A paraovarial cyst develops from the tubules of the appendage of the ovary (paraovarian). As a result of cessing with a cubic or cylindrical (ciliary) epithelium, which covers the inside of the tubule wall, the serous fluid expands into the lumen of the tubule and a retention cyst forms. The cyst is localized between the leaves of the broad ligament of the uterus (intraligamentally), more often one-sided, smooth-walled, rounded, single-chamber, usually small, but sometimes reaches enormous size. The contents of the cyst are serous, similar to a transudate.
Clinic of a paraovarial cyst
Clinically, the cyst does not manifest itself for a long time due to slow growth. During vaginal examination, a tumor-like formation with a smooth surface, elastic consistency, limited mobility, and painless is usually palpated on one side. When enlarged to a significant size (male fist), pain (compression) syndrome appears – pain in the lower abdomen and lower back (on the side of the cyst) of a bursting nature.
Treatment of a paraovarial cyst
Differential diagnosis with other tumors of the uterine appendages (non-proliferating and proliferating) is difficult, and therefore, as a rule, the cyst must be removed (it is desirable to save the ovary). In some cases, targeted puncture of the cyst with suction of serous contents and the introduction of alcohol into the cavity of the cyst is possible. Alcohol coagulates the secreting epithelium, as a result of which fluid secretion and tumor growth cease.
Germ cell tumors
They make up 20-25% of all ovarian tumors, and only 3% are malignant. Germ cell tumors most often originate from the gonads, extragonadal localization is less common – in the mediastinum or retroperitoneal space due to the migration of primary germ cells in embryogenesis from the yolk sac of the intestine, and then into the genital cords.
All tumors can be divided into three large groups: benign, mainly represented by dermoid cysts; malignant, emanating from the elements of a dermoid cyst, and initially malignant germ cell tumors.
Dermoid cysts, which make up 1 / 4-1 / 3 of all benign ovarian tumors, are more often detected in young women, but can occur in children and elderly patients.
Malignant tumors developing from the elements of a dermoid cyst are mainly represented by squamous cell carcinoma, which is 2-3% among ovarian carcinomas; the age of patients is the same as for carcinomas (adenocarcinomas) developing from the integumentary ovarian epithelium.
Primary malignant germ cell tumors account for 2-3% of ovarian cancer. Almost always detected in young women aged about 20 years. Germ cell tumors are not hormone-active.
Clinically important is the separation of germ cell tumors into dysgerminomas and non-dysgerminomas. The latter include embryonic cancer, teratoma of varying degrees of maturity, a yolk sac, choriocarcinoma and mixed variants of the above morphological types. Usually the first signs of the disease are pain in the lower abdomen and the presence of a palpable tumor in the pelvis. In about 10% of patients, intense pain in the lower abdomen is caused by torsion of the legs of the tumor or intra-abdominal bleeding from a decaying tumor. Less commonly, the disease is accompanied by spotting from the genital tract and fever. In connection with the appearance of an “acute” pain syndrome, germ cell tumors are detected mainly in the first stage of the disease. Tumor markers of some malignant germ cell tumors are a-fetoprotein (AFP), chorionic gonadotropin (CG). An increase in the concentration of CG over 10,000 ng / ml is most often due to the significant spread of the tumor process, the presence of choriocarcinoma elements in the tumor and correlates with a poor prognosis. Determination of AFP, CG, lactate dehydrogenase (LDH) and an enzyme similar to placental alkaline phosphatase in the blood serum makes it possible to accurately diagnose a germ cell tumor. But in 40% of patients with this form of the tumor, the concentration of markers in the blood does not exceed normal. Embryonic cancer secretes both AFP and CG. This tumor is formed by undifferentiated cells. More differentiated germinogenous tumors — a yolk sac secretion of AFP and choriocarcinoma secreting chronic hepatitis — come from extra-germ organs. Immature teratoma comes from the germ layers and, like dysgerminoma, does not secrete AFP and chronic hepatitis C. The determination of AFP and CG is of great importance in the diagnosis and monitoring of patients with ovarian germ cell tumors. An increase in AFP level with dysgerminoma indicates the presence of other morphological variants of germinogenic tumors. In this case, this tumor should be considered as a non-dysgermin. The dynamics of the level of markers in the treatment process allows us to judge the effectiveness of the therapy. An increase in the level of markers after the end of treatment indicates a relapse of the disease even if there are no clinical manifestations of the disease and is an indication for chemotherapy. The classification of germinogenic ovarian tumors into stages is performed according to the FIGO classification used for staging ovarian cancer.