Uterine cysts and masses

**Review of adnexal masses:** **Non-neoplastic cysts:** **Follicular cyst:** is the most common type of physiological cyst. **Cyst of corpus luteum**: This type of cyst is 3-10 cm in size. If it remains stable and requires surgery, you should consider laparoscopy. **Endometriotic cysts:** They are associated with dense adhesion of the broad ligament or Col-de-Sac, and it is difficult to remove them. Most of the content is chocolate-colored and thick. Endometrioid carcinoma and ovarian clear cell can be associated with ovarian endometrioid cysts. **Ovarian neoplasms:** **epithelial masses:** **1- Serous tumors:** are the most common type of histology and its benign types make up about 70% of all benign neoplasms. **2- Mysino tumors:** 25% of all benign ovarian neoplasms form. These tumors can be large and multi-cavity. **3- Endometrioid tumors:** Most ovarian endometrioid neoplasms are malignant and the benign type is less common. **4- Clear cell tumors:** These tumors are rarely benign and mostly malignant. **5- Transitional cell tumors:** Germ cell tumors: 1- Dermoid cyst is a benign and common tumor that can affect any age. The most common age of diagnosis of this lesion It is the fertile period. 2- Malignant germ cell tumors: This tumor is the most common ovarian malignancy in pregnant women. Stromal tumors: Most hormone-producing tumors are of this type. This tumor is large and hemorrhagic and can cause pain. Metastatic tumors: 3-5% of ovarian malignancies are metastatic and most of these tumors originate from reproductive organs. The most common non-gynecological sites are the breast or the digestive system. Radiological assessment: 1- Transvaginal ultrasound: lumps that have one or more of these characteristics must be operated on: - Topper -Size more than 10 cm - Presence of thick and numerous septa - Presence of papules or nodular structures There are a few important points: - A large amount of liquid is dangerous and can be a sign of malignancy The presence of calcium in the vicinity of fat indicates a dermoid tumor Endometriomas can be troublesome Tumor indices: The most important tumor index for ovarian epithelial cancers is CA-125, which values more than 35U/ml are abnormal. - Benign causes of CA-125 increase - Gynecological causes - Endometriosis - Leiomyoma - Adenomyosis - Pelvic inflammatory disease - Menstruation in the luteal phase - Ovarian hyperstimulation - Pregnancy - Ovarian adenoma cyst - Non-gynecological causes - Heart failure - Chronic kidney disease - Chronic liver disease - Colitis, appendicitis, diverticulitis - Pneumonia - SLE - Peritonitis - Uncontrolled diabetes Pancreatitis - **Other malignancies that can increase this tumor marker include:** Colon cancer **-Lung cancer** **-breast cancer** Pancreatic cancer **-vaginal cancer** Endometrial cancer Fallopian tube cancer CA-125 is a valuable index for following up ovarian cancer and in 95% of patients this index is The accuracy shows the progression or regression of the disease. **Surgical evaluation:** 1- The most common type of incision is the transverse cut above the pubic hair. But it is used to stage the vertical incision. 2- Washing to prepare a cytology sample 3- Inspection of other parts of the abdomen 4- Examining the adnexal mass Ovarian cancer mainly affects postmenopausal women, so hysterectomy and bilateral adnexal removal may be required during surgical evaluation. But a similar malignancy in young women may only be associated with removal of the involved organ. **A review of the types of ovarian masses** **functional cyst** Sometimes functional, functional or physiological cysts, which are harmless, are considered abnormal, and the patient undergoes surgery without reason, while the treatment of many benign cysts is wait-and-see treatment. **follicular cyst** The follicular cyst grows on the surface of the ovary and reaches more than three centimeters. Its wall is often thin and reaches six to eight centimeters. It usually goes away by itself after two months, but you can use contraceptives to get rid of it. **corpus luteum cyst** This cyst has a larger size and reaches three to ten centimeters. One of the problems of corpus luteum cyst is bleeding. Bleeding leads to clot formation. Long remaining clot sometimes necessitates laparoscopy. Patients who take heparin or warfarin and have coagulation problems are more likely to experience rupture and bleeding as a result. **Takalutein cyst** Tacalotein cyst appears more often in multiple or molar pregnancies and disappears gradually when the causative agent of the cyst is removed. This cyst also grows rapidly and may be very large **Endometriosis** Endometriosis is the presence of uterine tissue somewhere other than the uterine cavity. One of the areas where uterine tissue may grow is the ovary. The contents of these cysts are chocolate, and one of the main problems is adhesion between tissues. Endometriosis contains clots and blood and is sometimes mistaken for malignancy in ultrasound. It is often bilateral and the treatment is surgery. This cyst in the ovary indicates that the disease is advanced endometriosis. For treatment, if the patient no longer wants fertility, the best way is to remove the ovaries and uterus **Polycystic** As the name suggests, there are many cysts on the ovary in this syndrome, but the presence of a number of cysts on the ovary cannot confirm the diagnosis that the patient has polycystic ovary syndrome. In addition to the ultrasound report, there must be clinical symptoms. Oligomenorrhea, which means periods with long intervals in the patient, indicates that she is not ovulating properly, (chronic ovulation with spaced periods), an increase in androgens is also seen in these patients, which brings symptoms such as increased hair loss, male pattern hair loss, and skin acne. In ultrasound, the number of follicles is usually high. It means that there are more than 12 follicles and sometimes the size of the ovary increases. All the mentioned cases must be together to make the diagnosis of the disease final. Polycystic ovary syndrome sometimes leads to weight gain, and more importantly, the amount of estrogen in the body of these women is high due to lack of ovulation, and this can increase the risk of uterine cancer in them in the future. It may seem that the number of people with polycystic syndrome is increasing, but at the same time, the power of diagnosis has increased. In the past, hair growth in women or long-term delays in menstruation may not have been seen much, but today, with a ten-day delay, patients quickly go to the doctor to find out the reason, and for this reason, the diagnosis of the disease has become easier and faster. In any case, the disease has an environmental and genetic background, and the possibility of developing diabetes mellitus, cardiovascular diseases, high blood pressure and infertility is also high in patients. **Malignant cysts have a different pattern** Malignant cysts also have different types, but if we want to mention them completely, the discussion may become a bit specialized. These cysts have symptoms that distinguish them from the benign type. If during the examination, a lump is felt in the pelvic area and around the ovaries, vaginal ultrasound is requested because it has a better view than abdominal ultrasound. **What are the malignant masses?** In the ultrasound, solid, bilateral and more than ten cm masses with thick walls or nodular dural walls have been reported, the suspicion of malignancy increases and these cases should be investigated further. Repeat vaginal ultrasound or tumor marker tests are helpful. Of course, masses that are benign in appearance, but have an increasing growth, need a faster reaction, and we must rule out the possibility of malignancy. In these cases, to increase the detection power, Doppler ultrasound is used to check the blood flow in that area. An increase in blood flow is usually seen in malignant masses. Ovarian cancer is usually seen in women over 45 years of age, but risk and protective factors include: Having a child can protect a woman against ovarian cancer. Taking birth control pills for five years prevents ovarian cancer, but increases the risk of cervical cancer. - If one of the first or second degree relatives has ovarian cancer, the risk of infection is very high and breast and ovarian cancer usually coexist. - The disease of one of the family members at a young age also increases the possibility of risk. **-Genetic counseling is recommended for people at risk** Those who have ovarian or breast cancer in their family should undergo genetic counseling and genealogical analysis. If this gene mutation is seen in a woman and the number of children is complete, we recommend removing the ovaries, uterus and fallopian tubes as a preventive measure. Of course, this work does not keep a person 100% immune from infection, because cancer may start in the area around the uterus, such as the covering peritoneum, but it greatly reduces the risk. Of course, the use of contraceptive pills for this group of women can play a preventive role. #### Dr. Siddiqa Akhan Tabib **Surgeon and specialist in gynecology, childbirth and infertility** **Office:** Valiasr Street, below Vali Asr Square, Voldi Street, No. 21, 1st floor Appointment by phone: 021-88938793