Papillary cystoma of an ovary

Description:

Papillary cystoma of an ovary – the gynecologic deviation connected with education in ovarian fabric of a serous tumor. Externally it represents the capsule which internal surface is covered by epithelial papillary growths, and contents are presented by liquid exudate. The deviation of this kind is most widespread among women of childbearing age, occurs at women of a climacteric slightly less often and extremely seldom can develop at girls before puberty. Among all tumors of ovaries about 7% make papillary cystomas and 34% among epithelial tumors. In 50-70% of cases there is a blastomatous regeneration of a cystoma in this connection, it is estimated as a precancerous state. In 40% of cases the papillary cystoma is combined with other deviations of a reproductive system (a hysteromyoma, an oothecoma, uterus cancer, endometriosis).

Reasons of a papillary cystoma of an ovary:

In a question of origins of a papillary cystoma of an ovary the modern gynecology has several hypotheses.
It agrees one of theories, papillary cystomas of an ovary, as well as other tumoral formations of ovarian fabric, develop against the background of the chronic giperestrogeniya caused by a hyperactivity of gipotalamo-pituitary system. Other theory is based on arguments about the "constant ovulation" caused early by menarche, a late menopause, the small number of pregnancies, refusal of a lactation etc. According to the theory of genetic predisposition, in development papillary cystomas of an ovary existence at female members of the family of tumors of ovaries and a breast cancer matters.
It is supposed that cystomas of an ovary can develop from a cover epithelium, from the rudimentny elements or sites of the displaced uterine or pipe epithelium surrounding an ovary.
Development of a papillary cystoma of an ovary can be associated with a carriage of VPCh or herpes of the II type, frequent inflammations (an endometritis, an oophoritis, an adnexitis) broken by a menstrual cycle, repeated abortion.

Classification:

At a papillary cystoma of an ovary there is a growth of a papillary epithelium on internal, and is slightly more rare – an outside surface. Depending on localization of a new growth distinguish several types of cystomas. The mixed cystoma type (60% of cases) is most widespread, then there is an inverting cystoma (30%) and an evertiruyushchy cystoma (10%). The mixed form of a deviation is characterized by papillary growths with outside and the interior of the capsule. At the inverting cystoma the deviation is observed only on an internal wall of a tumor, at evertiuyushchy – on an outside wall.

Cystomas differ also in the histologic form. There are cystomas without onkootkloneniye signs proliferating cystomas which are estimated as a precancerous state and malignant (malignizirovanny) educations.

As a rule, the structure of a cystoma is characterized by existence of several cameras, convex walls, a short leg and the irregular rounded shape. The internal cavity of the camera is filled with yellowish-brown liquid. Walls of cameras are unevenly covered by sosochkovidny epithelial growths which are externally a little similar to a form of corals and can quantitatively change. If educations multiple and small, the wall of a cystoma can have a velvety appearance. In certain cases epithelial nipples can burgeon through a kistomny wall therefore there is planting of the second ovary, a diaphragm, peritoneum of a basin and the next bodies. For this reason the evertiruyushchy and mixed papillary cystomas as they are most inclined to a malignancy are considered as the most dangerous. Papillary cystomas are localized from two parties, have intraligamentarny growth and develop with a different speed. Such educations reach the big sizes very seldom.

Symptoms of a papillary cystoma of an ovary:

At an early stage of a disease symptoms are not expressed. The clinic of a papillary cystoma of an ovary demonstrates from emergence of heavy feelings, morbidity in the bottom of a stomach; pains quite often irradiate in the lower extremities and a waist. Development of the dysuric phenomena, disturbances of defecation, the general weakness is early noted. At some women disturbance of a menstrual cycle on type of an amenorrhea or menorrhagia can be observed.
At the evertiruyushchy and mixed forms of cystomas ascites of serous character develops; hemorrhagic character of ascitic liquid indicates existence of a malignant cystoma. Ascites is followed by increase in the sizes of a stomach. Commissural process in a small basin quite often leads to infertility.
At torsion of a leg of the papillary cystoma of an ovary formed by the stretched ligaments, an ovarian artery, absorbent vessels, nerves, a uterine tube there is a tumor necrosis that clinically is followed by signs of an acute abdomen. The rupture of the capsule of a cystoma is followed by development of intra belly bleeding, peritonitis.

Diagnosis:

The papillary cystoma of an ovary is distinguished by means of carrying out vaginal examonation, ultrasonography, a diagnostic laparoscopy, the histologic analysis.
At a bimanual gynecologic research one is palpated - or the bilateral painless ovoidny education which is pushing aside a uterus to a pubic joint. Cystoma consistence tugoelastichesky, sometimes uneven. The Evertiruyushchy and mixed cystomas covered with papillary outgrowths have a melkobugristosty surface. The intercopular arrangement causes limited mobility of papillary cystomas of an ovary.
In the course of gynecologic ultrasonography the cystoma sizes, capsule thickness precisely are established, existence of cameras and sosochkovidny growths is specified. At a stomach palpation, and also by means of ultrasonography of an abdominal cavity ascites can come to light.
Detection of a tumor of an ovary demands a research of an onkomarker of SA-125. In some cases for specification of the diagnosis carrying out KT or MPT of a small pelvis is reasonable.
Final confirmation of the diagnosis and clarification of a morphological form of a papillary cystoma of an ovary is made in the course of a diagnostic laparoscopy, an intraoperative biopsy and histologic studying of material.

Treatment of a papillary cystoma of an ovary:

Treatment of a papillary cystoma is performed only by surgical intervention. In the absence of strong indications of an ozlokachestvleniye of a cystoma at women of the reproductive period, treatment can be limited to an ovariektomiya – elimination of an ovary on the damaged party. If existence of cystomas is revealed from two parties, then the full ovariektomiya is carried out.

The panhysterectomy - supravaginal amputation of a uterus with appendages is carried out to the premenopauzalny and menopausal period, and also at detection of signs of a malignancy. The histologic research allows to define a morphological form of a cystoma and necessary volumes of surgical intervention.