Endometrioid oothecoma

Description:

Endometrioid oothecomas, unlike functional cysts, have other mechanism of development and in most cases are bilateral. In gynecology the endometrioid oothecoma belongs to often found manifestations of a genital form of endometriosis at which cells of the mucous membrane covering the internal surface of a uterus are found in uterine tubes, ovaries, a vagina and an abdominal cavity. The arisen endometrioid centers are functionally active and hormonal dependent therefore cyclically are exposed to menstrualnopodobny reaction. Growth of monthly bleeding endometria fabric in a bast layer of an ovary leads to formation of endometrioid oothecomas ("chocolate" cysts) filled with the dense, dark brown contents which did not find a way out.

The endometrioid oothecoma develops at women at reproductive age (30 - 50 years), usually against the background of internal endometriosis, can be combined with a fibromyoma of a uterus and a hyperplasia of an endometria. The size of an endometrioid oothecoma can reach 10-12 cm. A histologic sign of an endometrioid oothecoma is lack of glands in its wall.

Reasons of an endometriodny oothecoma:

Despite a large number of theories of an origin of endometriosis, exact causes of illness are still unknown.

According to an implantation hypothesis endometriosis and endometrioid oothecomas can arise in the course of retrograde periods when endometria cells together with blood migrate and get accustomed in tissues of uterine tubes, ovaries, an abdominal cavity.

The drift of scraps of an endometria is also possible at the surgical manipulations injuring a mucous membrane of a uterus: gynecologic and obstetric operations, diagnostic scraping, medical abortion, diathermocoagulation of a neck of uterus.

Assume also that the endometrioid centers can be result of a metaplasia of the remains of embryonal fabric, genetic defects (family forms of endometriosis) or weakening of immune responses.

There is a communication between development of an endometrioid oothecoma and endocrine disturbances in an organism: decrease in level of progesterone, increase in level of estrogen (giperestrogeniya) and prolactin, dysfunction of a thyroid gland, bark of adrenal glands.

Can act as the provocative moments in development of endometriosis: any emotional stress; long use of Naval Forces; endometritises, oophorites, abnormal liver function, obesity, adverse ecology.

Symptoms of an endometrioid oothecoma:

Expressiveness of clinical manifestations of an endometrioid oothecoma depends on a number of factors: extents of spread of endometriosis, existence of associated diseases, psychological state of the patient etc.

In some cases formation of an endometrioid oothecoma proceeds asymptomatically or is shown by disturbance of reproductive function (infertility). The endometrioid oothecoma can be followed by a pain syndrome in the bottom of a stomach and in a waist, amplifying during periods, at the sexual intercourse. Pains can sometimes be very strong, and at the big size and a rupture of the capsule of a cyst the clinic of "acute abdomen" develops.

Are characteristic of an endometrioid oothecoma plentiful monthly, lengthening of a menstrual cycle with the smearing allocations before and after periods. Emergence of symptoms of intoxication is possible: weaknesses, nausea, the increased temperature.

Growth of an endometrioid oothecoma can lead to local changes of ovarian fabric: degenerations of ova, to follicular cysts, emergence of the hems breaking normal functions of an ovary. At long existence of an endometrioid oothecoma commissural process in a small basin with disturbance of functions of intestines and bladder (locks, a meteorism, disturbance of an urination) can come to light.

Endometrioid oothecoma – serious gynecologic pathology which can be complicated by suppuration, a rupture of walls of a cyst with izlitiy its contents in an abdominal cavity and development of peritonitis.

Diagnosis:

Gynecologic survey not always allows to reveal symptoms of endometriosis. At an endometrioid oothecoma it is possible to find existence of slow-moving painful education in an ovary and its increase before periods. The diagnosis of an endometrioid oothecoma is established by results of ultrasonography of bodies of a small pelvis with a dopplerometriya, MRT and laparoscopies.

Ultrasonography with a dopplerometriya defines lack of a blood-groove in walls of endometrioid oothecomas. When determining level of an onkomarker of SA-125 in blood, its concentration can be normal or is a little increased. In the presence of infertility carry out a gisterosalpingografiya and hysteroscopy.

The diagnostic laparoscopy is the most exact diagnostic method of an endometrioid oothecoma. Carrying out a biopsy and the subsequent histologic research of the center of endometriosis in ovarian fabric is necessary for identification of probability of its ozlokachestvleniye.

Treatment of an endometrioid oothecoma:

Treatment of an endometrioid oothecoma can be conservative (hormonal, the nonspecific antiinflammatory and anesthetizing therapy, reception of immunomodulators, vitamins, enzymes), surgical (organ-preserving removal of the endometrioid centers laparoscopic or laparotomny access) or combined. Complex treatment of endometriosis is aimed at elimination of symptoms, the prevention of progressing of a disease and treatment of infertility.

Tactics of treatment of an endometrioid oothecoma depends on a stage, symptomatology and duration of endometriosis, age of the patient and existence of problems with conception accompanying genital and extragenital pathology.

At the insignificant size of an endometrioid oothecoma performing long hormonal therapy with use of the low-dosed monophase the COOK, derivative norsteroid (levonorgestrel), the prolonged MPAS, derivative androgens, synthetic agonists of GNRG is possible. The pain syndrome connected with growth of an endometrioid oothecoma is stopped reception of NPVS, spasmolytic and sedative drugs.

At inefficiency of conservative therapy at endometrioid oothecomas more than 5 cm in size, a combination of endometriosis and infertility, risk of complications and oncological vigilance only operational treatment is shown.

At women of reproductive age, persons interested to have children, try to avoid radical operations. Procedures of choice of surgery of endometrioid cysts are enucleation of geterotopny educations or a resection of an ovary. It is reasonable to carry out removal of the centers of endometriosis and endometrioid oothecomas with preliminary and postoperative hormonal therapy.

Preoperative hormonal therapy allows to reduce the endometriosis centers, their blood supply and functional activity, inflammatory reaction of surrounding fabrics. After surgical removal of an endometrioid oothecoma the corresponding hormonal treatment promotes regress of the remained endometrioid centers and the pathology recurrence warns.

In the post-operational period administration of physical therapy for the purpose of correction of an endocrine imbalance, prevention of infiltrative and commissural processes, a recurrence of endometrioid oothecomas is reasonable (an electrophoresis, ultrasound, a fonoforez, endonasal galvanization, SMT-therapy, magnetotherapy, laser therapy, acupuncture, radonic bathtubs, etc.).

Forecast:

After removal of an endometrioid oothecoma in most cases pains considerably decrease, it is recovered normal menstrual and genital functions. After treatment of an endometrioid oothecoma dynamic observation of the gynecologist with ultrasonography – control and a research of the SA-125 level is recommended.