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Can a chocolate cyst resolve? The influence of a chocolate cyst on the life of a representative of the fairer sex

The problem of ovarian endometriosis has affected millions of women on the planet today. It is this type of endometriosis that causes particular concern for the category of such patients, since ovarian endometriosis in some cases tends to malignize and form malignant ovarian tumors.

Endometrioid ovarian cysts have a characteristic clinical picture and require the earliest possible detection and prescription of an effective treatment regimen in order to prevent oncological pathology and restore the normal function of the woman’s reproductive system.

Ovarian endometriosis: main symptoms and diagnostic methods

Ovarian endometriosis occurs as a result of lymphogenous or hematogenous introduction of endometrial cells into the area of the uterine appendages. Often, ovarian endometriosis manifests itself in the formation of cysts and pseudocysts, which give a very characteristic clinical picture.

Symptoms of endometrioid cysts significantly disrupt a woman’s quality of life and affect her general condition and disrupt reproductive function. In addition, endometrioid cysts in some cases can transform into malignant ovarian tumors. Characteristic clinical picture And modern methods diagnostics help in identifying ovarian endometriosis.

Ovarian endometriosis:

main forms of ovarian endometriosis depending on their structure;
characteristic clinical picture of ovarian endometriosis;
main methods for diagnosing ovarian endometriosis.

The main forms of ovarian endometriosis depending on their structure

Ovarian endometriosis is manifested by the formation of pseudocysts up to one centimeter in diameter, which are filled with a brown mass. When such pseudocysts merge, endometriomas or so-called “chocolate cysts” are formed. Endometriotic lesions are most often localized in the cortical layer of the ovaries, but sometimes they can also affect the medulla. Depending on the structure, the following forms of ovarian endometriosis are distinguished:

glandular endometriosis;
cystic endometriosis;
glandular cystic endometriosis;
ovarian stromal endometriosis.

It is the glandular cystic form of ovarian endometriosis that is most often prone to excessive proliferation and malignant transformation. Endometrioid pseudocysts are lined with connective tissue, and endometriomas are lined with columnar or cuboidal epithelium. The dark brown color of the contents of these cysts is due to a large number hemosiderin in the cystic mass.

Characteristic clinical picture of ovarian endometriosis

In the presence of small foci of ovarian endometriosis, the clinical picture is absent in most cases. The first symptoms of the disease occur when pseudocysts merge and form endometriomas. In this case, the parietal and visceral peritoneum is drawn into the pathological process, and as a result of the subsequent spread of pathological foci, adhesions are formed.

In this case, the patient feels constant pain in the lower abdomen of a dull, aching nature, which can radiate to the rectum and perineum. During menstruation, the pain intensifies significantly. Due to the adhesive process, pain syndrome also occurs during physical activity and sexual intercourse. Patients with ovarian endometriosis are also characterized by menstrual dysfunction such as algodysmenorrhea.

Basic methods for diagnosing ovarian endometriosis

Diagnosis of ovarian endometriosis is based on anamnestic data, where the patient complains of chronic pain syndrome, as well as on the results of a gynecological examination and instrumental methods diagnostics

Palpation is uninformative in the presence of small endometrioid pseudocysts, but endometriomas are palpably defined as tight-elastic formations localized posterior to the uterus, limiting its mobility. After menstruation, the size of endometriomas increases.

During ultrasound examination, the presence of pseudocysts can be indicated by hypoechoic inclusions on the surface of the ovaries and thickening of their tunica albuginea as a result of the formation of adhesions.

Endometriomas during ultrasound examination are visualized as round formations with a pronounced echo-positive capsule, localized behind the uterus, having a fine echo-positive suspension against the background of liquid contents.

Laparoscopy allows not only to clarify the diagnosis of ovarian endometriosis, but also to directly treat this pathology.

The most common benign non-blastomatous tumors include follicular, luteal (corpus luteum cyst), endometrioid (chocolate), paraovarian cysts, tumor-like formations due to inflammatory process .

Follicular cyst

A follicular cyst develops from a primary ovarian follicle. It has a smooth surface and a thin capsule. The inside of the cyst capsule is covered with one or two layers of cubic epithelial cells. The contents of the follicular cyst are a transparent lemon-yellow liquid that does not contain mucus or mucin. The cyst grows towards the abdominal cavity.

Clinically, a follicular cyst can manifest itself as uterine bleeding as a result of overproduction of estrogens, which leads to hyperplastic processes in the uterine mucosa, slight nagging pain in the lower abdomen, and when the cyst pedicle is twisted, cramping pain. Uncomplicated follicular cyst small sizes, as a rule, is asymptomatic and is detected during a gynecological examination.

Treatment of follicular cysts involves the use of combined oral contraceptives, inhibiting gonadotropic stimulation of the ovaries while simultaneously monitoring the growth of the cyst using ultrasound scanning. Surgical removal is indicated in cases where there is no reduction in the size of the cyst within three months of treatment, especially if the symptoms of excessive estrogenization increase.

A corpus luteum cyst is a functional ovarian cyst, sometimes called a "cystic corpus luteum." The corpus luteum cyst is usually one-sided, up to 5 cm in diameter, has a folded surface, is yellow in color, and contains clear or hemorrhagic fluid. It is formed under the influence of excess gonadotropic hormones, possibly prolactin. The role of the inflammatory process in the area of the uterine appendages, which contributes to impaired lymph and blood circulation in the area of the corpus luteum, cannot be ruled out.

Corpus luteum cyst

The corpus luteum cyst produces an increased amount of progesterone, and since it exists longer than the usual corpus luteum, women with this formation experience a delay in their next menstruation.

Treatment of corpus luteum cysts involves anti-inflammatory measures. If there is no effect, it is shown surgical treatment laparoscopically. This tactic is justified due to the impossibility of excluding a true ovarian tumor by other means.

Endometrioid (chocolate) cyst

An endometrioid (chocolate) cyst is usually small in size and contains a thick, dark-colored fluid. brown, accompanied by massive inflammatory adhesions with neighboring organs. The cyst is the result of implantation into the ovary of the endometrium, carried through the fallopian tubes from the uterine cavity. The endometrium develops on the surface of the ovaries and goes through all phases of the menstrual cycle until the release of menstrual blood. Aseptic inflammatory adhesions with the surrounding peritoneum and organs form around the ovary.

Clinically, an endometrioid cyst is accompanied by pain. The pain is associated with the menstrual cycle, increases during menstruation, subsides or disappears after menstruation.

When the capsule of an endometrioid cyst ruptures, the clinical picture of an “acute abdomen” develops.

Treatment of endometrioid cysts consists of removal of the cyst, coagulation of endometrioid heterotopias of the peritoneum, fallopian tubes and ligaments. IN postoperative period regulation of pituitary-ovarian relations is carried out. For this purpose, danol, danazol, decapeptyl and other drugs that reduce the secretion of gonadotropins are used.

Paraovarian cyst

A paraovarian cyst develops from the tubules of the epididymis. The cyst is localized between the leaves of the broad ligament of the uterus (intraligamentary); more often it is one-sided, smooth-walled, round in shape, single-chamber. The contents of the cyst are serous, similar to transudate. It does not manifest itself clinically for a long time due to its slow growth. When it increases to a significant size, a pain syndrome appears with compression phenomena - pain in the lower abdomen and lower back (on the side of the cyst) of a bursting nature.

Treatment of paraovarian cysts involves surgical laparoscopy. For an uncomplicated cyst, the operation is reduced to its enucleation with dissection of the broad ligament of the uterus (preferably in front) from the intraligamentary space. In this case, the ovary and fallopian tube are preserved. Despite the significant deformation and stretching of the fallopian tube, thanks to its good retraction ability, the fallopian tube contracts and restores its previous shape.

Chocolate cyst (endometrioma) is a type of ovarian cyst and, in fact, is ovarian endometriosis. is a condition during which endometrial tissue is located outside the uterus, usually on the ovaries, fallopian tubes or in the pelvic area.

Every month (during menstrual bleeding), the endometrial tissue inside the cyst reacts to monthly hormonal fluctuations by bleeding, as a result of monthly “bleeding” the contents of the cyst are represented by old blood, which in appearance and color resembles chocolate, hence the name. If the chocolate cyst continues to grow, the result is a gradual destruction of the ovarian tissue, which is necessary to provide normal level sex hormones. In the presence of a chocolate cyst, the endometrioid process can spread to nearby organs in the pelvic cavity. The size of endometrioid cysts can vary, ranging from 1-2 cm to 10-15 cm in diameter.

In most cases, in the presence of ovarian endometriosis, if a woman has a chocolate cyst, foci of endometriosis can also be located in other pelvic organs.

Chocolate cyst - Symptoms

Symptoms in the presence of chocolate cysts are similar to typical symptoms of endometriosis, since a chocolate cyst is a manifestation of endometriosis. However, not all women with endometriosis have the same symptoms. Symptoms may vary in intensity or be completely absent.

The most common symptoms of endometriosis include:

Chocolate cyst - pain

Algodysmenorrhea - pain associated with the menstrual cycle;
Cramping abdominal pain, pain and swelling during menstruation;
Dark - brown discharge between menstruation, brown spotting before and after menstrual bleeding;
or acyclic bleeding;
Pain during urination;
Pain during bowel movements;
Pain during intercourse;
Abdominal pain during some physical exercise(bending or stretching);
Intense and sharp pain in the abdomen, sometimes combined with nausea, vomiting and fever (rarely, in case of emergency) - in cases of torsion or rupture of a chocolate cyst.

Chocolate cyst - diagnosis

It can be detected by a gynecologist during a gynecological examination. Ultrasound examination may suggest the presence of a chocolate cyst based on its specific ultrasound picture, but a final diagnosis is possible after therapeutic and diagnostic laparoscopy and biopsy followed by histological examination.

Chocolate cyst - treatment

Treatment options include medication and surgical treatment. Medicines, which are used for endometriosis may be useful in temporarily relieving symptoms, but they cannot cure the cyst. Danazol and gonadotropin-releasing hormones (GnRH) are most often used as drug therapy; gonadotropin-releasing hormone agonists are also quite effective.

Danazol is usually taken orally for a long period of time (about 6-9 months). All symptoms of endometriosis are associated with increased level estrogen, the above drugs work by lowering estrogen levels. These drugs cause a false menopause (lack of regular menstruation) in a woman’s body, resulting in suppression of ovulation, reverse development of endometrioid lesions, and reduction of pain associated with endometriosis. The drugs used in the treatment of endometriosis are most effective during the first year of treatment, but they have certain disadvantages and side effects. According to some experts, chocolate cysts do not respond to drug therapy and surgery is an option. best method treatment of endometrioid cysts. There are currently several modern surgical methods treatment of chocolate cysts.

When performing surgery, one should also take into account possible complications, such as:

Postoperative adhesions;
Removal of the entire ovary, since in some cases it is not possible to remove a cyst without an ovary;
Trauma to neighboring organs (rectum or bladder);
Relapses of endometriosis.

is a disease in which the presence of endometrial glands outside the uterus is detected. Chocolate cysts are a special type associated with endometriosis. So-called “Chocolate cysts”, also well known as endometriosis or endometriotic ovarian cystoma, are cysts in the ovaries formed by endometrial tissue (the tissue of the lining of the uterus).

In fact, a chocolate cyst is an ovarian cyst with intracavitary hemorrhage and a formed hematoma containing old brown blood. The term chocolate cysts comes from the appearance of the cyst, as the growths are typically composed of dried blood and create a brown appearance. An endometrioid ovarian cyst is usually filled with old, dark, reddish-brown blood.

The size of the cyst can vary from 1.5 to 20 cm in diameter. If they rupture, their contents can leak into the ovaries and pelvic cavity. This can be very painful. If this occurs in the area of the fallopian tubes and ovaries, it can lead to infertility.

Chocolate cysts typically develop in women during their reproductive years and can lead to chronic pelvic pain associated with menstruation (menstrual cramps, endometriotic pain).

In general, chocolate cysts are not life-threatening, but if they rupture, such a cyst can be life-threatening. In this case, urgent medical attention is required.

When the cyst ruptures, the contents of the chocolate cyst are released into the abdominal cavity, causing severe pain that cannot go unnoticed.

Chocolate cysts - symptoms

Painful periods - often starting a few days before and then throughout the period;
Painful sex (dyspareunia) - as a rule, pain is felt in the depths and lasts for several hours after sexual intercourse;
Pain in the lower abdomen and pelvic area;
– due to blockage of the passage of the egg from the ovary into the fallopian tube.

Chocolate cysts - diagnosis

Chocolate cysts can be diagnosed by vaginal examination and transvaginal ultrasound. Positive results on the CA125 blood test may also indicate the presence of a chocolate cyst, although ovarian cancer will also give positive result, so this may be a cause for concern. In these cases, exploratory surgery may be necessary to determine the nature of the problem.

A woman's reproductive age is very vulnerable in terms of a large number of pathological processes that regularly occur in the genitals. This is due to constant fluctuations in hormonal levels that occur during different phases of the menstrual cycle. or, as it is also called, chocolate ovarian cyst, is proof of this.

It is immediately worth noting that the reasons for the development of endometriosis have not yet been fully studied. All existing information today boils down to the fact that there are only assumptions as to why this happens, and factors have been identified that increase the risk of developing the disease:

The presence of hormonal disorders that lead to problems with the functioning of the ovaries themselves and to disruption of the menstrual cycle;
Development of dysfunction of the thyroid gland, as well as the adrenal cortex;
The presence of a hereditary predisposition to pathology, which will be indicated by a “family” history when relatives are identified with similar problems;
Long-term use of intrauterine contraceptives;
Problems with liver function;
Severe stress and prolonged psycho-emotional tension.

Symptoms

At the first stages of its development, this pathology often has an asymptomatic form, and therefore is detected by chance when treatment for another disease is required and its examination is carried out. This is usually the case with infertility. As for the appearance of symptoms and their severity, this directly depends on what stage the disease is at, as well as the degree of its spread.

The most common manifestations of such a “chocolate” cyst are the following symptoms:

Infertility, which appears due to the progression of the adhesive process taking place in the pelvis;
Painful sensations in the lower abdomen, which have a pulling nature and varying intensity, sometimes reaching a level of pain similar to that present during menstruation;
Longer menstrual cycle, which also has brown discharge, which is not typical for normal menstruation;
Pain that appears during sexual intercourse, greatly disturbing the woman and causing her significant inconvenience;

Diagnostics

Even a healthy woman should regularly visit a gynecologist for examination, even if she considers herself completely healthy. This will allow you to identify the disease at an early stage and begin its treatment in a timely manner. But if we talk about the targeted identification of such a cyst, then the diagnosis will come down to the following studies:

A gynecological examination is performed, which makes it possible to suspect the presence of a formation during palpation;
Ultrasound of the pelvic organs is considered very effective method diagnostics that make it possible to detect an abnormality in the ovary with a high degree of probability;
Cytological diagnostics, which is carried out during the initial examination, will reveal the presence of a pathological process in the organ;
MRI. A very high-quality diagnostic method, but due to its high price it is not widely used;
Laparoscopy today is considered the most accurate way to identify chocolate ovarian cysts, and also makes it possible to extract the necessary material;
Carrying out a histological examination of the biopsy taken makes it possible to make a final diagnosis, and, if there is malignancy, to identify it.

Cytological diagnosis

Laparoscopy

Treatment

It is immediately worth noting that treatment with conservative methods is prescribed only if the formation is asymptomatic and does not have a large size, as well as prerequisites for mutation into a malignant form. This therapy comes down to the use various drugs, which regulate hormone levels in the body. This is due to the fact that other methods only deal with symptoms and do not eliminate the very cause of the pathology. However, most in an efficient way elimination is surgery, while conservative methods will be used as additional ones.

Treatment occurs through the use of an endoscope equipped with micro-instruments. The image from the device will be transmitted to the screen, which the surgeon will use to navigate during the operation.

In total, there are several results of the operation, such as:

Removal of only the cyst when it has reached a significant size and is easy to separate from nearby tissues;
Removal of not only the formation, but parts of the ovary. An economical resection of the ovary is performed, which makes it possible to preserve a certain part of the organ;
Carrying out complete excision of the affected ovary.