Papillary ovarian cystadenoma - is it oncology or not? Reasons for the formation of papillary cystadenoma

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-jumping 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.

Serous ovarian cystadenoma is perhaps the most common among all ovarian cysts (about 70%). It best fits the classic description of the term “” - a bubble with a transparent liquid. In medicine, such a clear, light-colored liquid is called serosa, hence the name of the tumor.

Depending on the structural features of the wall, this cyst is divided into simple serous cystadenoma (has a smooth, even surface) and papillary (or papillary) cystadenoma. On the inner surface of the latter there are small dense growths resembling warts.

Simple serous cystadenoma.

This ovarian cyst has different names - simple serous cystadenoma, smooth-walled ciliepithelial cyst, serous cyst. Since this is the most common cyst, some doctors shorten the term and simply say “cystadenoma.”

This tumor has a fairly dense capsule, is usually unilocular, and most often affects only one ovary. The size of cystadenoma ranges from 4-5 to 15 cm. Quite often, serous cystadenoma occurs in older patients (after 50 years). This is written about in another article ().

Papillary (papillary) cystadenoma.

As mentioned above, the main difference between papillary ovarian cystadenoma is the presence of papillae on the inner surface of the cyst. They appear in simple cystadenoma several years later. That is, in fact, papillary cystadenoma is the next step in the development of the disease.

Sometimes these growths occupy almost the entire area of ​​the tumor and can even appear on the outside. Papillary cystadenoma may contain not one, but several cavities (chambers), and often affects both ovaries.

All these features make it easy to make the correct diagnosis using ultrasound examination (ultrasound) and immediately recommend surgical treatment. A distinctive feature of papillary cystadenoma is its more frequent malignant degeneration. Therefore, before removal, all patients must undergo a blood test for the level of tumor markers (CA-125, HE4). Their value will allow the surgeon to choose the correct volume of surgery.

Causes of serous cystadenoma

The causes of serous cystadenoma are still being clarified. Most scientists agree that they occur against the background of temporary hormonal disturbances in the body or after suffering inflammation (of the uterine appendages).

According to one theory, serous cystadenoma is formed from functional ovarian cysts (and). Typically, functional cysts resolve on their own within a few months of their appearance. This happens due to a special layer of cells in their wall. But the more time passes, the fewer of these cells remain. And after about a year, the ability of the functional cyst to resolve on its own is lost and a serous cystadenoma is formed.

Typically, cystadenomas appear after 30 years of age, although recently they are increasingly occurring at an earlier age.

Symptoms of serous cystadenoma

The symptoms of serous ovarian cystadenoma directly depend on its size. As it grows, discomfort or nagging pain in the lower abdomen from the cyst and pain in the lower back appears. With a significant size of the cyst, there may be an increase in the size of the abdomen and a feeling of the presence of a foreign body in it. Papillary ovarian cystadenoma sometimes causes fluid to accumulate in the abdomen (ascites), which also causes it to become enlarged.

Diagnosis of serous cystadenoma

Serous cystadenoma is clearly visible during ultrasound examination. On the ultrasound screen it will appear as a black round spot with clear contours. The main difficulty in diagnosis, as I mentioned above, is that the first time it can be difficult to distinguish it from a functional cyst. Therefore, most often, in the absence of indications for urgent surgery, such a cyst is observed for several months.

This observation allows us to understand whether your cyst is still functional or not. In 1-3 months, the functional cyst will significantly decrease in size or disappear completely. Nothing usually happens to serous cystadenoma during this time.

For trial purposes, anti-inflammatory or hormonal treatment (contraceptives) is sometimes prescribed, which accelerates the resorption of functional cysts.

Treatment of serous cystadenoma

If the functional nature of the cyst is nevertheless excluded, then treatment of ovarian cystadenoma should only be surgical. Such an ovarian cyst will never disappear on its own. The extent of the operation depends on age, condition of the ovary and type of cyst.

As mentioned above, papillary cystadenoma is especially dangerous due to frequent malignant degeneration. This forces the surgeon to more often remove the entire affected ovary in older age group patients.

Solution to the problem.

Based on foreign experience, I introduced a technique for careful removal of cystadenoma, depending on the oncological alertness. It is slightly different from typical laparoscopy and produces excellent results.

The main task when removing cystadenoma at a young age is to preserve as much healthy ovarian tissue as possible.

In practice, this provides a number of undeniable advantages:

• Possibility to have children, because the follicular reserve of the ovaries is preserved
• No weight gain because the ovaries continue to maintain normal hormone levels
• Elasticity and youthfulness of the skin, because ovarian estrogens are responsible for this
• Maintaining sexuality and a good relationship with your partner because normal levels of sex hormones are maintained
• Feeling great, no depression or mood swings because there are no sharp fluctuations in hormone levels
• Preventing the development of many serious diseases (cardiovascular, diabetes, joint diseases) because ovarian estrogens protect your body
• Fast recovery after surgery because we use modern anesthesia
• Reduced risks of surgical complications because we use disposable and high-quality tools
• Well tolerated surgery because we only practice non-traumatic techniques
• Excellent cosmetic effect, because we apply intradermal sutures that don’t even need to be removed
• Cancer prevention, because we remove all potentially dangerous sources

If you are no longer young, then a slightly different surgical technique is provided for you, aimed at reducing all possible risks and complications. Among other things, the methodology we implemented:

• Reduces the risks of surgical complications because we use disposable and high-quality tools
• Prevents exacerbation of chronic diseases and the emergence of new ones because the operation is low-traumatic
• Is a cancer prevention, because we remove all potentially dangerous sources
• Promotes rapid rehabilitation and recovery because we use modern and safe anesthesia
• Easy to carry because we do not remove healthy tissue

If this is exactly what you need, then you will find more detailed information about conducting a gentle and gentle operation.

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.

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

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

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

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

Rice. 10.4

Rice. 10.5

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

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

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

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

Ovarian cystadenoma is a benign hollow formation filled with viscous exudate that affects the epithelial layer of the female appendages. A characteristic feature of a benign cyst is that, being under prolonged exposure to a provoking factor, it degenerates into a malignant tumor. In addition to the high risk of developing cancer, papillary ovarian cystadenoma causes reproductive dysfunction, as a result of which a girl develops infertility.

Features of the papillary form of cystadenoma

Papillary cystadenoma is characterized by papillary growths, which is considered its main distinguishing feature. The growths formed on the epithelial layer tend to increase: reaching a diameter of 10 cm, the papillae also affect the abdominal cavity.

Depending on the area of ​​manifestation of the papillae, there are three types of papillary cystadenoma:

1. An everting cyst is characterized by the presence of papillae on its surface, formed from connective tissue.
2. An inverting benign formation is accompanied by the formation of growths in the capsule cavity.
3. A mixed cyst is characterized by simultaneous damage to the cavity and the surface of the capsule.

Another characteristic feature is its bilateral localization: cystadenoma of the left ovary increases the risk of developing a cystic cavity in the right appendage, and vice versa. Despite this, the right gonad is considered more vulnerable to the formation of a hollow capsule, which is due to the presence of a large artery in its structure.

Classification

In addition to papillary, serous and mucinous cystadenomas are also distinguished. A serous ovarian cyst is a single-chamber round capsule, the walls of which are formed from a dense epithelial lining. Depending on the form of manifestation, serous papillary cystadenoma occurs without complications or is accompanied by the formation of whitish papillae.

The mucinous cyst of the epididymis is a multi-chambered hollow capsule that reaches impressive sizes and contains a secretory substance of dense consistency in its cavity. This type of tumor is easily diagnosed by ultrasound, which is explained by the extensive area of ​​​​damage to epithelial tissue.

Probability of cancer

Detection of adnexal cystadenoma at an early stage of formation and timely surgical intervention provides a favorable prognosis. Ignoring a benign tumor that affects the ovarian parenchyma, on the contrary, contributes to the development of oncology, which complicates the treatment process and increases the risk of reproductive dysfunction.

Causes

The main reason for the formation of papillary-type cysts on the ovary is considered to be hormonal imbalance. Benign tumors that form as a result of hormone imbalance tend to resolve within 12 months.

Other reasons for the development of papillary cystadenoma include:

• irregular intimate life, which is accompanied by constant abstinence;
• physical and emotional stress;
• damage to the female reproductive system by genital herpes or papilloma virus;
• chronic diseases of the reproductive organs;
• ectopic pregnancy and poorly performed abortion;
• hereditary predisposition;
• a disorder of local blood supply, which is characterized by disruption of the flow of lymphatic fluid.

A high probability of cyst formation on the appendage is present in nulliparous girls and women who have given birth and who refuse to breastfeed. Adolescent girls who are menstruating prematurely are also at risk.

Signs and symptoms

The first stage of development of cystadenoma of the appendage is characterized by an asymptomatic course. The only sign of the formation of a cystic cavity at the initial stage is disruption of the menstrual cycle, which is caused by a disorder of reproductive function.

As the hollow capsule increases, the woman feels painful pulling sensations that are localized in the groin and lumbar areas, as well as in the lower abdomen. If the capsule reaches an impressive size, the pain syndrome also spreads to the lower limbs and sacrum.

The pain syndrome is aggravated by the development of dysuria - a malfunction of the urinary system, in which the production of biological fluid increases. The rapid growth of the cyst precedes compression of the ureters, resulting in stagnation of urine.

Papillary ovarian cysts also have a negative effect on the gastrointestinal tract. Increasing in volume, it compresses nearby organs, which leads to the development of discomfort in the intestines and disruption of its functioning. A disorder of the digestive system precedes the occurrence of chronic constipation, nausea and swelling.

The advanced form of the papillary cyst is accompanied by ascites, which is formed as a result of the accumulation of liquid mass in the abdominal cavity. In turn, ascites precedes unnatural protrusion of the peritoneum and the development of pronounced asymmetry.

Diagnostics

A papillary cyst is diagnosed in several stages. At the first stage, the doctor performs a gynecological examination of the external genitalia and assesses the condition of the gonads by palpation. If during the examination a small-tuberous mobile capsule was identified in the parenchyma of the appendages, the doctor makes a preliminary diagnosis of cystadenoma.

The second stage of diagnosis involves taking a blood test. If the tumor affecting the gonad is malignant, a laboratory blood test will detect an oncological marker. The absence of tumor markers in the liquid connective tissue indicates the benign nature of the papillary cyst.

At the third stage of the examination, the patient undergoes an ultrasound examination, through which the size of the capsule, its consistency and exact location are determined, and the depth of the lesion of the appendage is determined. To obtain a reliable result, it is necessary to perform an ultrasound a week after the end of the critical days.

Determination of the type of benign neoplasm and qualitative study of its parenchyma is carried out using magnetic resonance imaging. If cystadenoma provokes a digestive system disorder, the patient additionally attends a gastroscopy so that the doctor has the opportunity to assess the condition of the stomach.

Complications and consequences

Papillary cyst is accompanied by the following complications:

1. Torsion of the base of the hollow capsule provokes a disruption of the local blood supply, resulting in soft tissue necrosis.
2. The rupture of the cystadenoma precedes the release of secretory fluid, which causes bleeding and inflammation.
3. Suppuration of the cyst is accompanied by the spread of purulent bacteria to nearby tissues.

The above complications provoke a worsening of general symptoms: acute painful sensations become permanent and are complemented by hyperthermia, arrhythmia, and hypotension.

Ignoring an ovarian tumor provokes the development of the following consequences:

1. Ascites is characterized by the formation of bloody impurities in the serous substance.
2. The adhesive process causes damage to the peritoneal membrane with a thin film.
3. Disorders of the digestive system and the functioning of the genitourinary organs.
4. Impaired reproductive function, which leads to the development of infertility.

The most dangerous consequence of cystadenoma is considered to be its degeneration into a malignant tumor.

Treatment methods

If during the diagnosis a functional type cyst was identified, surgical intervention is not recommended. Functional cystadenoma resolves on its own within three months: surgery can cause associated complications.

A papillary cyst discovered during a comprehensive examination is an indication for surgical intervention. When determining the operating technique, the surgeon takes into account the size and location of the hollow capsule, the condition of the ovary, and the age of the patient.

If the cyst is localized bilaterally and there is a high risk of its degeneration into a malignant tumor, the doctor performs a laparotomy, which involves resection of both ovaries. If the diagnostic results confirm the presence of a malignant nature of the hollow capsule, the surgeon performs a panhysterectomy, during which both the gonads and the uterine cavity are removed.

Laparoscopy

Removal of papillary cystadenoma by laparoscopy is advisable for patients of reproductive age, due to the possibility of preserving childbearing potential. In addition to the absence of damage to the uterus and ovaries, laparoscopy also ensures the absence of deep postoperative sutures.

The operation begins with determining the exact area of ​​the ovarian lesion and forming a small puncture in it. Having gained access to the cyst, the surgeon removes the accumulated fluid from its cavity, and then carefully separates the capsule from the gonad and removes it.

Through resection of the papillary cyst, the doctor removes a small amount of soft tissue. When the capsule actively grows, its elastic shell stretches: to avoid secondary tumor formation, the doctor removes healthy tissue in contact with the tumor.

At the final stage of laparoscopy, the surgeon assesses the patency of the fallopian tubes, separates the formed adhesions and, if fibroids are present, removes them. The total duration of the surgical intervention does not exceed 50 minutes.

During pregnancy

Often, papillary cysts are diagnosed in pregnant girls, which is due to a sharp change in hormonal levels. If the diameter of the hollow capsule does not exceed 2 cm, surgery is postponed until delivery, since a small tumor does not put pressure on nearby tissues and does not disrupt embryonic development.

Rapid growth of the cyst and a high probability of a malignant nature is an indication for surgery. The most optimal period for surgical intervention is considered to be the second trimester. If the condition of a pregnant girl worsens, the operation is performed urgently, without waiting for the 16th week.