Ovarian cysts

Whether young or old, one of the fears that many women often experience is having a cyst in their ovaries. Indeed, if regular controls are made, almost every woman can have a cyst in her ovaries at some point in her life. These lesions, which do not even require any treatment most of the time, probably do not give any symptoms. Although they are generally innocent, ovarian cysts, which are known as a disease to be feared among the public, are not always of the same type.
The ovary organ contains many different types of cells as tissue. Cell types, which are under the influence of many hormones, including the existing and changing cells starting from the embryonic period of the person, make the ovaries different from other organs. These different types of cells can grow and become cysts under the influence of various factors. Depending on the type of cell they contain, the cysts may secrete hormones or similar substances.

What is a cyst?

Roughly speaking, cysts are fluid-containing masses surrounded by a different tissue called the cyst wall. No substance in the human body is static. All cells die constantly and are replaced by new ones of the same type. Again, all cells secrete fluid in different amounts and structures. Some of the fluids between cells come from the bloodstream, while some are made by the cells themselves. These fluids are constantly absorbed and remade. Excessive accumulation of fluid due to an imbalance in this absorption and production phase or for another reason is called edema. If the fluids are surrounded by a different tissue and fluid exchange is prevented, the resulting lesion is called a cyst. Cysts can occur in almost all tissues in the body, but cysts of organs other than the ovaries can give symptoms much more quickly and easily. The reason for this is that cysts occurring in other organs disrupt the functions of these organs. While some of the ovarian cysts cause symptoms by causing dysfunction in this way, the majority of them neither cause a loss in function nor give any symptoms for a long time.

Ovarian cysts are examined in two sections according to the form of formation, either as neoplastic, that is, as a tumor, or functionally.

Symptoms

Ovarian cysts can be roughly examined under the headings of malignant and benign. They are the most common benign ovarian cysts. The ovaries are poorer in terms of showing symptoms compared to other organs. Most of the time, they do not cause a complaint and are noticed during routine check-ups. The most common symptoms are non-specific symptoms such as menstrual irregularities, swelling in the abdomen, abdominal pain, digestive system disorders, urinary tract complaints. Since many conditions other than ovarian cysts cause similar complaints, people with such complaints generally do not care about their situation. An ovarian cyst that does not grow too much does not cause swelling as it can easily find a place in the abdominal cavity. Similarly, cysts that do not secrete hormones do not cause menstrual irregularity.

Pain is rarely seen in ovarian cysts. If there is pain, it indicates that the mass is inflamed or may be endometriosis. Rarely, the rotation (torsion) or bursting (rupture) of the cysts may cause severe pain and acute abdomen. Cysts can cause frequent urination by pressing on the bladder, and constipation by pressing on the rectum, or cause pain when defecating. From time to time, there may be digestive system complaints such as loss of appetite, weight loss, and mild nausea.

The point to keep in mind is that there are many different types of cysts and the complaints they cause may depend on the type of cyst.

Diagnosis

They are usually detected during routine examination or examination and ultrasonography performed for another reason. The age of the patient, the size and shape of the mass, whether it is a pure cyst or solid structure, whether it is adherent or not, and whether there is tenderness are important in the examination. Cysts that appear as pure cysts on ultrasonography and are smaller than 5-6 cm in diameter are likely to be benign and functional. In addition, according to the condition of the patient and the mass, tomography, magnetic resonance hormone tests and tumor markers in the blood are examined and a decision is made for the treatment.

cysts

Inclusion cyst : It is a non-functional cyst that is frequently encountered during uterine surgery. Most are microscopic in size. It does not cause any symptoms and cannot be noticed on ultrasound. It is probably due to the entrapment of the cell type called germinal epithelium in the tissue during the recovery period following the deterioration of the integrity of the ovarian wall after each ovulation. Some researchers claim that these cysts may undergo malignant change in the long term and may be a precursor to ovarian cancer.

Follicle cyst : It is one of the most common cysts in young people. It is thought to be because the developing egg cell does not crack and continues to grow. Their size is usually 2-3 centimeters, rarely exceeding 4 centimeters. They are cysts that are quite tense and contain clear fluid. They do not cause any complications.

The exact cause is known, but there are some accepted theories. In cases where the amount of blood going to the ovaries increases, such as chronic pelvic inflammation, due to the fact that the amount of hormones reaching the follicles is higher than normal, it is the most accepted mechanism in the scientific circles. Experiments have shown that this excess blood flow, called congestion, increases follicle activity.

Another possible reason is that they occur as a result of overstimulation of the ovaries in the presence of high doses of gonadotropins (hormones secreted from the brain that stimulate egg cell development in the ovaries). The supporter of this theory is that follicular cysts are seen more than normal in women who use ovulation-promoting agents during infertility treatment.

Even if the amount of gonadotropin is within normal limits, the imbalances in their secretion can also prevent the advanced egg cell from cracking and lead to a follicle cyst. Although there may be many factors that impair the way gonadotropins are secreted, usually no underlying cause can be found.

According to another theory, adhesions around the ovary and thickening of the ovarian wall for any reason prevent ovulation and lead to a follicle cyst. However, this view is not popular in the scientific community.

Follicle cysts usually do not give any symptoms. It is almost non-existent to explode or turn around and create an acute abdomen. Sometimes it can cause menstrual irregularity by secreting the hormone estrogen. Follicle cysts, which are often noticed during an ultrasound examination performed for another reason, most often cause delay in menstruation when they give symptoms, and they are noticed when patients apply to a gynecologist because of this delay.

Follicle cysts usually disappear on their own and do not require treatment. Cysts smaller than 5 centimeters detected in women of reproductive age are followed up. The patient is called for re-examination one month later. The cyst is expected to disappear spontaneously after 1-2 menstrual periods. Sometimes birth control pills can be given to make the cyst easier to shrink. The aim here is to suppress the gonadotropins secreted from the brain and to eliminate the stimulus on the ovaries.

Surgery may be necessary for cysts that do not shrink or grow despite treatment. Since these cysts are usually seen in young women of reproductive age, only the cyst is removed during surgery without damaging the ovary.

corpus luteum cyst : Normally, after each ovulation, the tissue where the egg cell is thrown differentiates and turns into a tissue called the corpus luteum. The task of the corpus luteum is to produce the hormone called progesterone, which allows the pregnancy to settle in the uterus without miscarriage in a possible pregnancy, until the placenta becomes functional. This tissue may become cystic from time to time due to fluid accumulation. It is usually 3-4 cm in size. It can cause delay in menstruation because it secretes hormones. If there is bleeding into the cyst, pain may be seen in the groin. Sometimes it can burst and cause bleeding into the abdomen. In this case, it can be confused with an ectopic pregnancy.

It does not require treatment in cases where no complications develop. It disappears by itself.

Theca-lutein cyst : It occurs due to excessive hormone secretion. they are almost always bilateral and can be as large as 20 cm. It is frequently seen in those receiving infertility treatment. Bed rest and follow-up are required for treatment. Sometimes surgical treatment may be necessary.

Pregnancy Luteoma : It is a solid mass seen during pregnancy. Sometimes it can grow up to 20 cm. In one fourth of the patients, an increase in hair growth may be detected due to the excessive secretion of male hormone. It regresses spontaneously when the pregnancy ends. However, it should be differentiated from other tumors.

tumors

Serous Cystadenoma : They are the most common tumors in the ovary. They are most common in women of reproductive age and do not go away on their own. They can be bilateral. About 30% can turn into a malignant disease.

They originate from the epithelial cells that make up the surface of the ovary. They can be single or multiple. They contain a clear liquid. Their size varies between 5-15 centimeters. If it is in both ovaries, the potential for malignancy is high. The presence of solid structures other than liquid increases the potential for malignancy.

There is no specific finding for serous cystadenomas of unknown cause. Generally, it does not cause any complaints or symptoms. It is diagnosed incidentally during a gynecological examination or on ultrasound. If there is calcification in it, it can be seen on the x-ray film. Rarely, the patient may apply to a gynecologist because of a slowly developing swelling in the abdomen.

Its treatment is surgery. During surgery, if the cyst is unilateral and does not look malignant, the ovary can be left and unilaterally removed. Our preference is to subject the cyst taken during the operation to pathological examination at that time (this is called frozen) and to continue the course of the operation according to the result.

Mucinous Cystadenoma : Up to 25% of benign ovarian tumors are mucinous cystadenomas. They are less likely to be bilateral than serous cystadenomas and less likely to be malignant. Although the mechanism of its formation is not fully known, the most accepted theory is that the epithelial cells that cover the ovaries change shape and turn into the epithelium lining the inside of the cervix (cervix) and secrete just like in the cervix. According to another theory, it originates from the remnants of the cells that make up the intestines in the embryonic period.

They are the largest cystic structures seen in humans. They can generally be 15-30 centimeters in size, but mucinous cystadenomas that have grown up to 60 centimeters are available in the literature. The cyst is usually divided into many chambers by the thin membranes inside. These membranes are called septa. The cyst contains a clear but non-viscous mucus-like fluid.

They usually do not give any clinical symptoms. They do not cause menstrual irregularity, but because their size is very large, there are signs of swelling and pressure in the abdomen. Frequent urination or constipation are common complaints in mucinous cystadenomas. Because they are so large, they are more likely to rupture (explode). In such a situation, the fluid emanating from the cyst spreads to the abdominal cavity and the cells continue to live here and continue their secretions. The inside of the abdomen is gradually filled with a gel-like liquid. Although it is not biologically malignant, it is a malignant event in behavior. pseudomyxoma peritonei is named. Abdominal pain, nausea, vomiting and severe abdominal distension occur. As a result, the patient suffers from malnutrition. It is a chronic disease and its final cure is unfortunately not available.

Surgery is the only way to treat mucinous cystadenomas. Since it is rarely seen in women of reproductive age, it is necessary to remove only the cyst or the ovary on that side if it is unilateral.

endometrioma : It occurs as a result of the presence of the membrane layer called the endometrium, which covers the inside of the uterus, in the ovaries and becomes a cyst by bleeding during each menstrual period. The cyst is filled with a liquid in the consistency of chocolate, so it is also called a chocolate cyst. Patients apply to the doctor with complaints of infertility, painful menstruation, pain during intercourse and excessive menstruation. Its treatment is described in the endometriosis section.

dermoid cyst : It is the most common tumor in women younger than 20 years of age. It may be bilateral in 10% of cases. It is caused by events that occur in the embryonic period. All kinds of tissues such as hair, skin, teeth, cartilage pieces, bone, nerve cells can be seen in the mass. It can cause abdominal pain as a complaint. It can turn around itself and cause acute abdomen. Sometimes it can lead to infertility. The treatment is surgery

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