What is an anechoic inclusion (formation) in the ovary, uterus? Benign tumors and tumor-like formations of the ovaries. In the projection of the ovary, the formation.

In medical terminology, the formation of fluid in a woman’s ovary is called a cyst. It is a small pathological cavity consisting of tissue fluid, blood and mucous secretions. The vast majority of ovarian cysts occur during a woman's active sexual life and disappear over time without any treatment. Some cysts can lead to complications, rupture and cause severe pain. In this case, you should immediately contact a gynecologist.

Causes of cyst formation

Follicular cyst. It is formed during the process of ovulation, when a mature egg cannot leave the follicle and enter the fallopian tubes. The unopened follicle continues to grow, gradually fills with fluid and stretches - a cyst is formed. Typically, this type of cyst disappears after two or three menstrual cycles.

Ovarian cysts are rare in women taking hormonal pills. The drugs block, leaving the ovaries at rest.

Polycystic ovary syndrome. The pathology is accompanied by impaired ovarian function. The size of the ovaries approximately doubles as a result of multiple formation of cysts. Patients suffering from polycystic ovary syndrome often have hormonal imbalances.

Dermoid cyst. Formed from cells that produce human eggs and may contain parts of hair, skin or teeth. This type of cyst is rarely malignant.

Other reasons. Serous or colloid cystadenoma and the occurrence of endometriosis.

Symptoms of ovarian cysts

Ovarian cysts, whether benign or malignant, do not cause symptoms in initial stage development. A benign cyst usually disappears within a few weeks. If the formation does not disappear, it can cause the following abnormalities:

• bleeding;
• abdominal pain;
• nausea and vomiting;
• feeling of bloating;
• pain during intercourse;
• irregular menstrual cycle;
• pain in the lower back or hip.

All these symptoms are not specific to ovarian cysts and may be signs of other diseases, such as uterine fibroids.

Treatment of ovarian cyst

In most cases, ovarian cysts disappear on their own within a few weeks. If this does not occur, treatment will depend on the size of the cyst, the age of the patient, and the type of cyst.

After initial examination and detecting a cyst at the initial stage of development, the doctor recommends waiting about three months and coming back for an appointment to confirm the disappearance of the cyst. Otherwise, treatment is prescribed.

To facilitate the disappearance of the cyst, the doctor may prescribe hormonal drugs and in case of pain, prescribe painkillers. If the cyst is large when examined by ultrasound, the patient constantly feels unwell and there is a suspicion of cancer, the doctor will recommend a laparoscopy or laparotomy procedure.

Exclude serious problems will help with health in case of cyst formation in the ovaries regular visit gynecologist and timely diagnosis. In case of changes in the menstrual cycle and pain in the lower abdomen, you should notify your doctor.

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Often when complete absence The woman does not experience any cycle deviations or adverse symptoms. Ultrasound helps to find out the cause. Suddenly it is discovered that a rounded neoplasm has appeared on the ovary, which is located in front of the entrance to the fallopian tube. Sometimes a cyst of the left (right) ovary is discovered during preventive examination. The doctor decides what to do about it, taking into account the consequences that may arise. If a woman is planning to give birth to a child in the near future, it is better to get treatment in advance so as not to be afraid of complications.

The functional activity of the left ovary is slightly lower than that of the right, which is explained by the peculiarities of their blood supply. Blood flows into the left ovary from the renal artery, and into the right ovary from the central vessel (abdominal aorta). In this regard, dominant follicles are less likely to form in the left ovary and, accordingly, functional neoplasms do not arise as often as in the right. However, there are rare cases when they occur simultaneously in both ovaries.

Organic cysts have no connection with the activity of the organs, so they can appear on both the left and right sides.

Functional cysts of the left ovary

Follicular and luteal cysts are formed, respectively, in the membranes of the follicle and corpus luteum. In the first phase of the cycle, maturation occurs in the ovary dominant follicle with the egg, and at a certain moment, if the capsule does not burst (ovulation does not occur), its shell stretches under the pressure of the accumulating liquid. A follicular ovarian cyst is formed - a bubble filled with secretory fluid.

A luteal cyst appears in the second phase of the cycle in the corpus luteum - a special gland formed in the ovary, at the site of the egg released from the follicle. As a rule, after restoration of hormonal levels, tumors gradually resolve.

Organic cysts

They are formed out of connection with the processes of the cycle. Their peculiarity is that they do not disappear on their own; as a rule, they have to be removed surgical methods If they start to grow, complications arise.

These cysts include:

1. Endometrioid. It is formed when the endometrium gets onto the left ovary after its pathological growth outside the uterine cavity. Neoplasms of this type are filled with blood, which due to oxidation has a chocolate color.
2. Dermoid ( congenital pathology, improper formation of ovarian tissue in the embryo). Its development begins unexpectedly at any age. The dermoid cyst of the left (right) ovary is filled with the remains of various body tissues. You can find particles of bones, skin and even teeth in it.
3. Paraovarian. It is not formed on the ovary itself, but is connected to it by a thin stalk, located between its body and the left fallopian tube. Occurs when the hollow rudimentary appendix (ovarian epididymis) overflows with fluid. Like functional ones, paraovarian cysts of the left ovary are retention neoplasms (having a liquid filling).

Formations appear predominantly in women of reproductive age. They can be small (up to 3 cm in diameter), medium (4-9 cm) and large in size (10 cm or more).

Why are ovarian cysts dangerous?

Cysts measuring 2-3 cm are usually not dangerous, but if they increase in size, the following complications arise:

1. Rupture of an ovarian cyst. This can happen if it increases to 8-10 cm. The consequence of the contents of the cyst entering the peritoneal cavity is peritonitis, a dangerous inflammatory process that can lead to death.
2. Twisting the leg. This condition occurs when a large left ovarian cyst is located on a thin base. Complications can be caused by awkward movements or sudden changes in posture. As a result, the blood supply to the cyst is disrupted, necrosis of its tissue occurs, which leads to blood poisoning.
3. Hemorrhage. When the cyst ruptures, blood enters the ovary. This leads to rupture of the membrane (apoplexy). If blood flows into abdominal cavity, then peritonitis occurs.

Note: A large cyst can rupture during sexual intercourse. In this case, the woman experiences sharp pain in the lower abdomen, bleeding begins, and possible loss of consciousness. This requires urgent hospitalization.

The consequences of growth are infertility, if it blocks the entrance to the fallopian tube, the egg cannot penetrate it. Another serious consequence is the pressure of a growing tumor on neighboring abdominal organs, compression blood vessels and nerve endings.

In 15% of cases, endometrioid and dermoid cysts of the left ovary degenerate into a malignant tumor.

Video: Symptoms of ovarian tumors, possible complications

Symptoms of cyst formation

If the size of the cyst is small, the disease is asymptomatic, the woman does not feel pain, and she does not even suspect its presence. Manifestations are possible when, due to an increase in the diameter of the cyst (more than 5 cm), nagging pain appears on one side of the lower abdomen (depending on the location).

In the presence of functional cysts Long-term (up to 3 months) delays in menstruation appear. There may be spotting that is not menstruation. Due to lack of ovulation, infertility occurs.

The pressure of a large cyst on bladder leads to urinary problems ( frequent urge due to incomplete emptying, inflammation, which is manifested by painful urination, increased temperature). Pressure on the rectum causes flatulence and constipation.

If such severe complications, such as rupture of cysts, twisting of the leg, bleeding, the condition “ acute abdomen", accompanied by severe pain. Blood loss is manifested by signs of anemia: weakness, dizziness, headache, fainting.

Reasons for education

A left ovarian cyst is formed as a result of hormonal disorders, congenital or acquired pathologies of the structure and development of the ovaries. The causes of hormonal imbalances may be the use of drugs with a high content of estrogen and progesterone, endocrine disorders in the body, liver disease.

Has a great influence on hormonal levels mental condition women. Stress, depression, and prolonged experiences contribute to the occurrence of menstrual disorders and the formation of cysts.

Ovarian dysfunction occurs due to inflammatory and infectious diseases organs reproductive system. Endometrioid cysts are formed when the development of the endometrium of the uterus is disrupted and are directly related to endometriosis. The entry of endometrial particles into the abdominal cavity is facilitated by an increase in intra-abdominal pressure during heavy lifting, physical exercise associated with abdominal muscle tension.

The reasons for the growth of cystic formations may be poor circulation in the ovary. Provoke the development of neoplasms and bad habits. Smoking, drug use, and drinking large doses of alcohol lead to hormonal imbalances.

Diagnostics

If it is assumed that a woman has a left ovarian cyst, then full examination to identify the type of neoplasm, its location in relation to other pelvic organs, the presence of inflammatory processes, and determine the possibility of complications.

Using abdominal and transvaginal ultrasound, the exact size and type of cyst can be seen. The condition of the vessels is determined by Doppler ultrasound (a type of ultrasound). To detect the cause of cyst formation and determine the nature of tumor-like formations, tomography methods (CT and MRI) are used.

If a malignant nature is suspected, diagnostic laparoscopy is performed with sampling of the contents of the cyst or its complete removal.

A blood test for tumor markers can confirm the presence of cancer cells. Blood tests allow you to determine the content of leukocytes and other blood components, the ratio of which changes due to the presence of inflammation. To detect its cause, blood, urine, and vaginal smear tests are performed. different kinds infections.

The state of hormonal levels is determined using special blood tests.

Video: How ovarian cysts form. Diagnosis and treatment principles

Treatment

The choice of treatment for the presence of a left ovarian cyst depends on its type, size, severity of symptoms and complications. The woman’s age and desire to have children in the future are taken into account. Conservative and surgical methods are used.

When small (up to 5 cm) functional neoplasms are detected, doctors usually adhere to the tactic of waiting and monitoring for changes in its condition. In this case, only anti-inflammatory therapy and restorative treatment with vitamins and drugs that stimulate the immune system are carried out.

If the tumor does not disappear after 3 months, then apply conservative treatment to restore hormonal levels in the body. For this purpose, young women are most often prescribed combined oral contraceptives with a low content of estrogen and progesterone (Zhanine, Yarina). They are taken strictly according to the schedule to avoid menstrual disorders.

Treatment with duphaston (a synthetic analogue of progesterone) is often prescribed. It is taken from the 11th to the 26th day of the cycle, when the likelihood of the formation of functional cysts is maximum. Conservative treatment is carried out for 3 months.

Organic cysts larger than 3-5 cm are removed laparoscopically, allowing the functionality of the ovary itself to be preserved.

If a left ovarian cyst is discovered during pregnancy, then if it is small in size, no treatment is carried out; the woman is only under constant medical supervision. The indication for immediate removal is noticeable growth of the cyst, large size. In this case, it is removed to prevent tearing and twisting of the leg. In addition, a large cyst compresses the uterus, interfering with the development of the fetus, and can complicate the birth process.

In women of menopausal age, the cyst is often removed along with the ovary in order to completely eliminate the risk of malignancy of the tumor.

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Functional ovarian cysts, such as follicular and corpus luteum cysts, account for 25-30% of all benign formations in young women.

Follicular cyst

A. Follicular cyst — tumor process, formed due to the accumulation of follicular fluid in a cystic follicle and characterized by the absence of true proliferative growth.
The diameter of follicular cysts ranges from 2 to 12 cm. The shape in the vast majority of cases (94.1%) is round. Internal structure The cyst is completely homogeneous, anechoic, and has high sound conductivity. The wall of follicular cysts is even, smooth; its thickness averages 1.0±0.3 mm.

Dynamic echographic observation shows that during the first menstrual cycle, 25.9% of follicular cysts undergo spontaneous regression, the second - 33.4%, and the third - 40.7% of follicular cysts. At the same time, a relationship was noted between the size of the cyst and the period of its disappearance. Thus, formations more than 6 cm in diameter regress within 3 menstrual cycles. This is apparently due to the fact that the wall of the follicular cyst is devoid of vascularization, so involution occurs through gradual passive collapse of the walls of the cavity and resorption of the fluid contained in the cyst.

Endoscopic picture

Follicular cysts are usually unilateral, their diameter is 2-12 cm, their shape is round, they have a thin smooth wall, a single-chamber structure and a tight-elastic consistency. The capsule is smooth, whitish or pale pink, the contents are transparent. The proper ligament of the ovary is not changed. The course of the vessels of the mesovarium has the usual direction. When enucleating a cyst, the wall is difficult to separate from the ovarian tissue and breaks.

Corpus luteum cyst

B. Corpus luteum cyst is formed at the site of a progressive corpus luteum, in the center of which, as a result of circulatory disorders, liquid contents accumulate.

The cyst has dimensions from 2 to 8 cm. Four echographic variants of the structure of the corpus luteum cyst have been described.

1. In option 1, most often the cyst has a mesh structure of medium echogenicity. In most cases mesh component fulfills all or most of the cyst.
2. In option 2, the contents of the cyst are homogeneous and anechoic. In its cavity, multiple or single, tender, complete or incomplete, irregularly shaped septa are determined.
3. In the 3rd option, dense, highly echogenic inclusions (blood clots) are detected in the cyst cavity. More often they are small in size (1-1.7 cm in diameter), single (1-3) and localized near the wall. These formations can be either irregular or club-shaped or spindle-shaped.
4. In option 4, the contents of the cyst are completely homogeneous and anechoic. Its echographic image resembles a follicular cyst.

Despite the differences in the internal structure of corpus luteum cysts, their sound conductivity is always high. The wall thickness ranges from 2 to 4 mm, averaging 2.8±0.4 mm.

In most women, cysts regress spontaneously. The duration of involution depends on the size, and not on the internal structure of the cyst. Unlike follicular cysts, corpus luteum cysts in the vast majority of cases (86.2%) regress within 1-2 menstrual cycles.

Endoscopic picture

Cysts of the corpus luteum are usually unilateral, although it is possible that a small cyst (up to 4 cm in diameter) is present in the other ovary. The size of the cyst is 2-8 cm, the shape is round or oval, the wall of the cyst is thickened, folding of the inner surface is noted, the contents are hemorrhagic. The cyst has a bluish-purple tint.

The proper ligament of the ovary is not changed. The course of the vessels of the mesovarium has the usual direction. When enucleating a cyst, the wall is separated from the ovarian tissue with great difficulty and often breaks.

Paraovarian cyst

B. Paraovarian cyst- retention formation located between the leaves of the broad ligament of the uterus.

The sizes of paraovarian cysts range from 3 to 15 cm. The thickness of the cyst wall varies from 1 to 3 mm, averaging 1.5±0.4 mm. There is a clear correlation between the possibility of ultrasound diagnosis of paraovarian cysts depending on their size. Only when the cyst diameter is more than 5 cm, in all cases, transvaginal ultrasound reveals an unchanged ovary.

With large paraovarian cysts, the ovary is not always visualized. In 88% of patients, the ovary is identified as a separate anatomical education, and as the size of the cyst increases, careful scanning using transabdominal and transvaginal sensors is necessary to identify the ovary. Unlike follicular cysts and corpus luteum cysts, paraovarian cysts do not regress.

Endoscopic picture

Paraovarian cysts, as a rule, are unilateral formations up to 10-15 cm in diameter, round or oval in shape, tight-elastic consistency, the capsule is usually thin but quite strong, the contents are transparent. Depending on the size of the cyst, the fallopian tube is located differently, sometimes it is spread out on the surface of the cyst. The paraovarian cyst and the ovaries are defined as separate anatomical structures.

Peritoneal cystic formations

G. Peritoneal cystic formations . Peritoneal cystic formations (serosoceles) are also among the rather difficult to diagnose pelvic formations. Differential diagnosis of serosocele, tumor-like formations and ovarian tumors presents significant difficulties.

Anamnestic data

Anamnestic data have some features: transection is detected in 80% of cases, acute inflammation of the uterine appendages with pelvioperitonitis - in 10-25%, common forms of endometriosis - in 5-15%. The duration of existence of serosocele ranges from 3 months to 4.6 years (after previous operations), and among women with acute pelvioperitonitis - from 2 to 5 months.

Criteria for serosocele

1. Liquid formation in the pelvic area, detected after operations or an acute inflammatory process of the internal genital organs.
2. Absence of a clearly visualized wall (capsule) on the echogram.
3. Irregularity of the contours of the cystic structure located in the pelvis.
4. Change in the shape of the formation during repeated ultrasounds.

Endoscopic picture

Peritoneal formation can be single-chamber or multi-chamber, the walls are represented by adhesions. The shape is round or oval, sizes from 1 to 25 cm, tight-elastic consistency, filled with a yellowish opalescent liquid. The adhesive process in the abdominal cavity and pelvis causes certain technical difficulties when performing laparoscopy.

Mature teratomas

D. Mature teratomas. According to the WHO International Classification (1977), ovarian teratomas are classified as germ cell tumors. Mature teratomas are benign neoplasms containing tissue elements that do not differ from similar structures of the body (the most commonly found elements are skin, hair, fat, smooth muscle fibers, cartilage and bone tissue, elements of the nervous system).

In 80% of cases, mature teratomas are unilateral formations. Often a relapse of the disease is diagnosed with the identification of a teratoma in the other ovary. More often (60-70% of cases) the tumor comes from the right ovary.

Simultaneous transabdominal and transvaginal ultrasound can improve diagnostic accuracy and identify 6 types of echographic images of mature teratomas.

1. In type 1, the tumor is completely anechoic internal structure and high sound conductivity. On the inner surface of the tumor, a parenchymal tubercle of medium or high echogenicity, round or oval, can be detected.
2. In type 2, the tumor has a completely dense internal structure, its structure is hyperechoic and mostly homogeneous.
3. In type 3 teratomas, they are characterized by a cystic-solid structure, the dense component usually has a homogeneous structure, high echogenicity and occupies from 1/3 to 3/4 of the tumor volume; in the cystic component, multiple hyperechoic small linear-striated inclusions are determined.
4. Type 4 is characterized by a completely solid tumor structure, consisting of two components - hyperechoic and dense, giving an acoustic shadow.
5. Type 5 teratomas have the most complex internal structure and are characterized by the presence of all of the above components (cystic, dense and hyperechoic solid, giving an acoustic shadow), they do not exceed 5 cm in diameter.
6. Type 6 teratomas have a varied internal structure (liquid with septa of varying thickness, dense inclusion of a spongy structure, fine- and medium-dispersed hyperechoic suspension).

The greatest difficulties arise in differentiating cystic teratomas (type 1) and serous cystadenomas. When performing an ultrasound in such cases Special attention You should pay attention to the condition of the inner wall of the formation. The presence of a smooth wall in most cases suggests a smooth-walled cystadenoma.

The detection of a dense component of a spongy structure on the inner surface of the tumor often indicates papillary cystadenoma. If the parietal component has a homogeneous structure and contains dense hyperechoic inclusions, especially those giving an acoustic shadow, then this most likely indicates a mature teratoma.

Certain difficulties arise in the differential diagnosis of mature teratomas (type 6) and ovarian fibromas that give an acoustic shadow. When performing an ultrasound, it should be borne in mind that with fibromas, the tumor area located between its upper pole and the acoustic shadow generally has low echogenicity, and with teratomas, high echogenicity.

Of particular value is the identification of mature teratomas in the thickness of the ovary, when the size of the ovary is not increased and the surface is not changed. In these clinical observations, the diagnostic capabilities of ultrasound are superior to those of laparoscopy.

Endoscopic picture

Macroscopically, the wall of a dermoid cyst consists of dense, sometimes hyalinized connective tissue. The shape is round or oval, the consistency is dense. Dimensions 1-16 cm. The surface is smooth or lumpy, elastic in some places, very dense in others.

The location of the cyst in the anterior fornix (as opposed to other types of tumors, usually located in the utero-rectal space) has a certain differential diagnostic significance.

When the cyst is cut, its thick, lard-like contents pour out, sometimes it looks like balls (dermoid with balls). Along with the fat, tufts of hair are found in the cyst. The inner surface of the cyst wall is smooth over a considerable extent, but in one area there is usually a protrusion - the so-called head, or parenchymal, tubercle. Teeth, bones, and parts of organs are often found in the tubercle.

Serous, or cilioepithelial, tumors

E. Serous, or cilioepithelial, tumors are divided into smooth-walled and papillary, and papillary, in turn, into inverting (papillae are located inside the tumor capsule) and everting (papillae are located on outer surface capsules). There are also mixed tumors, when the papillae are located on both the inner and outer surfaces of the capsule.

Serous cystadenoma

1. Serous cystadenoma- most simple form Serous tumors are usually unilateral, single-chamber and smooth-walled. The epithelium lining the tumor wall is single-row cubic, less often cylindrical.

Endoscopic picture

The shape is spherical or oval, the surface is smooth, shiny, whitish in color. The contents of the cyst are transparent, with a yellowish tint. Sizes can vary significantly. In appearance, serous smooth-walled cystadenomas resemble follicular cysts, but unlike retention formations, the tumor has a different color - from bluish to whitish-gray, which is due to the uneven thickness of the capsule.

Papillary cystadenoma

Endoscopic picture

The tumor is usually visible as a mass with a dense, opaque whitish capsule. The most characteristic sign is papillary growths on the outer surface of the tumor capsule.

With pronounced dissemination of capillary growths (cauliflower type), the everting form of the tumor can be mistaken for cancer.

Papillary cystadenoma can be a bilateral formation, in advanced cases it is accompanied by ascites, inflammatory process in the small pelvis, the intraligamentous location of the tumor and the proliferation of papillae along the peritoneum are possible.

The contents of cystadenomas are liquid, transparent and have a brown, reddish or dirty yellow color. Unlike mucinous tumors, there is no pseudomucin.

Mucinous cystadenoma

Endoscopic picture

The surface of the tumor is mostly uneven, with numerous protrusions due to the presence of chambers. The size of the tumor varies widely. The tumor is irregular in shape with a dense, thick, opaque capsule, the color ranges from whitish to bluish. In side lighting, the boundary between the cameras is visible.

On section, the tumor is rarely single-chamber; for the most part it is multi-chamber with the formation of daughter and grandchild cavities. Between the individual cavities, the remains of partitions destroyed due to significant pressure tumor contents. The inner surface is smooth.

Torsion of the pedicle of an ovarian tumor

G. Torsion of the pedicle of the ovarian tumor occurs quite often, especially under favorable conditions: high mobility of the tumor, small size, significant stretching of the anterior abdominal wall(saggy belly), pregnancy, in postpartum period. Most often, torsion occurs before sexual activity begins.

Endoscopic picture

In case of torsion of the pedicle of the ovarian tumor, a bluish-purple formation is visualized. Its appearance is determined by the degree of torsion of the tumor pedicle by 180° or more (partial or complete torsion) and the time elapsed from the moment of circulatory disturbance to endoscopic surgery.

Ovarian apoplexy

Ovarian apoplexy- sudden hemorrhage, accompanied by a violation of the integrity of the ovarian tissue and bleeding into the abdominal cavity. Among the causes of intra-abdominal bleeding, 0.5-2.5% of cases are due to ovarian apoplexy.

The most common source of bleeding is the corpus luteum or its cyst. The possibility of rupture of the corpus luteum during pregnancy cannot be ruled out.

Endoscopic picture

The affected ovary is of normal or enlarged size due to a previous hematoma, usually bluish in color. Even a small tear (up to 1 cm) can lead to heavy bleeding. There are blood clots and free blood in the pelvis and abdominal cavity.

The operation is performed as conservatively as possible. The ovary is removed only if there is massive hemorrhage that completely affects the ovarian tissue. If the corpus luteum of pregnancy ruptures, it is sutured without performing a resection, otherwise the pregnancy will be terminated.

Often apoplexy is combined with ectopic pregnancy And acute appendicitis. Apoplexy can be bilateral. In this regard, during the operation it is necessary to examine both ovaries, fallopian tubes and appendix.

Polycystic ovaries

In accordance with the WHO International Classification of Diseases, 9th Revision, 1993, “polycystic ovaries” or the synonym “Stein-Leventhal syndrome” is coded as 256.4 in section No. 3 “Diseases of the endocrine system”.

Frequency of polycystic ovaries in structure gynecological diseases varies widely - from 0.6 to 11%.

Endoscopic picture

Characteristic signs of polycystic ovaries: slight bilateral enlargement of organs (up to 4-5 cm), smooth thickened capsule with a vascular pattern varying degrees severity, the presence of subcapsular cysts, the absence of free peritoneal fluid.

An anechoic formation in the ovary is a symptom that is determined by ultrasound examination female genital and pelvic organs. Various pathologies of the female reproductive system require careful diagnosis, so the “golden method” of research is ultrasound. This method is based on the ability of ultrasound beams to penetrate deep into tissues and reflect from organs that have different densities, which is characterized by an image in the form of different echo signals. If tissue, such as bone, has a high density and conducts rays well, then the image is hyperechoic and appears as a bright area. If the tissue has low density and does not reflect the signal well, the area will be hypoechoic or anechoic. Anechoic formation in the ovary can be of various etiologies, and according to this there is different methods differential diagnosis.

ICD-10 code

N83 Non-inflammatory diseases of the ovary, fallopian tube and broad ligament of the uterus

Causes of anechoic formation in the ovary

An anechoic formation during ultrasound examination looks like a darkened structure of a certain size in the projection of the ovary. Typically, this is a cavity filled with liquid, which explains the good conductivity of ultrasound beams. Therefore, the most common cause of such a symptom on ovarian ultrasound is the formation of cysts or cysts. This is the most common reason, which is accompanied by similar changes on ultrasound. According to statistics, ovarian cysts in women of reproductive age are very common and account for more than 60% of all benign neoplasms of the female genital organs, and more than 85% of benign formations in the ovary. The reasons for the formation of ovarian cysts can be varied, and it is very difficult to establish the exact etiological factor. First of all, it should be noted that there is a violation of the hormonal balance in the regulation of the ovario-menstrual cycle, which affects the functioning of both the ovary itself and the follicle cycle. Also among the causes of the development of cysts (anechoic formations of the ovary) one should highlight inflammatory diseases of the ovaries, postoperative adhesions, and ovarian trauma. All these factors can cause the development of cysts, but very often, it is not possible to identify any factors in a woman’s history that could influence this process.

Pathogenesis

The pathogenesis of the development of anechoic formations in the ovary differs, depending on the type of neoplasm - cyst or cystoma.

A cyst is a benign non-proliferating neoplasm of the ovary, which has a thin wall and fluid inside. Liquid contents are formed due to the secretory activity of cells and disruption of the excretion of this secretion. The size of the cyst can range from several millimeters to several centimeters, but compared to the cystoma, the size of the cyst does not reach enormous sizes.

Cysts are distinguished:

• Follicular is an ovarian formation, which is characterized by a thin shell and the presence of fluid inside, and is formed as a result of a violation of the physiological rupture of the follicle and the accumulation of fluid in it that is secreted. Therefore, follicular cysts have their own characteristics on ultrasound.
• Paraovarian is a cyst located around the ovary, which is formed due to the accumulation of fluid in the ovarian tissue.
• Dermoid is a cyst that is congenital and occurs as a result of disruption of ontogenesis processes and is characterized by the presence in the cavity of dysgerminogenic inclusions in the form of hair, teeth, and skin. Doesn't happen very often.
• Corpus luteum cyst is a special type of cyst that forms in the second phase of the menstrual cycle - luteal, when after the rupture of the follicle the corpus luteum of pregnancy is formed and under certain conditions hormonal disorders the process of involution of the corpus luteum, it persists with the accumulation of fluid inside. Then a thin-walled capsule forms around the corpus luteum and fluid is secreted inside.

These are the main types of cysts that are found in the ovary, although there are a huge number of them according to their structure, but these types can be found most often.

Cystoma – benign neoplasm ovary, which has distinctive features from a cyst. Firstly, cystomas are proliferating structures that are formed not due to the accumulation of fluid, but due to cell proliferation. Therefore, their structure is heterogeneous and can consist of several chambers, and can also be of enormous size due to uncontrolled cell division. Main types of cysts:

• Mucinous is a cyst that is formed during the proliferation of glandular epithelial cells and due to this, cavities are formed containing a viscous mucous-like substance inside - mucin.
• Papillary or cystadenoma is a cystoma of the papillary epithelium, which has heterogeneous structure due to the number of cells that proliferate as warts on the skin. This type of cyst is the most dangerous in terms of possible complications.
• Serous is a type of epithelial cyst, which is characterized by cell proliferation and accumulation of serous matter inside.

Separately, it is necessary to note endometrioid cysts, which, when localized in the ovary, are also called “chocolate cysts.” This is a type of disease – endometriosis. At the same time, areas of the endometrium are dispersed outside the uterine cavity - both to the external and internal genital organs, and extragenitally - which is accompanied by their secretion, that is, these areas menstruate. When endometrioid cysts are localized in the ovary, they also have their own characteristics, both clinically and during ultrasound examination.

Symptoms of anechoic formation in the ovary

As described earlier, an anechoic formation in the ovary is a cyst or cystoma. The specifics of the clinic and differences in ultrasound depend on this.

The first signs of this pathology are often detected already at the moment when the formation reaches enormous sizes. Basically, the course of cysts is asymptomatic, but it all depends on the location.

Ovarian cysts can disrupt the normal ovario-menstrual cycle with delayed menstruation, which often alarms women and forces them to see a doctor. This is due to the fact that the ovarian cyst prevents the release of the egg from the follicle and menstruation does not occur, since there is no normal level of hormones, which is maintained by the corpus luteum, among other things. This applies mainly to follicular cysts and corpus luteum cysts, which is due to their localization in the area of ​​the follicle that was supposed to rupture.

As for dermoid cysts, they are often asymptomatic until the very end of a woman’s life, since they do not tend to grow.

A paraovarian cyst is located between the ovary and the uterus, so it is often clinical symptom is a torsion of the pedicle of an ovarian cyst, which is accompanied by a clinical picture of an acute abdomen. At the same time, the woman feels a sharp pain in the lower abdomen or in its lateral parts, the general state, symptoms of peritoneal irritation may be positive. Moreover, if examined over time, the cyst increases in size due to the fact that the outflow of blood through the veins is disrupted, and arterial inflow doesn't suffer. This may be the first sign of a cyst in a woman who previously had no idea about its presence.

As for cysts, their symptoms are often associated with large sizes, which is accompanied by a feeling of pressure on neighboring organs. In this case, cystomas can be so huge that they lead to an increase in the volume of the abdomen. This may be the first and only sign of the presence of cysts.

The clinical features are endometrial cysts, which are characterized by small discharges of blood similar to the uterine endometrium. At the same time, a woman before or after menstruation experiences severe pain in the lower abdomen, which is often regarded as premenstrual syndrome and women do not focus on this. This occurs because the blood that is released from the endometrial ovarian cyst enters the free pelvic cavity and the abdominal cavity, which causes irritation of the peritoneum and severe abdominal pain.

Regarding the distinctive ultrasonic features different types cysts, then:

1. An anechoic round formation in the ovary, especially if it is avascular, then it is definitely a cyst. What does the concept “avascular” mean? This is the absence of blood vessels, that is, this formation is not supplied with blood. This once again proves that this is a cyst, since, differentiating from malignant formations or with a myomatous node, it should be noted that they have a good blood supply.
2. An anechoic liquid thin-walled formation in the ovary indicates a cyst, while the cavity is homogeneous in the form of darkening with a clear structure. In this case, there is a thin membrane, which also makes it possible to differentiate a cyst from a cystoma.
3. An anechoic heterogeneous ovarian formation is an endometrioid cyst, which has a heterogeneous structure due to the presence of endometrial cells that can secrete blood. In this case, a cavity is not formed, or there is a small cavity that contains blood inside, and since blood has a higher density than liquid, an unclear structure of the formation is determined.
4. A two-chamber anechoic formation in the ovary - this also indicates a cystoma, since in the process of cell proliferation, both single-chamber and multi-chamber formations can form.
5. An anechoic formation of the ovary during pregnancy is also often a cyst. But at the same time, such a cyst should be monitored very carefully, since its course can vary from regression after the birth of the child to the occurrence of complications with the growth of this cyst and enlargement of the uterus. Treatment tactics are also slightly different.

These are the main ovarian neoplasms with clinical differentiation and ultrasound signs that help clarify the diagnosis.

Complications and consequences

The main complications that can occur with asymptomatic anechoic formations in the ovary are conditions associated with torsion of the pedicle of the ovarian cyst, which is accompanied by a clinical picture of an acute abdomen and requires immediate surgical intervention, since the death of the cyst tissue occurs, which, if waited, may be accompanied by necrosis of the ovarian tissue. Also, one of the complications may be rupture of the cyst, which is accompanied by the release of contents into the pelvic cavity and initiates the clinical picture of peritonitis. Since the fluid can also be with blood, a long process can contribute to the formation of inflammatory transudate. The consequences of an anechoic formation in the ovary may be a disruption of the ovario-menstrual cycle, which leads to infertility or miscarriage.

Diagnosis of anechoic formation in the ovary

If any symptoms characteristic of ovarian cysts appear, a woman should immediately consult a doctor. A very important step in making a diagnosis is collecting an anamnesis with details of the monthly cycle, characteristics of sexual life, symptoms of the disease and the dynamics of their origin. Complaints of menstrual irregularities with delayed menstruation or polymenorrhea may suggest possible problems with the ovary, one of the causes of which may be cysts.

When examining a woman in the mirror, no changes are detected, but during a bimanual vaginal examination, a unilateral round-shaped neoplasm can be palpated in the projection of the ovary, which immediately makes it possible to suspect an ovarian cyst.

Tests for ovarian cysts are not specific, so all general clinical examinations are carried out. Special smears from cervical canal also uninformative for diagnosing ovarian cysts in the absence of concomitant pathology.

Instrumental diagnostics allows you to clarify the diagnosis and establish treatment tactics. The most informative method is ultrasound of the ovaries and pelvic cavity.

Ultrasound is performed transvaginally, with the sensor located close to the ovaries, which allows better visualization of changes. At the same time, the exact localization of the anechoic formation in the ovary, its size, structure, edges, cavity, capsule, and homogeneity are described. This allows the possible process to be accurately identified. They also describe the condition of the uterus, its length, and the height of the endometrium, which makes it possible to determine the phase of the cycle.

Diagnosis and accurate confirmation of the diagnosis of the cyst is possible only after postoperative histological examination of the material.

These are the main types of diagnosis of anechoic formation in the ovary.

Differential diagnosis

Differential diagnosis must be carried out with ovarian cancer and other malignancies. In this case, ovarian cancer has the appearance of an unstructured formation with unclear edges and possible spread to neighboring organs. It is also necessary to differentially diagnose an ovarian cyst with an ectopic ovarian pregnancy. In this case, there is a delay in menstruation, a positive pregnancy test and the fertilized egg is visualized.

A fibromatous node with subserous localization can also resemble a paraovarian ovarian cyst, but with fibroids the node is of varying density and has a higher echogenicity.

Treatment of anechoic formation in the ovary

The issue of treatment of cysts is discussed in each case individually, since there are cases when only observation is necessary. Treatment can be either conservative or surgical.

Asymptomatic small cysts that were discovered by chance during examination in girls of puberty or under 20 years of age, as a rule, are not subject to treatment, but only to careful observation. This is due to the fact that such formations can regress on their own after restoration of normal hormonal levels.

Also, cysts during pregnancy are subject to observation, in the absence of complications. This is due to the fact that conservative treatment with medications during pregnancy can negatively affect the fetus. Also, surgical treatment can bring more complications, and after childbirth such a formation may disappear. Otherwise, after childbirth the issue of treating such a cyst is considered.

Only endometriotic and functional cysts (follicular and corpus luteum cysts) are subject to drug treatment of anechoic formations in the ovary. This is due to the fact that in the pathogenesis of the formation of such cysts, hormonal imbalance plays a major role, therefore medicinal hormonal drugs as replacement therapy help reduce the size of these cysts and lead to their regression.

The main hormonal drugs prescribed in this case are progesterone drugs. They allow you to equalize hormone levels by replenishing hormones in case of luteal phase deficiency.

1. Duphaston is an oral hormonal drug that is a synthetic analogue of natural progesterone. The mechanism of action of this drug, like others, is replacement therapy for failure of the second ovarian phase, which leads to the formation of functional or endometrioid cysts. The drug is available in the form of 10 mg tablets, used according to an individual regimen with general dosages in the form of taking 10 mg twice a day from the 5th day of the cycle or from the 11th day of the cycle. The specifics of administration depend on the type of cyst and are decided by the doctor on an individual basis, since a combination of the drug with estrogen drugs is possible.

Contraindications to the use of the drug are acute lesions liver, acute heart failure and lactation. Side effects– these are allergic manifestations, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, impaired libido, uterine bleeding requiring dosage changes.

1. Marvelon is a combined estrogen-progesterone drug that contains 5 times more progesterone. The principle of action of the drug on the regression of cysts is due to the regulation of hormonal levels, which is accompanied by a reduction in the cyst. The drug is available in 100 mg tablets and is taken one tablet per day. same time from 1 to 21 days of the cycle. This ensures a constant normal concentration of hormones in the blood. Side effects of the drug are allergic manifestations, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, impaired libido, and weight gain. Contraindications for use are acute liver dysfunction, acute cholecystitis, malignant processes of any localization.
2. Janine is a low-dose, biphasic combined estrogen-progesterone drug, which has the same mechanism of action on anechoic formations in the ovary as previous hormonal drugs. It is available in the form of tablets, the number of which is 21. Reception begins on the first day of the menstrual cycle. Due to the content of estrogen and progesterone, the drug can regulate any hormonal imbalance. Take one tablet per day for 21 days, then take a break for 7 days, then resume taking it. Side effects can develop in the form of dyspeptic manifestations, skin allergic reactions, changes in the mammary gland in the form of pain, swelling, as well as bloody uterine discharge. Contraindications to the use of the drug are diabetes, thrombosis and other vascular problems, migraine, as well as pregnancy and lactation.
3. Anteovin is a combined biphasic estrogen-progesterone drug that suppresses the processes of the normal menstrual cycle by regulating hormonal levels and preventing the process of ovulation. This promotes regression of functional cysts. The drug is available in the form of tablets, 21 pieces per package. Among them are 11 white, and 10 are pink according to the difference in composition. Take one tablet from day 5 of the cycle. Side effects can develop in the form of dyspeptic symptoms, discomfort in the mammary glands and a feeling of their tension. Contraindications to taking the drug are diabetes mellitus, arterial hypertension, epilepsy, varicose veins veins, and smoking is not recommended while taking this drug.

It is important to carry out restorative and immunomodulatory treatment in the form of vitamin therapy in parallel with hormone replacement therapy. Vitamins A and E are recommended, or better yet, multivitamin complexes. Among the physiotherapeutic methods of treatment, iontophoresis and electrophoresis are recommended, as well as magnetic resonance therapy for asymptomatic forms of cysts. This helps reduce them in size.

Surgical treatment is a priority in the case of cysts, since due to their proliferation they sooner or later become symptomatic and can also become malignant. Conduct surgical interventions in the scope of lower laparotomy and resection of the ovarian cyst. In this case, the postoperative material is sent for cytological examination to differentiate the type of cyst.

The surgical treatment method is more reliable and is used in older women, since the risk of malignancy of the cyst is reduced. In case of complications, surgical treatment of anechoic formations in the ovary is the method of choice.

Traditional treatment of anechoic formation in the ovary

There are many traditional methods treatment of cysts. These include methods using many herbs, honey and other natural substances, as well as homeopathic remedies.

Basic folk recipes:

• Honey has a lot nutrients and microelements that increase local immunity and stimulate regeneration. To create medicine from honey, you need to take the core of the onion and place it in a glass of honey until it is completely filled with it. Leave this solution overnight and in the morning moisten a tampon in this solution and insert it into the vagina at night, which is repeated for 10 days, after which the cyst should shrink.
• Flaxseed oil regulates the disturbed ovario-menstrual cycle, and therefore it must be used a teaspoon daily in combination with carrot juice. To do this, dilute five drops of fresh juice in a teaspoon of oil and drink on an empty stomach.
• Walnuts one of the most effective means for regulating hormonal imbalance. You can use both nut shells and partitions. They need to be poured with a glass of alcohol and left in a dark place for 3 days, after which they should be taken on an empty stomach, one tablespoon at a time, for at least a week.

Recipes using herbs are as follows:

• Cooking herbal tea from mint, nettle and currant leaves - take them in equal quantities, pour hot water and boil for another 5 minutes, after which it is cooled and drunk warm, half a glass every other day for a month.
• Pine buds are brewed at the rate of one tablespoon of raw material per liter of water, infused in a thermos overnight and drunk throughout the day, half a glass 3-4 times a day for at least a month.
• Raspberry leaves and meadowsweet inflorescences are steamed in hot water and a glass of this tea is taken in the morning and evening and drunk for three weeks.

Homeopathic remedies are also widely used to treat ovarian cysts, for this you need to consult a professional homeopathic doctor. The main homeopathic remedies are:

• Dysmenorm - complex homeopathic medicine, which affects hormonal imbalances, including benign ovarian formations. The drug is produced in the form of tablets and taken 1 tablet 3 times a day, half an hour before meals. Side effects are rare, but nausea and temporary worsening may occur. Not recommended for patients with celiac disease.
• Lycopodium is a monocomponent homeopathic medicine that is effective for cysts of the right ovary. The drug is produced in the form of homeopathic granules of 10 g in a jar, also in the form of tincture of 15 ml. Take between meals, dissolve under the tongue until completely dissolved, 1 granule 4 times a day. Not recommended for pregnant women. Side effects not detected.
• Gynekohel is a combined homeopathic medicine, which comes in the form of drops and is used 10 drops three times a day, before which it must be dissolved in warm water. Side effects are rarely observed in the form of allergic phenomena.
• Cyclodinone is a homeopathic drug that normalizes the ovario-menstrual cycle in case of insufficiency of its second phase. The drug is available in tablets or drops. Dosage – 1 tablet in the morning or 40 drops once a day. The course of treatment is at least three months. Contraindications for use are pregnancy and allergic hypersensitivity to the components of the drug.

An anechoic formation in the ovary is not a diagnosis to be afraid of, but an ovarian cyst. It is necessary to differentiate different types of cysts, which depends on the clinic and affects treatment tactics. These formations are benign and there are many methods of treating this pathology, both medicinal and traditional, as well as surgical. Therefore, you should not be afraid of this diagnosis, but it is better to consult a doctor earlier for timely diagnosis and treatment, which helps prevent various complications.

After undergoing an ultrasound, some women discover that the ovary contains a fluid formation. In such cases, it is not always necessary to sound the alarm, because this kind of cyst often goes away on its own along with the next monthly cycle.

Such formations cause danger if:

• Pain after and during sexual intercourse;
• Nagging pain during physical activity;
• Nausea, etc.

In this case, we can talk about the development of the tumor and the need for its detailed examination. It should be said that a fluid formation in the left or right ovary is typical for women after forty years of age, but can be detected at any age.

Causes of neoplasms in the ovary

Such neoplasms are quite common, but it is still quite difficult to study the nature of their occurrence. However, we can definitely say that fluid formation in the ovary is a consequence of hormonal imbalance. The nature of this failure can be either pathogenic, caused by the body itself, or artificial, arising as a result of taking hormonal drugs.

Regardless of the cause of the pathology, it needs further examination and study, otherwise the following consequences may be observed:

• Risk of uterine cancer;
• Hair loss;
• Infertility;
• Swelling;
• Pain;
• Obesity.

Diagnosis and treatment of formations in the ovary

Basic examinations carried out when a fluid formation in the left ovary is suspected are limited to ultrasound and blood tests for hormonal levels. This approach allows you to obtain general data about the condition of the body and prescribe further therapy. For the most part, in women with this pathology, the menstrual cycle and ovulation are disrupted, first of all, the reproductive and then other human systems suffer.

If the body is prone to the occurrence of neoplasms, then stress, lifestyle, poor nutrition, non-compliance with work and rest schedules, etc. can push it to develop abnormalities. If you find follicular cyst or fluid formation in the right ovary, you should immediately seek help from specialists.

When you are concerned about the manifestation of certain symptoms of the disease or it is discovered that the ovary contains a fluid formation after an ultrasound examination, then you need to make an appointment with a specialist.