissue. It is performed in case of benign formation in women who want to have children.
2. Removal of the cystoma along with resection of the affected gonad (oophorectomy). At the same time, the ability to conceive is preserved.
3. Excision of both ovaries, if papillary ovarian cystadenoma is localized on both sides, and there is a suspicion of a cancerous process. Can be done at any age.
4. Removal of the gonads along with amputation of the uterus (panhysterectomy). It is recommended for patients near menopause and during menopause, as well as at any age with borderline and cancerous cystadenoma.

If a rough papillary cyst is detected in pregnant women, the operation is postponed until after birth. In case of rapid growth of the tumor or suspicion of cancer, surgical intervention is planned after 16 weeks or immediately, which depends on the severity of the process. If the cystoma ruptures or the leg is torsed, the tumor is removed immediately to save the patient’s life.

Forecast

A timely diagnosis and removal of papillary cystadenoma almost eliminates the likelihood of developing cancer. In young women, early surgery allows preserving the ovaries with the possibility of further conception.

After removal of the papillary cystoma, foci of papillary growths on other organs also regress, and signs of ascites do not appear.

Many women periodically face many gynecological problems throughout their lives. Unfortunately, medical statistics indicate that the number of visits by representatives of the fair sex to specialists regarding “female” diseases increases every year. The number of cases of detection of various neoplasms of the reproductive organs has especially increased. Moreover, if previously it was mainly women over twenty-five years of age who were ill, now even younger people are turning to a gynecologist. An ovarian tumor called a cystadenoma (or cystoma) is often detected.

What is ovarian cystadenoma

Cystadenoma is considered a common benign ovarian tumor, which is a round neoplasm similar in structure to a cyst. It has clear contours, a dense, shaped capsule and a cavity that is filled with liquid contents. In this regard, the pathology was previously called cystoma (now considered an outdated name and practically not used when making a diagnosis) and was considered a very serious disease, because of which a woman was deprived of reproductive abilities by removing both ovaries. The main difference from a cyst is that the tumor is prone to malignant degeneration. Despite this fact, she is successfully treated thanks to the latest medical technologies, which allow the woman to calmly become pregnant, carry and give birth to a child.

Cystoma usually affects one ovary

As a rule, it is a unilateral formation, that is, it most often affects one ovary. However, there are situations when doctors identify bilateral pathology, when both female glands are involved.

The right ovary is most susceptible to tumor development due to good innervation and abundant blood supply, against the background of which cystadenoma develops quite quickly and acquires an impressive size. On the left ovary, the formation also occurs, but much less frequently. This is due to its less abundant blood supply, which is why the tumor is poorly “nourished” and slowly increases in size.

Cystadenoma often appears in women during menopause. This is primarily due to hormonal changes in the body: there is a lack of a certain group of hormones and special substances that previously prevented the development of the tumor.

Causes and growth factors of neoplasms

The exact causes of the development of the disease in women are unknown to science, or rather, they are not fully understood. But today there are known factors that predispose to the formation of a neoplasm on the ovary. These include:

• various hormonal disorders;
• pathologies of the endocrine system;
• metabolic disorders (including diabetes and obesity);
• tendency to frequent formation of luteal (corpus luteum) or follicular ovarian cysts;
• the presence of various inflammatory processes in the pelvic organs (especially if the reproductive organs are involved);
• infectious diseases of the genital area (including sexually transmitted diseases);
• long-term sexual abstinence;
• excessive sexual activity and frequent changes of partners;
• history of abortion (including spontaneous) and other surgical interventions on the reproductive organs;
• stressful situations and frequent nervous tension;
• infertility;
• heavy physical activity;
• early onset of menstruation and late onset of menopause;
• improper use of hormonal medications (especially oral contraceptives) or their use without a doctor’s prescription;
• bad habits (smoking, alcohol abuse, drug use);
• improperly designed diets for weight loss;
• genetic predisposition.

The presence of inflammatory processes in the pelvic organs can cause cystadenoma.

Types of tumors and their features

There are several types of cystadenomas, differing in structure and composition, as well as in the symptoms they exhibit.

Serous

There are two types of serous cystadenoma: simple serous smooth-walled and papillary.

Simple smooth wall

Serous ovarian cystoma (also called smooth-walled celioepithelial cystadenoma or serous cyst) is considered the most harmless neoplasm. It is a true benign ovarian tumor. It is formed from previously unresolved follicular or luteal cysts, which normally should regress within several months (on average, over three to four cycles). Previously, this type of cyst was found in women over thirty years of age, but now the disease has become “younger” and is detected even in twenty-year-old girls.

The surface of the tumor is smooth, and its serous contents are in most cases transparent and yellow in color. Most often it has one chamber and affects one ovary. It is quite mobile and does not cause pain. It can be located to the left or right of the body of the uterus (depending on which ovary is affected) or is found behind it. As a rule, small serous cystadenomas do not bother women. As the size of the tumor increases, general symptoms gradually appear.

Serous cystadenoma has a smooth surface and one chamber

Papillary - papillary and rough papillary

Papillary papillary and papillary rough papillary cystadenomas are a type of serous type cystadenomas. But they stand out separately. Such neoplasms are usually multi-chambered and on the surface lining the cavity from the inside there are quite dense papillary (papillary) outgrowths of a whitish hue on a wide stalk. These growing seasons can be either single or numerous. A feature of coarse papillary growths is the absence of the likelihood of tumor degeneration into cancer.

Papillary papillary cystadenoma, on the contrary, is capable of malignancy (malignancy). This is due to the fact that the outgrowths have a soft consistency and often merge with each other, forming peculiar tumors (nodes) that can grow outward through the wall of the capsule, resembling cauliflower in appearance. The spread of the tumor to neighboring organs indicates malignant degeneration. As a rule, such cystadenomas form on two ovaries. Initially, the tumor is mobile. As its size increases, mobility becomes limited.

On the ultrasound image, the doctor will clearly see papillary growths

Mucinous

Mucinous cystadenoma (or pseudomucinous tumor) refers to benign epithelial neoplasms of the ovary. Most often detected during postmenopause. The tumor, as a rule, is multi-chambered, filled from the inside with mucinous contents, which is a mucous or jelly-like substance of a yellow or brown (due to the blood content) hue with the inclusion of special proteins - glycoproteins and heteroglycans. The surface is even and smooth outside and inside. Usually reaches impressive sizes; there are cases when the formation grew to thirty centimeters in diameter or more. At the same time, its wall was thin and transparent.

Additionally, borderline mucinous tumor, pseudomyxoma of the ovary and peritoneum, and Brenner's tumor are distinguished, which have a high risk of degenerating into cancer.

Mucinous cystadenoma has a capsule of uneven thickness and many chambers

Borderline mucinous cystadenoma

Borderline ovarian cystadenoma is potentially malignant. It has a smooth surface outside and inside, with a multi-chamber structure. The cells of the inner membrane are capable of proliferative growth. In this regard, the risk of malignant degeneration of the tumor increases. As a rule, such cystadenomas are not characterized by invasive growth, that is, they do not grow into surrounding organs and tissues.

Pseudomyxoma of the ovary and peritoneum

Pseudomyxoma of the ovary and peritoneum is considered a fairly rare tumor, usually affecting women over fifty years of age. The main feature of the neoplasm is that it is not capable of infiltration and germination into surrounding organs and tissues, so it is difficult to talk about the malignant nature of such a cystadenoma.

Pseudomyxoma has a thin capsule that can rupture spontaneously or during a bimanual examination by a gynecologist. In this case, pseudomucin - the jelly-like contents of the tumor chambers - enters the abdominal cavity, settling on organs and tissues. Its particles become overgrown with capsules, blood vessels and nerves. In this way, new pseudomyxomas are formed.

Brenner's tumor

Brenner's tumor is also called fibroepithelioma or mucoid fibroepithelioma. The tumor is formed from the ovarian stroma - connective tissue containing blood vessels. The peculiarity of this neoplasm is that it can appear in the fair sex at any age: at fifty or five. It can reach large sizes and most often appears on the left ovary. It has an ovoid (round or oval) shape and a smooth shiny surface. As a rule, it is rare and characterized by a benign course. But the possibility of malignant degeneration cannot be ruled out.

The tumor is named after Franz Brenner, who first described it.

Malignant cystadenocarcinoma

Malignant cystadenocarcinoma is a malignant tumor resulting from the degeneration of serous or mucinous cystadenoma.

Serous cystadenocarcinoma is the most common and is detected in 70% of cases, characterized by accelerated growth and rapid spread to surrounding tissues and organs. Mucinous cancer is detected much less frequently (in approximately 10% of cases) and is characterized by slow development and asymptomatic course in the initial stages. When large in size, it causes discomfort in the lower abdomen, similar to those that occur with intestinal problems.

Manifestations of pathology

Despite the fact that cystadenomas are different, they have the same symptoms. Small tumors do not cause concern; as they grow, characteristic symptoms gradually appear. Mostly women complain about the following manifestations:

• heaviness in the lower abdomen;
• increase in the size of the anterior abdominal wall (on the affected side);
• an increase in the size of the abdomen due to ascites - accumulation of fluid in the abdominal cavity (occurs in forty percent of cases and most often with large tumors);
• nagging pain on the affected side;
• pain in the lumbar region;
• difficulties with urination and defecation (usually with large tumor sizes);
• menstrual irregularities, accompanied by long delays in menstruation;
• reproductive dysfunction (infertility).

Pain in the lower abdomen and a feeling of heaviness may indicate the presence of ovarian cystadenoma

In addition, symptoms such as weakness, high fatigue, pain during intercourse on the affected side, and decreased sexual activity may be observed.

With ruptures of cystadenomas, the clinical picture of an acute abdomen is clearly expressed: body temperature rises, cold sweat appears, pallor of the skin is noted, a sharp dagger pain is felt in the abdomen, especially on the affected side, flatulence and bloating are noted. This requires an immediate emergency call and hospitalization in the surgical department. Otherwise, there is a high risk of developing peritonitis and sepsis, which can lead to the woman’s death.

Diagnosis of the disease

Diagnosis of the disease is complex. Small cystadenomas are usually discovered accidentally during a routine gynecological examination. During a bimanual (using hands) examination of a woman in a chair, the doctor will detect an increase in the size of the ovary with a tight-elastic to the touch, usually painless and mobile formation, located to the left, right or posterior to the body of the uterus. In addition, the doctor will collect anamnesis, listen and evaluate all the patient’s complaints. To clarify which tumor has affected the ovary, the woman will be asked to undergo a series of diagnostic procedures, including the following methods:

• Ultrasound examination of the pelvic organs (ultrasound). The specialist will see the size of the tumor, the number of chambers, evaluate the nature of the internal contents, the presence of suspension in it and other parameters, on the basis of which he will make a preliminary diagnosis. This is the most common and accessible method for identifying ovarian tumors and has no contraindications.
• Computed and magnetic resonance imaging (CT and MRI). These are more accurate diagnostic methods than ultrasound, allowing a detailed study of the structure of the tumor. The disadvantages are their high cost, the presence of contraindications and unavailability in many medical institutions.
• Laparoscopy. Refers to endoscopic research methods and is inextricably linked with surgical treatment. Using a laparoscope and special instruments, you can see the tumor in detail “from the inside” and also remove it.
• Blood test for tumor markers. The doctor will be most interested in the indicators of such markers as CA-125, CA-19.9, CA-72.4. Exceeding the permissible values ​​will indicate a malignant course of the process. In this case, diagnostic laparoscopy for examining the patient is strictly contraindicated.

Ultrasound examination is a fast and affordable method for diagnosing pathology

Treatment of neoplasm

Treatment of the tumor is usually only surgical. No conservative therapy will help get rid of cystadenoma. Medications will be useful only to relieve unpleasant symptoms and as a preventive measure after surgery.

Removal of a cystadenoma is possible using the laparoscopic method (if the tumor is small) or abdominal surgery (if the tumor is large).

Laparoscopic surgery is a minimally invasive method of removing a tumor. Several punctures are made in the abdominal cavity, through which a laparoscope and special instruments are inserted. All manipulations performed by the doctor are displayed on the monitor screen. The contents of the cyst are exfoliated and its capsule is removed. The recovery period after such an intervention is minimal. Typically, a woman is discharged from the hospital on the third to fifth day after the operation.

Laparoscopy is considered a gentle method of tumor removal

Abdominal surgery involves incision of the anterior abdominal wall. The scale of the “cut” depends on the volume of the tumor. The tumor is excised, usually together with the ovary, and the muscles and tissues are sutured. The recovery period is longer. Depending on the condition and well-being of the woman, discharge is carried out on the seventh to tenth day after the intervention.

Large tumors are removed using abdominal surgery

Predictions and consequences

If the disease is detected and treated in a timely manner, there are usually no serious consequences for a woman’s health. Her hormonal levels and reproductive function are normalized, and her libido increases. In addition, rehabilitation after surgery takes a minimum amount of time, and complications are kept to a minimum.

In advanced cases, a woman loses one ovary (or both at once), thereby dooming herself to infertility. In addition, life-threatening conditions such as ascites, peritonitis and sepsis may occur.

Prevention of pathology

Prevention of the occurrence of pathology comes down to minimizing the impact of provoking factors. A woman should lead a healthy lifestyle, not overexert herself emotionally or physically, be faithful to her partner, thereby eliminating the occurrence of various infectious diseases of the genital area, and avoid unwanted pregnancy by protecting against it (abortion prevention). And, of course, you must not neglect visits to your gynecologist. This should be done at least twice a year.

There are many diseases of the reproductive organs in women. Very often, in patients of all ages, during ultrasound diagnostics, special formations are observed, which are usually benign. Only a specialist can determine the type of tumor after conducting a thorough examination and monitoring changes in the size of the tumor over several months. Often women are diagnosed with cystadenoma, which requires surgical removal.

What is ovarian cystadenoma

Ovarian cystadenoma is a benign neoplasm that looks like a large cyst. Previously, this disease was called cystoma. In almost all patients, the tumor forms on only one side, so if an ultrasound reveals bilateral ovarian damage, doctors suspect the presence of a malignant process.

Cystadenoma can appear on both the left and right ovary, but most often this tumor is right-sided. This is due to the fact that on this side there is a more intense blood supply, and various types of neoplasms are formed here.

Currently, scientists are arguing about the exact causes of ovarian cystadenoma. Most experts are inclined to believe that this type of tumor is formed during serious hormonal changes or an inflammatory process in the pelvic organs. There is also a theory that cystadenoma can form from a follicular cyst, which tends to resolve on its own within a few months. But if this does not happen, then after a year a serous cystadenoma may form in its place.

Ovarian cystadenoma is also called cystoma

In addition, surgery on the pelvic organs, abortion, and even natural childbirth can be a predisposing factor. Doctors also believe that sexual abstinence and vice versa, frequent changes of sexual partners, can provoke the formation of cystadenoma. Sometimes the following diseases and conditions of the body can cause the appearance of this tumor:

• menopause period;
• prolonged stressful conditions, nervous overstrain;
• heavy lifting, excessive physical activity;
• ectopic pregnancy;
• endometritis;
• colpitis;
• virus infection.

The average age at which this disease is detected is about thirty years. However, cystadenoma is especially common in women during menopause. This happens due to fluctuations in the level of hormones, which at a younger age helped to avoid such diseases.

Video about cystoma, or cystadenoma, of the ovary

Types of tumors and their features

Currently, there are several different types of cystadenomas. They differ in their structure and additional formations that can grow inside the tumor and on its surface.

Serous cystadenoma of the ovary

This type is the most common and is found in 70% of patients with a cyst. The neoplasm can reach quite large sizes; on the outside it is covered with a rather dense and elastic membrane, under which there is a capsule with liquid serous contents. Depending on how the cyst wall is built, serous cystadenoma is divided into papillary and smooth-walled.

The main method for diagnosing various types of tumors is ultrasound, which clearly shows the pathological formation and papillary growths.

Sometimes it can be quite difficult to distinguish serous cystadenoma from an ordinary functional cyst, and doctors advise observing changes in the size of the tumor for several months. If the tumor shrinks, then surgery is not required, but if it grows or remains the same size, doctors diagnose the patient with cystadenoma, which requires surgical removal.

Often the operation is minimally invasive and is performed using laparoscopy. The ovary is removed only in older women if malignant degeneration of papillary cystadenoma is suspected. In other cases, girls' reproductive function is completely preserved.

On ultrasound, cystadenoma is visible as a dark, round formation.

Simple or smooth-walled serous cystadenoma

In this type of cyst, the shell has a smooth and even surface. In different sources, this neoplasm can also be called a smooth-walled celiac epithelial cyst, a serous cyst, and because of its prevalence, doctors often call it simply ovarian cystadenoma.

Usually this tumor has only one chamber, which is enclosed in a dense capsule. In some patients, the size of the cyst can reach fifteen centimeters. Most often it affects only one ovary, on the right side.

Papillary, rough papillary, or papillary, ovarian cystadenoma

A distinctive feature of this type of cyst is the special papillae that cover the inner surface of the capsule. They do not begin to form immediately, sometimes several years after the appearance of a simple serous cystadenoma. We can say that this is a more advanced stage, and not a separate species. Sometimes the papillae can grow so large that they occupy almost the entire cavity of the cyst and even extend to the outer part of the tumor. This type of cystadenoma is sometimes multi-chambered and forms on two ovaries at once; more often than others, malignant degeneration is recorded with this diagnosis.

Papillary cystadenoma has papillary projections on the inner and outer surfaces

This form of cystadenoma is also quite common. It can reach gigantic sizes; in some patients, a cyst weighing fifteen kilograms was removed. The walls of this formation are smooth and dense; the ovaries are often affected on both sides.

About 5% of patients with mucinous cystadenoma undergo malignant transformation, which requires removal of not only the tumor itself, but also both ovaries and the uterus.

Diagnosing this type of cystadenoma is quite easy; with an ultrasound examination, the doctor discovers quite extensive multi-chamber formations, which contain a special secretion - mucosis. It is heterogeneous, very dense and contains suspension and sediment, which are clearly visible on ultrasound.

Mucinous cystadenoma of the ovary can be multilocular

Endometrioid cystadenoma of the ovary

This type of cystadenoma differs from others in the type of tissue that covers the entire internal surface of the cyst. It is formed by the mucous endometrium. Inside the tumor, instead of serous or mucinous contents, old blood accumulates, the amount of which increases with each arrival of menstruation. This type can cause severe pain and spotting. Both the right and left ovaries can be affected simultaneously.

It is with this type of cystadenoma that women have a very high risk of developing infertility. Endometriosis, which is a provoking factor for the appearance of this cyst, is the reason for the inability to conceive a child in 75% of all cases.

Video about endometrioid ovarian cyst

Borderline ovarian cystadenoma

This species differs from others in a very large number of papillae and formed fields around them. Molecular examination of cystadenoma tissue reveals the presence of nuclear atypia, which is characteristic of oncological tumors. Patients are recommended to urgently remove the tumor to avoid its cancerous degeneration. In appearance, borderline cystadenoma is no different from serous cystadenoma. Ultrasound shows multilocular formations with a smooth surface.

In patients with this diagnosis, infertility is established in 20% of cases.

Symptoms and signs

The danger is that at the initial stage, cystadenoma may not manifest itself in any way. Patients can live with this tumor for several years and only accidentally discover it on an ultrasound. If any symptoms appear, this indicates a large size of the tumor or possible tissue necrosis. There is a certain list of signs that may indicate that a woman has cystadenoma:

Some symptoms are indicators of processes in the body that are very dangerous for the patient’s life. If they appear, you must urgently call an ambulance:

1. A woman's blood pressure rises sharply and her pulse quickens. Perspiration appears on the forehead and sweating increases.
2. With torsion of the leg and tissue necrosis, symptoms similar to acute abdomen occur. The pain becomes unbearable, the temperature rises, patients feel very weak and may faint.
3. Attacks of vomiting appear and at the same time long periods of stool retention are characteristic.
4. The woman's mental state becomes unstable. Attacks of fear may be followed by periods of apathy and lethargy.

Diagnosis and differential diagnosis

At the first signs of cystadenoma, you should consult a gynecologist. During the examination, the doctor will examine the symptoms and conduct an examination with palpation to preliminary determine the type of formation, its location, size, and mobility. Various types of instrumental studies are also prescribed:

If the presence of cancer is suspected, women are prescribed a blood test to determine the number of tumor markers CA-125, HE4. Differential diagnosis should be carried out with various types of tumors, ectopic pregnancy, endometriosis, appendicitis and some other diseases and conditions of the body.

Treatment of cystadenoma

At the moment, there are no conservative treatments for cystadenoma. All patients are prescribed surgical removal of the tumor. Any self-medication and the use of folk remedies are excluded, as this can lead to a strong growth of cystadenoma, as well as to its degeneration into a malignant tumor. Only a surgeon can determine which operation is suitable for the patient after studying the medical history, establishing the volume of the cystoma and the risk of developing oncology.

Laparoscopy

This type of operation is prescribed for small formations, up to four centimeters in size. Also important factors are the benignity of the tumor and the childbearing age of the woman who plans to have children in the future.

The operation is performed under general anesthesia; very small incisions are made on the abdominal wall, no more than two centimeters. A video camera with a gas supply and surgical instruments are inserted into them. Doctors try to save the ovary and remove only the cystadenoma. In just four months you can plan to conceive a child.

This type of operation is more serious; the surgeon makes a fairly large incision in the abdomen. Indications for laparotomy are menopause, large cysts, and malignant neoplasms. Most often, the doctor removes not only the cystadenoma itself, but also the ovary and fallopian tubes. This procedure will help prevent further development of cancerous tumors on the woman’s reproductive organs. If the patient had only one ovary removed, then in the future she will be able to become pregnant and carry a child.

During laparotomy, the affected ovary is usually removed along with the cystadenoma

Consequences and complications

In most cases, if no malignant transformation has been detected, the treatment prognosis for patients is favorable. Cystadenomas can be easily removed surgically. If there is no timely treatment, women may experience the following consequences:

• decreased ovarian function;
• infertility;
• malignant degeneration;
• metastasis of cancer tumors to other organs;
• disruption of the pelvic organs due to compression by cystadenoma;
• poor circulation due to squeezing of blood vessels, varicose veins;
• blood clot formation;
• spontaneous abortions.

In some cases, patients experience complications that require immediate hospitalization with emergency surgery:

• rupture of a cystadenoma and entry of its contents into the abdominal cavity, which leads to peritonitis;
• twisting of the tumor stalk, which leads to disruption of the blood supply and the onset of the necrotic process;
• suppuration of cystadenoma.

Cystadenoma is a benign tumor, but it requires careful medical observation and surgical removal, since this tumor does not resolve on its own. In most situations, women manage to preserve their ovaries, and therefore their reproductive function. In some cases, when there is a suspicion of the development of a cancerous tumor, it may be necessary to remove not only the cystadenoma, but also the reproductive organs. Typically, such operations are performed at an older age, when the patient does not plan to conceive a child.

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 perform 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 size 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 pretumor 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.