What does an ovarian cyst represent on an ultrasound and what can it be confused with during the study. Ultrasound of uterine cysts

An ovarian cyst is always diagnosed by ultrasound. Formations are easily detected during research. However, hydrosalpinx, ectopic pregnancy and other anomalies have an external resemblance to an appendage tumor, and therefore are interpreted incorrectly.

Most of the formations are benign. Complex foreign inclusions are hemorrhagic functional cysts, and dense ones are fibroids. At risk are women with a family history, including those who have entered menopause.

The study is carried out on days 5-7 of the cycle. During this period, the endometrium of the reproductive organ has a small thickness. If you need to track the condition of the tumor over time, it is recommended to repeat the procedure on days 10, 15, 22 of the cycle.

What does a simple ovarian cyst look like on ultrasound?

A simple cyst is a formation with thin walls. An increase in the echo signal is observed behind it. There is no dense content inside a simple cavity. No blood flow is observed. Often, functional formations are identified that appear in patients of childbearing age or during menopause.

Sometimes women are diagnosed with simple cysts, which in fact act as either paratubular tumors or cystadenomas. Malignant tumors are extremely rare in practice, especially when it comes to single-chamber tumors. Simple functional inclusions formed against the background of hormonal abnormalities are often identified.

Simple cysts up to 30 mm in size that occur in women of childbearing age are normal and do not pose a danger. If the size of the formation after menopause is up to 70 mm, then most likely it is benign. Foreign inclusions with a diameter of 70 mm or more are difficult to analyze on ultrasound, so an MRI is performed.

Follicular neoplasm

Functional formations on ultrasound: follicular and luteal

The diameter does not exceed 10 cm. It has a surface without protrusions, a thin wall, and filling with a watery consistency. Ultrasound reveals tissue of an unchanged appendage. Often the follicular cavity is single-chamber and is asymptomatic. Women with simple formations measuring 5 cm or more undergo a dynamic ultrasound.

In the study, the follicular cavity is defined as a thin-walled single-chamber inclusion, behind which an amplified acoustic signal can be traced. When bleeding into the formation, a diffuse hyperechoic suspension is detected. The ovarian parenchyma is visible along the periphery. A characteristic sign of follicularity on ultrasound is the absence of blood flow inside the cavity.

Has dimensions up to 40-50 mm. Sometimes hemorrhage occurs into the cavity. On ultrasound, a luteal tumor is determined by the “ring of fire” - numerous blood vessels piercing the wall. There is no blood supply inside the formation. The risk of its occurrence increases with the use of drugs that stimulate ovulation.

Hemorrhagic inclusion

Hemorrhagic cyst

Such a neoplasm of the appendage forms after hemorrhage into the luteal body or into a follicular cyst. In this case, an acute pain syndrome occurs in the lower abdomen, but sometimes an asymptomatic course of the pathology is observed. When the cavity ruptures, blood accumulates in the area of the reproductive organ and appendages.

On ultrasound it appears as a single-chamber formation with a hyperechoic suspension. Fibrin threads are transformed into an openwork mesh. Sometimes such extraneous inclusion looks dense. There is no blood flow inside it, but it can be traced along the periphery.

Formations with a size of 50 mm or more, formed during childbearing age, are subject to dynamic observation. Large tumors in patients in early menopause and 5 years after the last menstruation are regularly examined using magnetic resonance imaging.

Extraneous inclusion of a non-functional nature

This type of ovarian cyst is formed from ovarian tissue or has a different etiology.

Nonfunctional neoplasms include:

A paraovarian cyst, which is defined by ultrasound as an inclusion up to 15-20 cm in size, has a round shape and the contents have a liquid consistency. Unlike others, it does not have a leg. If the paraovarian inclusion is large, then when separated by a sensor from the paired organ, it looks like a bladder.
Inclusive formation of irregular shape, single or multi-chamber. The internal contents are anechoic; when hemorrhage occurs, fibrin impurities appear.
foreign inclusion up to 10-15 cm in diameter is filled with chocolate-colored contents inside. Seals are visible on the smooth inner surface. There may be several areas of endometriosis on ultrasound.

Endometrioma appears as a round formation with a double contour and a uniform hypoechoic structure, resembling opaque glass. Dense inclusions are not observed. The capsule consists of 30% hypoechoic foci. There is no internal blood flow.

Mature teratoma. Click to enlarge

in 85% of cases it is formed on one ovary and has dimensions from a pinhead to 20 cm, and an oval or circle shape. On ultrasound examination, in 90% of cases it is determined to be single-chamber. The formation has a hypoechoic structure and hyperechoic internal inclusions.

Thus, each ovarian cyst is characterized by features that differentiate it from other similar formations by ultrasound. Large foreign inclusions require dynamic monitoring.

Question. Often there is a tightening in the lower abdomen after taking a hot bath, in general. On the 11th day of the cycle, I did an ultrasound - a follicular cyst of the right ovary, they prescribed Diclovit for 10 days, vitamins, but they said that I need to do another ultrasound after menstruation. Tell me, how dangerous is this if the diagnosis is confirmed, and is it possible to get pregnant with a follicular cyst?

Answer. If the diagnosis is confirmed, the cyst will no longer be visible on ultrasound after menstruation. Pregnancy with follicular cysts is possible.

Question. I’m 20 years old, I haven’t given birth, but almost 3 years ago I had a mini-abortion. A year ago I had gardnerellosis and was cured. And I took the contraceptives Rigevidon for 3 years. But about half a year ago I stopped taking it. I have long been bothered by periodic (occurs once every few months, or even half a year to a year) very strong aching and nagging pain in the lower abdomen and frequent urge to urinate, the pain lasts about 1-2 weeks, then gradually passes. Also, sometimes there are disruptions to the menstrual cycle (most often they begin a few days later or earlier than usual). Also, in the last few months, I began to experience mild pain on the right side. About two months ago, an ultrasound showed a cyst on the right ovary, the doctor said most likely it was a cyst of the corpus luteum, but could not say for what reason and when it appeared, and for some reason the size was not established (I am going to do another ultrasound). The doctor prescribed Lindinet 20, Ofloxacin, Furodonin, Lavomax (to increase immunity), tampons with Vishnevsky ointment, Betiol rectally, injections: vitamins B1, B6, sodium thiochloride, aloe extract, etc. But after treatment the pain did not go away. Streptococcus was also detected, regarding it the doctor claims that it is not dangerous, the pain is most likely not due to it and you just need to increase your immunity. No other diseases were detected, urine and smear tests were good. Tell me, what could have caused the cyst to appear, due to an abortion, taking Rigevidon, or the fact that you stopped taking Rigevidon (the doctor says that most likely because of the latter)? Are Lindinet 20 and other medications effective in treating cysts? How do you know if it is really a corpus luteum cyst or something else? Is the pain that has been bothering me for a long time caused by a cyst or maybe it is streptococcus? Do we need to treat streptococcus or should we just boost our immunity? What other tests should I take in my case, besides those that I took (ultrasound without intravaginal examination, smear and urine test)? Do I need to undergo any physical therapy? Is it worth getting tested for cancer and hormone levels and which is better? How many months to treat before deciding to undergo surgery (laparoscopy)?

Answer. A corpus luteum cyst occurs due to a hormonal imbalance in the body, which can also be caused by stopping taking COCs. You can find out whether the cyst is functional (corpus luteum or follicular cyst) by repeating the ultrasound in the first phase of the cycle (on the 5-7th day of menstruation) - it should resolve on its own. Taking COCs accelerates the process of resorption of functional cysts. Physiotherapy for ovarian cysts is contraindicated. Pain can be caused by a cyst or any other reason, for example, inflammation of the appendages caused by the same streptococcus. You have been prescribed complex antibacterial therapy; this is sufficient to treat streptococcal infection. The issue of additional research can be decided in person after the control ultrasound.

Question. I had surgery to remove a cystoma on my right ovary. They deleted everything because there was nothing left to save. I haven’t been to the gynecologist yet, because... I don’t really trust it (she recommended that I treat an 8-centimeter cyst with tablets for ureaplasmosis, which was found during the examination). Tell me how best to recover after such an operation, whether to take any medications (in general, nothing bothers me), are there any restrictions on physical activity? when can you start working? And also, is it now necessary for my husband and I to treat ureaplasmosis (he has not been examined)? Thanks in advance for your answer.

Answer. The selection of therapy and postoperative recommendations should be given to you by the doctor who performed the operation. Unfortunately, we cannot recommend therapy for you in absentia. You can contact our center for a face-to-face appointment with the results of your tests, then it will be possible to determine the need for therapy and the means for treatment. The attending physician also determines the period of work restriction - issues a sick leave (usually, if everything is in order, it is issued for 10 days and extended as necessary).

Question. 6 months ago I was diagnosed with a 3 cm cyst on my left ovary. I was prescribed Duphaston, but since I am breastfeeding, I did not take it. Throughout this time, I went for an ultrasound every month. The cyst remained as it was. And the size hasn't changed. The ovary aches a little and the discharge becomes stronger and brownish. The doctor says to remove it. Having read everything that can be bad with a cyst, I don’t resist it. But I’m very afraid of the operation, and I don’t want to stop feeding. Can I wait a little longer and just watch her? And what will happen to me if I don’t cut it out?
And one more thing. If the cyst has not disappeared during this time, does this mean that it will not disappear? Maybe I should try taking hormones at the end of feeding and not immediately go under the knife?

Answer. You need to wait and take a course of hormonal therapy. You will have time to undergo the operation. A follicular cyst disappears during a control ultrasound after menstruation in 1-3 months, an endometrioid cyst exists for a long time and does not change its size. There are characteristic signs of certain cysts for diagnosing them on ultrasound.

Question. I am 25 years old. Six months ago, a cyst of the left ovary was discovered posterior to the uterus, size 77*64*70 mm, with thick, fine contents, in the posterior fornix - a small amount of free fluid. CA-125 = 19.9 (normal 2.6-18.0). I drank Yarina for 2 months. Ineffective. Afterwards the following treatment was prescribed: sodium thiosulfate (10 days, intravenously), diclofenac (5 times every other day), cycloferon (5 times every other day), Tsiprolet-250 (2 tablets per day for 7 days), rumicosis (3 days, 1 capsule 2 times a day), ichthyol suppositories, genferon. The cyst remained the same size. Now I am in my second month of being treated with herbs (calendula + yarrow + St. John's wort + nettle + sage). What do you recommend: have surgery or wait and maybe take some other medications? If the latter, which ones? I haven't given birth, I'm going to in three years. And one more thing: about a year ago, red plaques appeared on both legs (in the lower part) and they itch. I applied Locoid and took Cetrin; help temporarily. Could they appear due to a cyst?

Answer. In this situation, surgery is necessary. All other methods are ineffective. Plaques on the skin are not associated with a cyst.

Question. Tell me what to do, what is possible, what is not.
They found an endometrioid (presumably; maybe also dermoid) ovarian cyst, 3.5 cm. They will not remove it until the end of summer, because before that it is inconvenient for everyone, and, according to the doctors, there is no urgency. And how can I continue to live with her inside?
Is it possible:
ride a bike (a lot and often and far),
lift weights (10-15 kg),
sunbathe in the sun (well, yes! who doesn’t go south in the summer??),
swim in the sea/river,
climb mountains
endure strong shaking (it shakes on a country road in an old truck),
have sex,
go to the steam room/sauna for 5-7 minutes,
what else is possible/not possible?

Answer. If there is a cystic formation in the ovary, it is better to reduce physical activity, because there is a risk of cyst rupture (when lifting weights, for example) if it is endometrioid or torsion if it is dermoid. Therefore, all extreme sports, including mountain climbing, weight lifting, etc. You may consider them contraindicated for yourself. Cycling without excessive exertion, swimming in the river or sea and sex are possible. You can be in the sun, but it is better to avoid the most active sun rays (from 11 a.m. to 4 p.m.). Visiting the bathhouse is highly undesirable.

Question. I have been undergoing treatment for infertility for several years. 2 months ago, an ultrasound revealed an endometrioid ovarian cyst of 3.8 cm. There were no changes for two cycles, so he was referred for laparoscopy. When the doctor did an ultrasound before the operation, she said the cyst had burst, and the operation was performed urgently. The result of the operation and histology: a cyst of the corpus luteum with hemorrhages was removed and many foci of irregularly shaped brown endometriosis from 1 to 20 mm were found on the Douglas peritoneum and the vesicouterine fold, and on the left sacrouterine ligament there was a blue foci of 15 mm with scar changes around. The pipes are passable. The uterus is of normal size. Antibacterial therapy was carried out for 4 days - cefazolin. Treatment was prescribed for 6 months with nemestran and vitamins E. Two weeks after the operation, I did an ultrasound and again found a 2.8 cm endometrioid cyst in the same ovary. The doctor who performed the operation on vacation, and the doctor who did the ultrasound says they removed the corpus luteum cyst, but the main one was not noticed. Again after the menstrual ultrasound and if there are no changes, then again for surgery. How can this be, after all, they discovered one cyst in me, and could they have missed a 4cm cyst in the ovary during surgery? Please advise what to do and whether to start prem nemestran. Thanks in advance.

Answer. Your situation is quite complicated and it is difficult to answer your question in absentia. But I think there is no need to rush into the operation. The fact is that it is quite difficult to determine the nature of the cyst from ultrasound (endometrioid or corpus luteum cyst); this is usually determined over time against the background of ongoing therapy (hormonal). And I think that it is very unlikely that doctors during the operation would not notice a formation in the ovary, because during the operation it is very clear what kind of formation it is, whether it is a corpus luteum cyst or something else. A corpus luteum cyst is formed as a result of hormonal disorders and can often recur, so it’s not surprising that you were diagnosed with it again. Try taking contraceptives for 3 cycles (Zhanine or Diane-35), and after the first month of taking the drug, repeat the ultrasound. I think the result will be completely different.

Question. Hello, about 3 weeks before my period my side starts to hurt, alternately left and right. The ultrasound showed that there is significant ovarian dysfunction and a cyst appears before menstruation. (0.5 cm) What treatment may be suitable in this case? What can I do to prevent the cyst from appearing again and again?

Answer. Firstly, an ovarian cyst cannot be called a formation measuring 0.5 cm. In your case, you should conduct a diagnostic dynamic ultrasound and hormonal monitoring of ovarian function, a differential diagnosis to exclude small forms of endometriosis, persistence of an unruptured follicle, etc. Only after determining the diagnosis can you choose management tactics .

Question. 5 years ago I had all my female organs removed, leaving only 1 incisor and ovary. Every month, if I don’t take the hormone (femoden), follicular cysts form on it. I have been trying for a long time to understand why such formations occur, is there too much estradiol at the beginning of the cycle? If there is a cyst, does it mean the follicle is not ovulating at all?
At 21 d.c. progesterone was 9.34, elevated. I know that this cycle also had a cyst. Does this mean that when progesterone is elevated there is always a cyst in the cycle, if not, what does such an increase indicate?
How often would you recommend taking the hormone (femoden) to prevent cysts? I take 2 cycles a year. For me, the ovary is also important in terms of reproduction, for IVF. How many months do you need to take the hormone for the ovary to rest, for better ovarian output during stimulation of superovulation? Or is it impossible to say that the ovary will respond to stimulation better after blocking its work with a hormone?
If all my questions do not explain why cysts form, then please explain it yourself.
If you need additional information for this, I will be happy to provide it.

Answer. In order to correctly answer your questions, I need to familiarize myself with the medical documentation of the examinations, surgical interventions, etc.
It is also very important to conduct an ultrasound examination of the ovary and other examinations to identify ovarian reserve. I consider the situation solvable.

Question. I kindly ask you to answer my message. I am 27 years old. At the age of 21, I lost a lot of weight, I lost 12-14 kg in 2 weeks, a few months after that I developed a rash on my neck, and later on my face in the form of purulent boils. I took a hormone test, testosterone turned out to be high, and the gynecologist prescribed Mercilon. I started taking it, and the inflammatory process on the face and neck was suppressed. When I took a break, everything started again with even greater force. The entire neck was covered with multiple boils and ulcers. During the breaks, I consulted dermatologists, went through many treatment courses, but nothing helped. At the age of 23, I had a frozen pregnancy; after cleaning, I developed a follicular cyst with a diameter of 4 cm. I was afraid to have the operation because there is no guarantee against relapse. The gynecologist again prescribed Mercilon, the cyst did not resolve and did not change in size at all. At the age of 26, the cyst began to bother me, although before that I had not even felt it, a nagging pain appeared in my leg, and tingling in the area of the left ovary. An ultrasound showed that I had a dermoid cyst, and that some kind of process had begun in it. I turned to the head of the gynecology department of the regional hospital, after a series of tests, for some reason he did not recommend that I have surgery. I tried to be treated with herbs, also no result. Now I constantly drink Mercilon, as it saves me from boils on my face, although their aggressiveness has clearly increased, and it is prescribed for cysts. Tingling appeared again in the left ovary. Since I was 26 years old, I have not had a sexual partner, and the menstrual cycle has also been disrupted (constant delays, and the periods themselves are very scanty), and I began to gain weight. At the same time, the hairiness on the body increased sharply, and the hair on the head began to fall out profusely. Please tell me what is happening to me, recommend what I should do, how to stop all these processes in the body, I have already given up.

Answer. Please check what your height and weight are now. The dermoid cyst must be removed. We recommend an in-depth examination: immune status, liver and thyroid function tests, blood glucose, etc. It is better to cancel Mercilon and replace it (if contraception is needed) with another drug, but this is only after further examination.

Question. I am 26 years old. A diagnosis of sclerocystic disease was made. I tried to get pregnant for a year. To no avail. After which I decided to undergo hormonal treatment. With my diagnosis, is it possible to take clostilbegit without a preliminary follicular analysis? One doctor prescribes it, I consulted another doctor - definitely not. Who to believe? I took duphaston for 4 months from the 14th day of my cycle. Now esterlan from 1 to 21 and duphaston from 14. Please give me an analysis of my treatment.

Answer. We do not comment on prescribed treatment regimens in absentia; this is neither correct nor ethical. The doctor who prescribed therapy for you knows the results of your tests, ultrasound, etc., and he apparently justifiably prescribes this or that therapy for you. As for stimulating ovulation, to carry it out it is necessary to first establish the cause of infertility, namely, in addition to ultrasound, diagnose the patency of the fallopian tubes and evaluate the spermogram. Without these two studies, taking clostilbegide may not only be useless, but also dangerous, because can lead to the development of ectopic pregnancy. Of course, it is advisable to stimulate ovulation under ultrasound control (folliculometry), so it will be more effective.

Consulting doctors

The cyst usually does not pose a threat or danger and does not have obvious symptoms. This tumor does not require immediate treatment. But when the tumor is accompanied by severe pain, treatment should be started. Ultra diagnostics are required to determine the threat.

When is it better to do an ultrasound for an ovarian cyst?

Ultrasound examination is a completely safe and most accurate method for detecting a wide variety of changes, abnormalities or foreign formations in a woman’s pelvis. The procedure is quite effective and harmless to the body even of a pregnant woman.

Ovarian cyst ultrasound photo

There are several options for conducting echolocation research.

Transabdominal ultrasound. It is performed using a small portable device in the lower abdomen. It is the most commonly used method for examining ovarian cysts.
Another type of study involves the use of a special latex transducer for the procedure, which follows the shape of the female vagina.

The most optimal time period for diagnosing the ovaries is the first three to five days after the end of the menstrual cycle or directly during menstruation. It is during this period that the uterine lining has the thinnest structure, which contributes to better analysis by ultrasound. The waves pass through the membrane quite easily and transmit the most accurate data about the state of the reproductive system.

How can an ultrasound detect an ovarian cyst?

Diagnosis of the pelvic organs is carried out to achieve the following goals:

Determining the cause of pain and bleeding.
Detection of diseases of the vagina, uterus, ovaries or appendages, as well as benign tumors.
Designation of the nature of the tumor, its size, filling and the appointment of an effective treatment method if necessary.
Routine check of the condition of the ovaries.

Read also: Pregnancy with follicular ovarian cyst

Ultrasound diagnosis of an ovarian cyst makes it possible to determine the location of the tumor. What does an ovarian cyst look like on ultrasound? Usually it is located in the middle or on the surface of the ovary and is a cavity filled with some liquid, often transparent. The cyst itself may not pose a threat to a woman’s health, but sometimes a tumor is evidence of the presence of a serious pathological disease in the body.

Which doctor should I contact for an ovarian cyst?

An ovarian cyst is treated by a gynecologist. A gynecologist is a doctor who diagnoses, prescribes treatment and prevents diseases of the female reproductive system.

Make an appointment with a gynecologist

Ultrasound of the corpus luteum for cysts of both ovaries

The corpus luteum of the ovary is a temporary hormonal formation that occurs after the complete formation of the follicle with the egg. When the egg comes out of a special graafian vesicle, it is filled with a corpus luteum from granulosa cells of the follicular structure. If the normal process of ovulation and the release of the egg is disrupted, the follicle does not burst, but gradually continues to fill with a liquid substance. This leads to the formation of a corpus luteum cyst.

Ultrasound can detect a tumor of the corpus luteum of both ovaries. Typically, such a cyst is a clearly defined capsule, which is clearly visualized during ultrasound examination. The size can be approximately four millimeters. The corpus luteum cyst has different contents and sometimes turns into a hemorrhoidal form, which is accompanied by very strong pain.

Timely diagnosis of the pelvis using echolocation scanning allows the doctor to visualize a tumor on the ovaries, determine its size and characterize how dangerous the tumor is. Only ultrasound gives a complete picture of benign tumors and allows you to choose a therapeutic or surgical treatment method.

Classification of tumors

Functional cyst. It occurs as a result of natural physiological processes even in a completely healthy body. It resolves on its own within a couple of weeks and is not considered dangerous.
Dermoid tumor of the appendages. It is based on tissues that are not related to the structure of the ovaries. Such a neoplasm can be quite large in size. Most often, surgery is prescribed to eliminate a dermoid cyst.
A hemorrhagic cyst is accompanied by severe pain. This is caused by hemorrhage occurring in the cyst cavity. In some cases, an endometriosis cyst occurs - a blister on the ovary filled with blood.
Polycystic disease is the occurrence of not one, but several tumors at once, which can negatively affect reproductive function and lead to infertility. The most dangerous type of tumor is cystodenoma, which reaches a large size.

Ovarian cyst on ultrasound

The ovaries are paired organs that are of great importance during conception. It is in the ovaries that the egg is formed, which will subsequently connect with the sperm, and pregnancy will occur. Healthy ovaries are needed not only for conception; with their help, a woman’s overall hormonal background is created. Any disruption in their work entails serious complications, including infertility. The most common ovarian disease is the formation of cysts. These are benign tumors that can form in any woman.

How does a cyst form?

At a certain point in the menstrual cycle, a mature egg is released from the ruptured follicle, which is ready for fertilization. If there is a malfunction in the ovaries, and this can be due to various reasons, ovulation does not occur and conception does not occur. The unbursted follicle begins to grow and is filled with fluid inside. This is how atheroma is formed. It may appear alone, or polycystic disease may form - many small brushes. On ultrasound examination, this accumulation looks like a bunch of grapes.

Ovarian cysts increase in size over time. Inside they are filled with menstrual blood, and on a pelvic ultrasound they look like a bright spot. It can be confused with the corpus luteum, which dissolves on its own over time. Therefore, if there is a suspicion of an ovarian cyst, an ultrasound scan is performed again after three months. If a suspicious tumor does not resolve, but only increases in size, it is a cyst. If the atheroma is not removed in time, it may burst and all the accumulated blood will enter the abdominal cavity. This development of the situation threatens the occurrence of peritonitis.

The growing formation blocks the access of blood to the ovary and the tissue begins to die. If the disease is advanced, the organ will most likely have to be removed. If cystic formations have affected only one ovary, a woman has a chance of becoming pregnant, but if cysts have formed in two ovaries and caused great harm to the tissue, surgical intervention will be required. When two ovaries are removed, infertility occurs.

The appearance of cystic formations

At risk for this disease, first of all, are nulliparous women of reproductive age, girls who are just beginning their menstrual cycle, and women who have already reached menopause.

The main reasons for the appearance of cysts are:

Internal organ injuries;
Increased body weight;
Malfunction of the thyroid gland;
Tissue necrosis;
The appearance of malignant or benign tumors;
Poor nutrition;
Climate change;
Diabetes mellitus;
Inflammatory processes of the genitourinary system;
Failure of a woman’s hormonal levels;
Long-term use of hormonal drugs.

Most often, atheromas are formed due to inflammation of the internal genital organs. After treatment, the tissues on the ovaries become less elastic and cysts begin to form faster.

Symptoms

A woman's body signals the first signs of any gynecological disease with a disruption in the menstrual cycle. Too frequent or, conversely, infrequent periods are a serious cause for concern. Therefore, doctors recommend keeping a special calendar and marking the day of your period in it.

The first symptoms of ovarian atheroma are:

Deterioration of the woman's general condition. Irritability, fatigue, and headache appear. This begins to change hormonal levels;
Menstrual irregularities. Menstruation is accompanied by heavy bleeding and sharp cramps;
Body weight may increase for no apparent reason;
Lack of ovulation and resulting problems with pregnancy;
Discharge in the middle of the cycle with streaks of blood.

When the first symptoms appear, the woman will urgently need to undergo a full examination of the pelvic organs.

Diagnostics by ultrasound

The sooner a woman comes to see a gynecologist, the better. Delaying the examination can only contribute to the further development of the disease.

The main diagnostic method is to identify an ovarian cyst using ultrasound. When examined, the walls of the ovaries appear thickened and gray in color. The size of the organs becomes larger.

Many patients ask the question: on what day of the cycle should an ultrasound be done? Doctors determine the optimal time for the study from the third to the fifth day after the end of menstruation. If you do an ultrasound later, the ovaries change slightly.

Additional means of identifying a cyst are:

Laparoscopy. This method simultaneously diagnoses the disease and immediately removes unnecessary formations. Small incisions are made in the abdominal cavity and thin tubes are inserted. Recovery of the body after laparoscopy takes no more than two weeks.
Blood tests for levels of male hormones, fats and insulin.

Treatment

An advanced disease can trigger the occurrence of a number of other diseases:

The appearance of malignant tumors on the ovaries and adjacent pelvic organs;
Endometriosis;
Disease of the vascular system.

Treatment of cysts is most often complex: hormonal therapy and surgery. There is no point in hoping that the atheroma will resolve on its own; it can burst or lead to necrosis. Usually, after removal of the formation, hormonal treatment is recommended to restore the menstrual cycle and normalize hormone levels.

Types of cysts

Depending on the causes of occurrence and accompanying symptoms, cysts are:

Endometrial cyst. Everything inside the uterus is called the endometrium. If for some reason conception does not occur, the endometrium begins to be rejected by the uterus. This is how menstruation occurs. In certain cases, the endometrium may be located outside the uterus; this disease is called endometriosis. Neoplasms can attach to the wall of the ovary. After each monthly cycle, atheroma grows. A woman begins to experience pain during menstruation and deterioration in well-being. After an accurate diagnosis, the endometrial cyst is removed.
Paraovarian cyst. Typically, such an atheroma is formed from the remains of an egg or embryological tissue. It does not cause any particular harm to women; it is detected during a routine examination by a gynecologist. A paraovarian cyst can cause discomfort during sexual intercourse and is treated with hormonal medications. Surgery is rarely performed.
Follicular cyst. This is a benign tumor that occurs in the absence of ovulation. It is formed from a follicle and is filled with fluid inside. If the formation does not reach 5 centimeters, it may resolve after several menstrual cycles. With great physical exertion, this type of cyst can burst.
Serous cyst. The cause of this type of cyst may be promiscuous sex life, frequent abortions with complications, or sexually transmitted diseases. A large serous cyst requires only surgical intervention.

If any type of cyst is detected on the ovary, mandatory treatment is required. Most cysts do not resolve, and if treatment is delayed, they can reach alarming sizes. The consequences can be very dire - from long-term hormonal treatment to removal of the ovaries and, as a consequence, the appearance of infertility. Timely diagnosis and properly selected treatment will help a woman cope with the disease.

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Ultrasound of the ovaries: normal sizes, when to do it, preparation, ovarian cyst

Ultrasound of the ovaries shows the shape, size, and location of this paired organ. Thanks to ultrasound, it has also become possible to visualize the follicular apparatus, that is, to obtain an indirect idea of a woman’s fertility. This type of research can be carried out in several ways, each of them has its own preparation features. The description is carried out by a doctor based on a comparison of the resulting data with normal parameters.

The normal sizes of the ovaries according to ultrasound are as follows.

In women 16-40 years old, the right and left ovaries should be approximately the same. They have dimensions: 30-41 mm in length, 20-31 mm in width, but the normal thickness of the organ is about 14-22 mm. The volume of each ovary is about 12 cubic milliliters.

The surface of the organ is bumpy due to maturing tubercles-follicles. A fairly large number of blood vessels pass through the stroma. It has an average echogenicity comparable to the uterus.

The follicular apparatus is represented by approximately twelve maturing follicles (less than 5 in two organs - pathology) with a diameter of 3-8 mm.

In the middle of the cycle, a dominant follicle should be visible, measuring 10-24 mm, then an egg should be released from it, and in the same place, from the 12-14th day of the cycle, the corpus luteum is determined (its size can be estimated on days 18-23) .

It rarely happens that ultrasound diagnostics are performed only on the ovaries. Often, other reproductive organs of a woman are examined at the same time, which is called a gynecological ultrasound.

Types of ultrasound diagnostics

Examination of the ovaries using ultrasound can be carried out in several ways:

Transabdominal. that is, when an ultrasonic sensor of quite large width is located on the front wall of the abdomen. Previously, only this type of research was carried out. Now, with the advent of other methods, such ultrasound is considered less informative, capable of visualizing only gross pathology of the reproductive organs.
Transvaginal method of ultrasound diagnostics. It is carried out using a special transducer sensor, which is inserted into the patient’s vagina.
Transrectal examination is carried out in virgins, in whom it is necessary to diagnose a pathology that is not visible to the abdominal sensor. In this case, the sensor is inserted into the woman's rectum.

Ultrasound of the patency of the fallopian tubes is a separate type of examination, which can be performed by any of the above methods only when the uterus and tubes are filled with a special contrast agent.

How to prepare for the procedure

Preparation for the study depends on how the doctor plans to carry out this diagnosis:

Before the transabdominal examination, you will need to go on a diet for three days, excluding those foods that cause increased fermentation in the intestines (cabbage, legumes, carbonated drinks, black bread). In addition, you take Espumisan or one of the sorbents (White Coal, Sorbex, Activated Carbon). An hour before the ultrasound, you drink 0.5-1 liters of still water, and then do not urinate.
A vaginal examination is carried out after 1-2 days of taking Espumisan or sorbents. The procedure is performed with an empty bladder.
For transrectal examination, you will also need to take the above medications, and your bladder must also be empty. Half a day before the procedure, you will need to empty the rectum either on your own or after: an enema, a microenema (such as “Norgalax”), the introduction of a glycerin suppository, or taking a laxative (“Senade”, “Guttalax”).

By the way, pelvic ultrasound in women is performed after exactly the same preparation.

Timing of this study

The timing of when to perform this procedure should be discussed separately by the attending physician, depending on the purposes of the study.

Thus, a routine examination of the ovaries for their pathology is usually prescribed on days 5-7 of the cycle (that is, during menstruation or immediately after it). To assess the functioning of the organ, it is better to perform an ultrasound examination several times during one menstrual cycle: on days 8-10, then 14-16, and after - 22-24 days.

How the research is carried out

Since ultrasound diagnostics of the ovaries has several imaging methods, the examination will depend on which method you choose.

How to do the procedure using the transabdominal method

the patient undresses from the waist up
lies on the couch with his back
moves the underwear so that the suprapubic area is accessible to the sensor
gel is applied to the stomach
the sensor slides only along the abdominal wall.

Transvaginal examination

How this type of diagnosis is carried out:

a woman takes off her clothes below the waist, including underwear
lies on his back, bending his legs slightly
a little gel is applied to the thin sensor, a condom is put on top
The sensor is inserted into the vagina to a shallow depth; this should not cause pain.

Study in virgins

How is transrectal diagnosis done? Just like a vaginal ultrasound, only the sensor in a condom is inserted into the rectum.

How to decrypt received data

The normal sizes of organs were indicated above. The ovaries are located on both sides of the uterus, near its so-called ribs. The distance from them to the uterus can be different (the interpretation of pelvic ultrasound usually does not indicate such numbers).

Normally, the ovaries should not have cysts, that is, formations in which there is a cavity filled with fluid. There should also be no tumor-like or other formations.

If the ovary is not visible on ultrasound, this may be due to:

its congenital absence
removal during any celiac or gynecological surgery
premature organ failure
severe bloating
severe adhesive disease of the pelvis.

In this case, repeated thorough preparation is carried out with the obligatory intake of Espumisan or sorbents, only then a repeated ultrasound diagnosis is carried out.

Cystic formations - normal or pathological?

Sometimes an ultrasound still describes an ovarian cyst. This is not always bad, since there are cysts that form as a result of the work of the organ, which usually go away on their own when hormonal levels change. Such formations are called functional or physiological. These include:

corpus luteum cyst
follicular cyst.

Other types of cysts - endometrioid, dermoid, cystadenoma, and so on - are considered pathological and are subject to mandatory treatment.

What does an ovarian cyst look like on an ultrasound: as a liquid formation that has a diameter of 25 millimeters or more. It can also be described as a ball that has different structures and degrees of coloring.

"Normal" cysts

1. A corpus luteum (luteal) cyst is formed in the place where the mature egg emerged from the follicle. It has a diameter of 30 millimeters or more, and often disappears spontaneously within one or several cycles if pregnancy does not occur. Such a cyst can accompany half of a woman’s pregnancy, then disappear when the placenta completely takes over the function of the corpus luteum in producing progesterone.

2. A follicular cyst forms where the follicle matures. It grows from the first day of menstruation until the moment of ovulation, and can reach a diameter of up to 5 cm. Sometimes such a cyst ruptures, which causes severe abdominal pain and requires emergency surgery. Most often, this education goes away on its own.

Ultrasound of a functional ovarian cyst describes it as a round vesicle with dark contents and thin walls. Only a dynamic ultrasound examination will help to accurately determine its type - follicular or luteal.

Often, a pathological ovarian cyst and even ovarian cancer cannot be distinguished only by its appearance and with a single examination. Therefore, if the sonologist sees a cyst, he indicates his recommendations regarding when it is necessary to undergo a series of repeat ultrasounds.

Pathological cysts and formations

There are not very many of them. Below we will look at the most common of them.

1.Dermoid cyst

An ovarian dermoid cyst is a benign tumor that is formed as a result of a violation of intrauterine tissue differentiation. In its cavity there are cells that should have formed the skin and its derivatives elsewhere, but ended up in the ovaries. As a result, the cavity of such a cyst is filled with nails, hair, and cartilage.

On ultrasound, such a cyst has the following characteristics:

round formation
has thick walls (7-15 mm)
inside there are various hyperechoic inclusions.

Sometimes a CT or MRI is necessary to clarify the diagnosis, since ultrasound diagnostics does not provide complete information.

2. Endometrioid cyst

This cyst appears in women suffering from endometriosis. It is formed from the tissues of the uterine mucosa, but in the ovary.

An endometrioid ovarian cyst on ultrasound has the following characteristics:

located on one side
single-chamber round or oval cavity filled with fluid
has different wall thicknesses (2-8 mm)
the outer contour is clear, even
the inner one can be either smooth or uneven
the cavity contains echo-positive inclusions less than 2 mm thick, which have a ring, arc-shaped or linear shape (“honeycomb”)
the ovary is not differentiated from the side of such a cyst
the uterus enlarges, as during pregnancy, but without changing its shape and structure
Small follicles are often found in a healthy ovary; often 2-3 dominant follicles mature in it.

3.Polycystic ovary syndrome

This is a disease in which the cysts have a completely different character from that described above. The disease develops in young women and girls due to increased production of male sex hormones.

Polycystic ovary syndrome on ultrasound looks like:

ovarian enlargement more than 10 cm 3
thickening of the organ capsule
they contain multiple cysts 2-9 mm in diameter.

4. Malignant formations

Ovarian cancer is a malignant tumor that appears most often in women during menopause, very rarely in young women, and is sometimes found in girls before the onset of their menstrual period.

Ovarian cancer on ultrasound is not always distinguishable from a cyst, especially a type like cystadenoma.

The following should be on the lookout for cancer:

multilocular cyst
its spread to neighboring organs
unknown contents of the cyst
fluid in the pelvic or abdominal cavity.

Usually, when such signs are detected, a woman is prescribed a series of repeated ultrasound images over time. But if this description was made in a girl before menstruation or a woman over 45 years old, a biopsy date is set.

Where to get tested

Ultrasound diagnostics can be performed either free of charge at a antenatal clinic or maternity hospital, or for a fee – in multidisciplinary centers and specialized clinics.

The price of the study is from 800 to 1500 rubles.

Thus, ultrasound of the ovaries, subject to adequate preparation and selection of an informative research method, is a fairly accurate method for diagnosing a wide range of pathologies of this organ. In some cases, in order to differentiate various pathological conditions, this examination should be carried out over time.

therapycancer.ru

What is it

Cystic formations in almost 90% of cases are – or , which are associated with failures occurring in the work of the organ itself.

A follicular cyst is formed if the follicle does not burst, but remains in the ovary and accumulates fluid. A luteal cyst is formed when there is a malfunction in the corpus luteum - a temporary gland that remains at the site of the follicle rupture.

There are organic cysts, the causes and mechanism of development of which are somewhat different.

Such cysts include:

and others.

Most cysts are benign neoplasms that never transform into a malignant tumor, but, for example, a dysongenetic cyst can provoke oncological processes.

Since it is impossible to independently determine a cyst, its type and potential danger, if a cystic formation is present, a woman should undergo a thorough diagnosis and be observed by a professional doctor.

Clinical picture

The initial stages of cyst development are almost never accompanied by a clinical picture; most often a woman learns about her diagnosis during a routine examination.

As a rule, they begin to be observed when the formation becomes complicated or reaches a significant size and interferes with the functioning of other organs.

Of course, the signs of a cyst directly depend on the type of neoplasm, but there are also general symptoms that may indicate the presence of a cyst:

feeling of heaviness in the lower abdomen;
, which are most often aching, but in some cases sharp and strong;
, which are not the norm;
violations Menstruation may become more frequent or absent altogether;
unpleasant or even painful sensations during;
an increase in the size of the abdomen, in some cases this phenomenon can be observed only on one side;
stable, slightly elevated temperature;
constipation;
frequent urination, which is associated with the pressure of the tumor on the bladder.

A very dangerous condition is when the cyst ruptures; in this case, urgent hospitalization of the patient is necessary.

accompanied by the following symptoms:

severe pain that forces a woman to take an unnatural body position;
vomit;
abdominal swelling;
bleeding;
sometimes there is loss of consciousness;
a sharp increase in temperature, while antipyretic drugs remain ineffective;
the skin turns pale, lips may become bluish.

Diagnostic measures

In order not to miss the development of a cyst, it is necessary to undergo a diagnostic examination at least once a year.

Differential diagnosis is as follows:

gynecological examination and palpation. An experienced doctor, through visual examination and palpation, can determine the presence of a tumor in the ovaries. This may also be indicated by hypertrophied appendages and pain in the lower abdomen;
Ultrasound. This study allows not only to establish the presence of a cyst and estimate its size, but also to trace the dynamics of the pathology;
. This examination may be diagnostic or therapeutic in nature;
laboratory blood test. As a rule, in this case, it is especially important to examine the blood for tumor markers so as not to miss the onset of the development of the oncological process;
puncture. Examination of the fluid that fills the cystic formation;
CT or MRI. Most often, these studies are prescribed before surgery to obtain more information about the tumor.

PLEASE NOTE!

Quite often, doctors ask patients to do a hCG test (for pregnancy), since the manifestations of an ectopic pregnancy are very similar to cystic formations. This study is necessary to differentiate the disease and determine adequate therapy.

The most effective examination method

Most often, cystic neoplasms in women are diagnosed using ultrasound. This study is carried out on a full bladder, which makes it possible to determine with maximum accuracy the size of the woman’s genital organs, their shape and the degree of damage to ovarian cystosis. The reliability of this study is 99%.

If the doctor still has doubts about the correctness of the diagnosis after the ultrasound, the patient is offered to undergo a CT or MRI. But most often, ultrasound is sufficient, and these techniques are prescribed in complex cases when it is difficult to make a diagnosis.

The most common and effective way that doctors diagnose cystic neoplasms is through ultrasound. During this procedure, the patient does not experience any negative sensations, and ultrasound can be performed as many times as necessary during treatment and after removal of the cyst, without fear of a negative effect on the body. Ultrasound can be performed transabdominally or transvaginally (using special sensors). Transvaginal ultrasound gives a more detailed picture of the pathology, since in this case an umbrella with a sensor is inserted into the patient’s vagina, which determines the structure of the tumor and its type, the effectiveness of the therapy prescribed by the doctor depends on this.

What does a cyst look like on an ultrasound?

A cystic formation (simple) looks like an anechoic cavity with thin walls, the increase in the echo signal is clearly visible. There is no dense content in a simple cyst, and there is no blood flow.

As for malignant neoplasms, they are rare, especially if a single-chamber cyst is diagnosed. As a rule, functional cysts are identified that have formed against the background of hormonal imbalances in the body.

Simple neoplasms that do not exceed 3 cm, as a rule, do not pose a danger. If the size of the cyst after menopause reaches 7 cm, most often these are also benign formations.

If it is difficult to analyze any foreign inclusions on ultrasound, the patient may be prescribed an additional examination - CT or MRI.

When diagnosing a follicular cyst, ultrasound reveals a single-chamber thin-walled formation. If there is bleeding in the formation, a diffuse suspension can be observed.

A characteristic sign of a follicular cyst on ultrasound is that there is no blood flow inside the cavity.

A luteal cyst is identified by the numerous blood vessels that are observed in its walls. There is no blood supply inside the cavity.

A hemorrhagic cyst is a single-chamber cyst, inside of which a hypoechoic suspension is visible. You can also see an openwork mesh of fibrin threads. There is blood flow along the periphery, but there is none inside the formation.

The paraovarian cyst has a stalk. It can be single-chamber or double-chamber. The fluid inside the cavity is anechoic, but if there is hemorrhage, fibrin admixture is noticeable.

The endometrioid cyst is filled with dark contents inside. External seals are visible. There are areas of endometriosis.

Teratoma is a single-chamber cyst that has a hypoechoic structure; internal inclusions that are hyperechoic can also be traced.

The photo below shows an ultrasound of an ovarian cyst.

When to do an ultrasound?

When exactly to do an ultrasound, you need to check with your doctor, since it depends on the purposes of this study.

A routine examination of the ovaries to determine possible pathology is most often prescribed on days 6-7 of the cycle - immediately after the end of menstruation or in its last days.

To assess the functionality of the organ, it is necessary to conduct the study several times during one menstrual cycle - on days 9-10, on days 15-16, on days 23-24.

It is necessary to prepare for the procedure, and the preparation depends on the way the doctor will conduct the study:

before transrectal During the examination, the bladder must be emptied. 12 hours before the examination, it is necessary to empty the intestines naturally, or with the help of laxatives, enemas, suppositories;
before transvaginal During the study, you need to take sorbents for a couple of days to reduce gas formation. The bladder must be emptied before the study;
before transabdominal research requires eliminating foods that cause fermentation from the diet. An hour before the test, you need to drink about a liter of still water, and after that do not urinate.

Blood test

Diagnostics includes:

clinical analysis– general and biochemical analysis, analysis for infections, coagulogram;
hormonal analysis– progesterone, prolactin, testosterone, estradiol, LH, FSH;
– SA-125, NE-4, REA.

Tests are taken on an empty stomach; the last meal should be no later than 10 hours before blood donation. You need to exclude coffee, tea, and sweet drinks from your diet. The day before the test, you are not allowed to consume alcohol, fatty or fried foods, or medications, and it is also advisable to reduce physical activity.

Tumor marker test

A tumor marker is a protein that belongs to a glycoprotein. Human blood contains a large number of antigens, and in the event of a malignant process, their number exceeds the norm. Therefore, this analysis allows you to get ahead of the malignant process even before clinical signs appear.

Indications for this analysis:

weight loss for no apparent reason;
nausea and vomiting;
unbreakable subfertile temperature;
bloody vaginal discharge;
pain during intimacy;
false urge to urinate;
swollen lymph nodes;
increase in abdominal volume.

Conclusion and conclusions

To summarize, we can say that the diagnosis of cystic neoplasms in the ovary consists of the following activities:

taking anamnesis;
examination in a gynecological chair;
laboratory blood tests;
pregnancy test;
Ultrasound, CT, MRI;
Doppler color mapping;
laparoscopy.

In order for treatment to be as effective as possible, it must be correct. Prescribing the correct treatment is possible only with a thorough and comprehensive diagnosis. Therefore, doctors rarely prescribe any one type of study; most often it is a diagnostic complex.

Useful video

The video talks about the diagnosis and treatment of ovarian cysts:

An ovarian cyst is a fluid-filled sac that forms on the tissue of one or both ovaries.

All such formations are divided into functional and organic. The first are the result of a short-term malfunction of the organ, when the follicle does not rupture at the right time and does not release the egg. Cysts of this type either go away on their own within a month or are easily treated with hormonal medications. Organic cysts are more difficult to treat and may require surgery. In addition, cystic tumors can be either benign (mucinous and serous cystadenomas, dermoid cyst, cystedenofibroma, and sclerosing stromal tumor) or malignant (serous and mucinous cystadenocarcinomas, Brenner cystic tumor, endometrioid carcinoma, cystic metastasis, and immature theroma).

It is believed that ovarian cysts can result from:

Early onset of menstruation;
Hormonal disorders in the thyroid gland;
Abortion and other methods of termination of pregnancy;
Various diseases of the reproductive system;

Types of ovarian cysts in women

There are main types of ovarian cystic formations:

Physiological cysts are normal

Follicle
Corpus luteum

Functional cysts

Follicular cyst
Corpus luteum cyst
Thecal lutein cysts
Complicated functional cysts: hemorrhagic cyst, rupture, torsion

Benign cystic tumors (cystoma)

Dermoid cyst (mature teratoma)
Serous cystadenoma
Cystadenoma mucinous
Cystedenofibroma
Sclerosing stromal tumor

Malignant cystic tumors (cystomas)

Serous cystadenocarcinoma
Cystadenocarcinoma mucinous
Endometrioid cancer
Brenner's cystic tumor
Immature teratoma
Cystic metastasis

Other cysts

Endometrioma (chocolate cyst)
Polycystic ovaries (Stein-Leventhal syndrome)
Postmenopausal cyst
Ovarian hyperstimulation syndrome

Normal anatomy and physiology of the ovaries during reproductive age

Before considering pathological changes, we will highlight the normal anatomy of the ovary. A woman's ovary at the time of birth contains over two million primary oocytes, about ten of which mature during each menstrual cycle. Despite the fact that about a dozen Graafian follicles reach maturity, only one of them becomes dominant and reaches a size of 18–20 mm by the middle of the cycle, after which it ruptures, releasing the oocyte. The remaining follicles decrease in size and are replaced by fibrous tissue. After the oocyte is released, the dominant follicle collapses, and granulation tissue begins to grow in its internal lining in combination with edema, resulting in the formation of the corpus luteum of menstruation. After 14 days, the corpus luteum undergoes degenerative changes, then a small scar remains in its place - the white body.

Graafian follicles: small cystic formations found in the structure of the ovary normally in all women of reproductive age (premenopausal period). The size of the follicles varies depending on the day of the menstrual cycle: the largest (dominant) usually does not exceed 20 mm in diameter at the time of ovulation (14th day from the start of menstruation), the rest do not exceed 10 mm.

Ultrasound of the ovary is normal. Sonograms show ovaries containing several anechoic simple cysts (Graafian follicles). Follicles should not be confused with pathological cysts.

What do the ovaries look like on an MRI? On T2-weighted MR images, Graafian follicles appear as hyperintense (i.e., bright signal) cysts with thin walls surrounded by ovarian stroma, which gives a less intense signal.

Normally, in some women (depending on the phase of the menstrual cycle), the ovaries can intensively accumulate radiopharmaceuticals (RP) during PET. To distinguish these changes from a tumor process in the ovaries, it is important to correlate them with the patient’s anamnestic data, as well as with the phase of the menstrual cycle (the ovaries intensively accumulate radiopharmaceuticals in the middle of the cycle). Based on this, it is better for women before menopause to be prescribed PET scans in the first week of the cycle. After menopause, the ovaries practically do not take up radiopharmaceuticals, and any increase in its accumulation is suspicious for a tumor process.

PET-CT of the ovaries: increased accumulation of a radiopharmaceutical (RP) in the ovaries of a woman in the premenstrual period (normal variant).

Ovaries after menopause

Entering the postmenopausal period is defined as the absence of menstruation for one year or more. In Western countries, the average age of menopause is 51–53 years. In postmenopause, the ovaries gradually decrease in size, Graafian follicles stop forming in them; however, follicular cysts can persist for several years after menopause.

On a T2-weighted MR image (left) of a postmenopausal woman, the ovaries appear as dark “clumps” located near the proximal end of the round ligament. On the right, the tomogram also visualizes a hypointense left ovary, devoid of follicles. Although it is slightly larger than expected, overall the ovary appears completely normal. And, only if it is possible to detect an increase in the size of the ovaries compared to the initial study, the differential diagnostic series should first of all include a benign neoplasm, for example, fibroma or fibrothecoma.

Functional ovarian cysts

Much more common are benign functional ovarian cysts, which are Graafian follicles or corpus luteum, which have reached significant sizes, but otherwise remain benign. In the early postmenopausal period (1–5 years after the last menstrual period), ovulatory cycles may occur, and ovarian cysts may also be detected. And even in late menopause (more than five years after the end of the menstrual period), when ovulation no longer occurs, small simple cysts can be found in 20% of women.

What is a functional ovarian cyst? If ovulation has not occurred and the wall of the follicle has not ruptured, it does not undergo reverse development and turns into a follicular cyst. Another variant of a functional cyst is an enlargement of the corpus luteum with the formation of a corpus luteum cyst. Both formations are benign and do not require drastic measures. An expert second opinion helps distinguish them from malignant variants.

Follicular cysts

In some cases, ovulation does not occur and the dominant Graafian follicle does not undergo reverse development. When it reaches a size greater than 3 cm, it is called a follicular cyst. These cysts are usually 3–8 cm in size, but can be much larger. On ultrasound, follicular cysts appear as simple, unilocular, anechoic cystic formations with a thin and smooth wall. In this case, neither lymph nodes accumulating contrast, nor any soft tissue component of the cyst, nor septa that enhance with contrast, nor fluid in the abdominal cavity (except for a small physiological amount) should be detected. With follow-up studies, follicular cysts may resolve on their own.

Corpus luteum cyst

The corpus luteum can become obliterated and fill with fluid, including blood, resulting in the formation of a corpus luteum cyst.

Ultrasound: corpus luteum cyst. Small complex ovarian cysts are visible with blood flow in the wall, which is detected by Doppler sonography. Typical circular blood flow during Doppler examination is called the “ring of fire.” Note the good permeability of the cyst to ultrasound and the absence of internal blood flow, which correlates with the changes characteristic of a partially involuted cyst of the corpus luteum

It should be noted that women taking hormonal oral contraceptives that suppress ovulation usually do not develop a corpus luteum. Conversely, the use of drugs that induce ovulation increases the chance of developing corpus luteum cysts.

Pelvic ultrasound: corpus luteum cyst. On the left, the sonogram shows changes (“ring of fire”), typical of a corpus luteum cyst. On the right, in the photo of the ovarian specimen, a hemorrhagic cyst with collapsed walls is clearly visible.

Corpus luteum cyst on MRI. An axial T2-weighted tomogram reveals a cyst of the involuted corpus luteum (arrow), which is a normal finding. The right ovary is unchanged.

Hemorrhagic ovarian cysts

A complex hemorrhagic ovarian cyst is formed by bleeding from a Graafian follicle or follicular cyst. On ultrasound, hemorrhagic cysts appear as single-chamber thin-walled cystic structures with the presence of fibrin strands or hypoechoic inclusions, with good permeability to ultrasound. On MRI, hemorrhagic cysts are characterized by high signal intensity on T1 FS scans, while on T2 WI they give a hypointense signal. With Doppler ultrasound, there is no internal blood flow; the component accumulating contrast inside the cyst is not detected on CT or MRI. The wall of a hemorrhagic cyst has variable thickness, often with the presence of vessels located in a circular pattern. Despite the fact that hemorrhagic cysts usually manifest with acute pain symptoms, they can be an incidental finding in a patient who does not present any complaints.

Sonograms reveal a hemorrhagic cyst with a blood clot simulating a neoplasm. However, Doppler ultrasound did not reveal internal blood flow in the cyst, and its permeability to ultrasound was not reduced.

MRI picture of a hemorrhagic ovarian cyst: in T1 VI mode without fat suppression, a complex cyst is determined, characterized by a hyperintense signal, which can be caused by both the fatty component and the blood. On T1 fat-suppressed imaging, the signal remains hyperintense, allowing confirmation of the presence of blood. After administration of gadolinium-based contrast, no contrast enhancement is observed, which allows us to confirm the hemorrhagic nature of the ovarian cyst. In addition, it is necessary to include endometrioma in the differential diagnostic range.

Ultrasound reveals a soft tissue (solid) component in both ovaries. However, ultrasound permeability on both sides is intact, suggesting the presence of hemorrhagic cysts. Dopplerography (not shown) shows no blood flow in the formations.

How to distinguish a hemorrhagic cyst on MRI? In T1 mode, a component with high signal characteristics (fat, blood or protein-rich fluid) is detected in both formations. With fat suppression, the signal intensity does not decrease, which generally makes it possible to exclude teratoma containing adipose tissue and confirm the presence of hemorrhagic fluid.

Endometrioid ovarian cyst (endometrioma)

Cystic endometriosis (endometrioma) is a type of cyst formed by endometrial tissue growing into the ovary. Endometriomas are found in women of reproductive age and can cause long-term bothersome pain in the pelvic area associated with menstruation. Approximately 75% of patients suffering from endometriosis have ovarian damage. On ultrasound, signs of endometrioma can vary, but in most cases (95%) endometrioma appears as a “classic” homogeneous, hypoechoic cystic formation with the presence of diffuse low-level echogenic areas. Rarely, endometrioma is anechoic, resembling a functional ovarian cyst. In addition, endometriomas can be multilocular and contain septa of varying thickness. In approximately one third of patients, careful examination reveals small echogenic lesions adjacent to the wall, which may be due to the presence of cholesterol accumulations, but may also represent blood clots or debris. It is important to distinguish these lesions from true wall nodules; if they are present, the diagnosis of endometrioma becomes extremely likely.

A transvaginal sonogram visualizes a typical endometrioma with hyperechoic foci in the wall. Doppler ultrasound (not shown) failed to detect blood vessels in these lesions.

Endometrioid ovarian cyst: MRI (right) and CT (left). Computed tomography is used primarily to confirm the cystic nature of the formation. MRI can usually be used to better visualize cysts that are poorly differentiated by ultrasound.

On MRI, hemorrhagic contents within the endometrioma lead to increased signal intensity on T1 WI. On T1WI with fat suppression, endometrioma remains hyperintense in contrast to teratomas, which are also hyperintense on T1WI but hypointense on T1FS. This sequence (T1 FS) should always complement MR imaging because it detects small lesions that are T1 hyperintense.

Polycystic ovary syndrome

Radiation diagnostic methods suggest polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, or are used to confirm the diagnosis.

Radiation criteria for PCOS:

Presence of 10 (or more) simple peripheral cysts
The characteristic appearance of a “string of pearls”
Enlarged ovaries (at the same time, in 30% of patients they are not changed in size)

Clinical signs of polycystic ovary syndrome:

Hirsutism (increased hair growth)
Obesity
Fertility disorders
Male pattern hair growth (baldness)
Or increased androgen levels

What does PCOS look like? On the left, the MRI scan shows a typical “string of pearls” pattern. On the right, in a patient with an increased level of androgens in the blood, an enlarged ovary is visualized, as well as multiple small simple cysts located along the periphery. Obvious is the accompanying obesity. In this patient, MRI can confirm the diagnosis of PCOS.

Ovarian hyperstimulation syndrome: theca-luteal cysts

Ovarian hyperstimulation syndrome is a relatively rare condition caused by excessive hormonal stimulation of hCG (human chorionic gonadotropin) and usually manifests as bilateral ovarian damage. Excessive hormonal stimulation can occur with gestational trophoblastic disease, PCOS, as well as during treatment with hormones or during pregnancy (rarely in a normal pregnancy with a single fetus) with independent resolution after the birth of the child (according to research results). Excessive hormonal stimulation most often occurs in gestational trophoblastic disease, erythroblastosis fetalosis, or in multiple pregnancies. Radiation studies usually reveal bilateral enlargement of the ovaries with the presence of multiple cysts, which can completely replace the ovary. The main differential criterion for ovarian hyperstimulation syndrome is characteristic clinical and anamnestic data.

A sonogram performed on a young pregnant woman reveals multiple cysts in both ovaries. On the right, an invasive formation in the uterus is determined, comparable to gestational trophoblastic disease. The conclusion about this disease was made on the basis of characteristic clinical and anamnestic data (the fact of pregnancy in a young woman) and a sonogram, which revealed signs of an invasive form of gestational trophoblastic disease.

Inflammation of the appendages (salpingoophoritis) and tubo-ovarian abscess

Tubo-ovarian abscess usually occurs as a complication of an ascending (from the vagina to the cervix and fallopian tubes) chlamydial or gonorrheal infection. CT and MRI reveal a complex cystic formation of the ovary with a thick wall and lack of vascularization. Thickening of the endometrium or hydrosalpinx makes the diagnosis of tubo-ovarian abscess more likely.

An axial contrast-enhanced CT scan reveals a complex cystic formation on the left, resembling an abscess, with a thick wall accumulating contrast and gas inclusions inside.

On a CT scan in the sagittal plane (left), it can be seen that the ovarian vein approaches the mass, confirming its nature (arrow). On the coronal tomogram (right), the anatomical relationships of the mass and the uterus can be assessed. A gas bubble is visualized in the uterine cavity, which suggests an infectious onset here, with subsequent spread of infection through the fallopian tube to the ovary.

Mature teratoma (dermoid cyst) of the ovary

A mature cystic teratoma, also called a dermoid cyst, is an extremely common ovarian mass that can be cystic in nature. "Mature" in this context means a benign formation as opposed to an "immature", malignant teratoma. Benign cystic teratomas usually occur in young women of childbearing age. On CT, MRI and ultrasound they appear unilocular in (up to) 90% of cases, but can be multilocular or bilateral in approximately 15% of cases. Up to 60% of teratomas may contain calcium inclusions in their structure. The cystic component is represented by a fatty fluid produced by the sebaceous glands located in the tissue lining the cyst. The presence of fat is a diagnostic sign of teratoma. On ultrasound, it has a characteristic cystic appearance with the presence of a hyperechoic solid nodule in the wall, called Rokitansky's node or dermoid plug.

Ultrasound visualizes Rokitansky's node or dermoid plug (arrow).

Liquid-fat levels may also be detected due to density differences (fat, as a lighter, less dense substance, floats on the surface of the water). You can also visualize thin echogenic lines (“stripes”), the presence of which is caused by “hair” in the cyst cavity. Mature cystic teratomas, even benign ones, are most often removed surgically, as they pose an increased risk of ovarian torsion.

Complications of ovarian dermoid cyst:

Ovarian torsion
Infection
Rupture (spontaneous or as a result of trauma)
Hemolytic anemia (a rare complication that resolves after resection)
Malignant transformation (rare)

What does an ovarian dermoid cyst look like on an MRI? A cystic formation with hyperintense signal is visible, within which there are septations (found in approximately 10% of such cysts). In the fat suppression mode, the suppression of signal intensity is determined, which makes it possible to confirm the presence of a fatty component and make a conclusion about a teratoma.

Cystadenoma and cystadenofibroma of the ovary

These formations are also common cystic ovarian tumors (cystomas), which can be either serous or mucinous (mucous). On ultrasound, mucinous cystadenoma often appears as an anechoic, unilocular mass that may resemble a simple cyst. Mucinous cystadenomas often consist of several chambers, which may contain complex fluid with inclusions of protein debris or blood. “Papillary” protrusions on the walls suggest a possible malignancy (cystadenocarcinoma).

Ovarian cystoma on ultrasound. Transvaginal examination (top left) reveals a left ovarian cyst measuring 5.1x5.2 cm (anechoic and without septa). However, a nodule is found on the posterior wall of the cyst with no evidence of internal blood flow on Doppler examination (top right); The differential diagnostic range includes a follicular cyst, an accumulation of debris, and a cystic neoplasm. On MRI (below), thin septa accumulating contrast are detected in the formation. No tumor nodes, lymphadenopathy, or peritoneal metastases were detected. The minimum amount of ascitic fluid is determined. The formation was verified as a cystadenoma by biopsy.

Ovarian cystoma: MRI. On MRI scans performed on the same patient five years later, the mass had grown. On T2 WI a complex cyst is visualized in the left ovary with a solid node on the posterior wall. After contrast administration, a slight increase in signal intensity from thin septa and a node in the wall is detected on T1 FS. MRI data did not allow differentiating between benign (eg, cystadenoma) and malignant ovarian neoplasms. Histological examination of the resectate confirmed cystadenofibroma.

Malignant cystic ovarian tumors

Radiation diagnostic methods, such as ultrasound or MRI, are not intended to determine the histological type of tumor. However, with their help it is possible to differentiate benign and malignant neoplasms with varying degrees of certainty and determine further tactics for patient management. Detection of radiation signs of malignant tumor growth should direct the attending physician (gynecologist, oncologist) to further actively determine the nature of the cyst (surgery with biopsy, laparoscopy). In unclear and contradictory cases, repeated interpretation of pelvic MRI is useful, as a result of which you can obtain a second independent opinion from an experienced radiologist.

Serous cystadenocarcinoma

Ultrasound reveals a complex cystic-solid formation in the left ovary, and another large complex formation containing both a solid and a cystic component in the right half of the pelvis

A CT scan of the same patient reveals a complex cystic-solid formation with thickened septa accumulating contrast in the right ovary, extremely suspicious for a malignant tumor. There is also bilateral pelvic lymphadenopathy (arrows). Histopathological examination confirmed serous ovarian cystadenocarcinoma (the most common variant)

CT scan and macroscopic photograph of serous ovarian cystadenocarcinoma.

Ultrasound (left) shows a large multilocular cystic formation in the right parametrium; Some of the chambers are anechoic; in others, uniform low-level echogenic inclusions are visualized, caused by protein content (in this case, mucin, but hemorrhages can also look similar). The partitions in the formation are mostly thin. No blood flow was detected in the septa, the solid component was also absent, and no signs of ascites were detected. Despite the absence of blood flow during Doppler ultrasound and a solid component, the size and multilocular structure of this formation allows us to suspect a cystic tumor and recommend other, more accurate diagnostic methods. Contrast-enhanced CT scan (right) shows similar changes. The formation chambers have different densities, corresponding to different protein contents. Histopathological examination confirmed mucinous cystadenocarcinoma with low malignant potential.

Endometrioid ovarian cancer

Bilateral cystic solid ovarian masses are suspicious for tumor and require further evaluation. The importance of radiological research methods is to confirm the presence of formation; however, it cannot be concluded with absolute certainty that it is benign or malignant. For patients who have epithelial tumors (a much more common group of ovarian neoplasms), even after surgical treatment, determining the exact histological type of the tumor does not affect the prognosis as much as FIGO stage, degree of differentiation, and completeness tumor resection.

The sonogram (left) shows enlargement of both ovaries, inside of which there is both a cystic and soft tissue (solid) component. A CT scan of the same patient reveals a large cystic-solid formation extending from the pelvis to the abdomen. The role of CT in this case is to stage the formation, however, based on CT (MRI) it is impossible to determine the histological structure of the tumor.

Cystic metastases to the ovaries

Most often, metastases to the ovaries, for example, Krukenberg metastases - screenings from stomach or colon cancer, are soft tissue formations, but often they can also be cystic in nature.

A CT scan reveals cystic formations in both ovaries. You can also notice a narrowing of the rectal lumen caused by a cancerous tumor (blue arrow). Cystic metastases of rectal cancer are clearly visible in the recess of the peritoneum (red arrow), which in general are not a typical finding.

Ovarian cancer treatment

Treatment of patients with ovarian cancer has traditionally included initial staging, followed by aggressive cytoreductive surgery in combination with intraperitoneal cisplatin. In early stages (1 and 2), total hysterectomy and bilateral salpingo-oophorectomy are used (or unilateral if a woman of childbearing age wishes to preserve her fertility, although this approach is controversial).

For patients with advanced tumors (stages 3 and 4), cytoreductive intervention is recommended, which involves partial removal of the tumor lesions; This operation is aimed not only at improving the quality of life of patients, but also at reducing the likelihood of intestinal obstruction and eliminating the metabolic effects of the tumor. Optimal cytoreductive intervention involves the removal of all tumor implants larger than 2 cm; with suboptimal, the transverse size of the remaining tumor nodes exceeds 2 cm. Successful cytoreductive surgery increases the effectiveness of chemotherapy and leads to increased survival.

Patients with stage 1a or 1b ovarian tumors may require only elective surgery without subsequent chemotherapy, while more advanced stages require postoperative chemotherapy with cisplatin (the most effective drug for ovarian cancer). Despite the fact that the positive response to platinum therapy reaches 60-80%, about 80-90% of women with the third stage of the disease and about 97% with the fourth stage die within 5 years.

For patients receiving treatment for ovarian cancer, the most effective method of monitoring is measurement of serum CA-125 levels and physical examination. Repeat laparotomy remains the most accurate method for assessing the effectiveness of chemotherapy, but it produces many false-negative results and does not lead to an increase in survival. CT is used to look for a macroscopic lesion and avoids repeat biopsy. If residual tumor tissue is detected using diagnostic methods, the patient may be prescribed additional treatment; however, radiation methods show a large number of false negative results.

Methods for diagnosing the disease

Today, ovarian cysts are quite well diagnosed using a number of tools:

An examination by a gynecologist, during which the patient’s complaints are clarified, and it is also determined whether the appendages are enlarged and whether there is pain in the lower abdomen.
Pregnancy test. It is necessary not only to exclude ectopic pregnancy, but also to determine the possibility of performing a computed tomography scan.
Ultrasound examination, which allows you to quickly and accurately determine the presence of a cyst and monitor the dynamics of its development.
Laparoscopic examination. Its advantage is that it gives absolutely accurate results and, if necessary, precise and minimally invasive surgery can be performed during the procedure.
Computed and magnetic resonance tomography.

CT scan for ovarian cyst

CT and MRI are fairly accurate methods that allow you to determine the presence of a cyst, suggest whether it is benign or malignant, clarify its size and exact location, etc. In addition, in the case of a malignant cyst, diagnosis using contrast makes it possible to determine whether the tumor has metastasized to other organs and to accurately determine their location.

CT is performed using X-rays, which makes it possible to obtain sections of the organ in increments of approximately 2 mm. The collected and computer-processed sections are assembled into an accurate three-dimensional image. The procedure is absolutely painless, does not require complex preparation (all you need is to adhere to a certain diet for a couple of days before the procedure and, in case of constipation, take a laxative) and lasts no more than 20 minutes.

Given that the slice step is 2 mm, CT can detect formations of 2 mm in cross section or more. These are fairly small cysts and tumors that are at an early stage of development. Such accuracy of CT diagnostics allows you to begin timely treatment and avoid more serious consequences.

Contraindications to the method are pregnancy (due to exposure of the body to X-ray radiation) and allergic reactions to the contrast agent (in the case of CT with contrast). Such allergic reactions are not very common.

A second opinion is very simple

A feature of almost any modern diagnostic method, be it ultrasound, MRI or CT, is the possibility of obtaining an erroneous result for objective or subjective reasons. Objective reasons include errors and shortcomings of diagnostic equipment, and subjective reasons include medical errors. The latter can be caused both by a lack of experience of the doctor and by simple fatigue. The risk of receiving false positive or false negative results can cause a lot of trouble and even lead to the disease progressing to a more severe stage.

A very good way to reduce the risk of diagnostic error is to obtain a second opinion. There is nothing wrong with this, it is not distrust of the attending physician, it is just getting an alternative view of the tomography results.

Today, getting a second opinion is very easy. To do this, you just need to upload the CT results into the National Teleradiological Network (NTRS) system, and in no more than 24 hours you will receive the conclusion of the best specialists from the leading institutes of the country. No matter where you are, you can get the best advice available in the country wherever you have internet access.

Vasily Vishnyakov, radiologist