Anechogenic mass in the ovary

An anechoic formation in the ovary is a symptom that is determined during an ultrasound examination of the female genital organs and pelvic organs. Various pathologies of the female reproductive system require careful diagnostics, so the "golden method" of examination is ultrasound. This method is based on the ability of ultrasound rays to penetrate deep into tissues and reflect from organs that have different densities, which is characterized by an image in the form of various echo signals. If the tissue, such as bone, has a high density and conducts rays well, then the image is hyperechoic and appears as a light area. In the case where the tissue has a low density and poorly reflects the signal, then the area will be hypoechoic or anechoic. An anechoic formation in the ovary can be of various etiologies, and according to this, there are different methods of differential diagnostics.

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Causes an anechogenic mass in the ovary.

An anechoic formation during an ultrasound examination looks like a darkened structure of a certain size in the projection of the ovary. As a rule, this is a cavity filled with fluid, which explains the good conductivity of ultrasound rays. Therefore, the most common cause of such a symptom during an ultrasound examination of the ovaries is the formation of cysts or cysts. This is the most common cause that is accompanied by such changes in ultrasound. According to statistics, ovarian cysts in women of reproductive age are very common and account for more than 60% of all benign neoplasms of the female genital organs, and more than 85% of benign formations in the ovary. The causes of ovarian cysts can be varied, and it is very difficult to establish the exact etiological factor. First of all, it should be noted that the hormonal balance of the regulation of the ovariomenstrual cycle is disrupted, which affects the functioning of both the ovary itself and the follicle cycle. Also among the causes of cyst development (anechoic ovarian formations) it is necessary to highlight inflammatory diseases of the ovaries, postoperative adhesions, ovarian injuries. All these factors can cause the development of cysts, but very often, in the woman's medical history it is not possible to identify any factors that could influence this process.

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Pathogenesis

The pathogenesis of the development of anechoic formations in the ovary differs depending on the type of neoplasm - cyst or cystoma.

A cyst is a benign, non-proliferating ovarian neoplasm that has a thin wall and fluid inside. The liquid content is formed due to the secretory activity of cells and the disruption of the excretion of this secretion. The size of a cyst can be from several millimeters to several centimeters, but compared to a cystoma, the size of a cyst does not reach enormous sizes.

Cysts are classified as:

• Follicular is an ovarian formation characterized by a thin membrane and the presence of fluid inside, and is formed as a result of a violation of the physiological rupture of the follicle and the accumulation of fluid in it, which is secreted. Therefore, follicular cysts have their own characteristics on ultrasound.
• Parovarian cyst is a cyst located around the ovary, which is formed due to the accumulation of fluid in the ovarian tissue.
• Dermoid - a cyst that is congenital and occurs as a result of a violation of ontogenesis processes and is characterized by the presence of dysgerminogenic inclusions in the cavity in the form of hair, teeth, skin. It is not very common.
• Corpus luteum cyst is a special type of cyst that forms in the second phase of the menstrual cycle - luteal, when after the rupture of the follicle, the corpus luteum of pregnancy is formed and with certain hormonal disorders of the process of involution of the corpus luteum, it persists with the accumulation of fluid inside. Then a thin-walled capsule forms around the corpus luteum and fluid is secreted inside.

These are the main types of cysts that occur in the ovary, although there are a huge number of them in terms of structure, but these types can be found most often.

A cystoma is a benign ovarian neoplasm that has distinctive features from a cyst. Firstly, cystomas are proliferating structures that are formed not by fluid accumulation, but by cell proliferation. Therefore, their structure is heterogeneous and can consist of several chambers, and can also be enormous due to uncontrolled cell division. The main types of cystomas are:

• Mucinous is a cyst that is formed by the proliferation of glandular epithelial cells and, as a result, cavities are formed containing a viscous mucous-like substance called mucin.
• Papillary or cystadenoma is a cystoma of papillary epithelium, which has a heterogeneous structure due to the numerous cells that proliferate in the form of warts on the skin. This type of cystoma is the most dangerous in terms of possible complications.
• Serous - a type of epithelial cyst, which is characterized by cell proliferation and accumulation of serous substance inside.

Separately, it is necessary to note endometrioid cysts, which when localized in the ovary are also called "chocolate". This is one of the types of disease - endometriosis. In this case, areas of the endometrium are scattered outside the uterine cavity - both on the external and internal genital organs, and extragenitally - which is accompanied by their secretion, that is, these areas menstruate. When endometrioid cysts are localized in the ovary, they also have their own characteristic features, both clinically and in ultrasound examination.

These are the main types of anechoic formations in the ovary and they have both specific causes of occurrence and special pathogenesis, therefore the picture on ultrasound differs.

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Symptoms an anechogenic mass in the ovary.

As described earlier, an anechoic formation in the ovary is a cyst or cystoma. The clinical features and differences in ultrasound depend on this.

The first signs of this pathology are often detected already at the moment when the formation reaches enormous sizes. Basically, the course of cysts is asymptomatic, but everything depends on the localization.

Ovarian cysts can disrupt the normal ovariomenstrual cycle with a delay in menstruation, which often alarms women and makes them see a doctor. This is due to the fact that the ovarian cyst prevents the egg from leaving the follicle and menstruation does not occur, since there is no normal level of hormones, which is maintained by the corpus luteum, among other things. This mainly concerns follicular cysts and corpus luteum cysts, which is associated with their localization in the area of the follicle that was supposed to rupture.

As for dermoid cysts, their course is often asymptomatic until the very end of a woman's life, since they do not tend to grow.

The paraovarian cyst is located between the ovary and the uterus, so a common clinical symptom is torsion of the ovarian cyst stalk, which is accompanied by the clinical picture of acute abdomen. In this case, the woman feels sharp pain in the lower abdomen or in its lateral parts, the general condition is disturbed, there may be positive symptoms of peritoneal irritation. In this case, in the case of a dynamic examination, the cyst increases in size due to the fact that the outflow of blood through the veins is disrupted, and the arterial inflow does not suffer. This may be the first sign of the presence of a cyst in a woman who previously did not suspect its presence.

As for cysts, the symptoms of their manifestation are often associated with large sizes, which is accompanied by a feeling of pressure on neighboring organs. At the same time, cystomas can be so huge that they lead to an increase in the volume of the abdomen. This may be the first and only sign of the presence of cysts.

The clinical features are endometrial cysts, which are characterized by small blood discharges similar to the uterine endometrium. In this case, a woman experiences severe pain in the lower abdomen before or after menstruation, which is often regarded as premenstrual syndrome and women do not focus on this. This occurs because the blood released from the endometrial ovarian cyst penetrates into the free cavity of the small pelvis and the abdominal cavity, which causes irritation of the peritoneum and severe pain in the abdomen.

As for the distinctive ultrasound features of different types of cysts, then:

1. An anechoic round formation in the ovary, especially if it is avascular, is definitely a cyst. What does the term "avascular" mean - it is the absence of blood vessels, that is, this formation is not supplied with blood. This once again proves that it is a cyst, since, differentiating with malignant formations or with a myomatous node, it should be noted that they have a good blood supply.
2. An anechoic fluid thin-walled formation in the ovary indicates a cyst, while the cavity is uniform in the form of a darkening with a clear structure. At the same time, there is a thin membrane, which also makes it possible to differentiate a cyst from a cystoma.
3. An anechoic heterogeneous formation of the ovary is an endometrioid cyst, which has a heterogeneous structure due to the presence of endometrial cells that can secrete blood. In this case, a cavity is not formed, or there is a small cavity that contains blood inside, and since blood has a higher density than liquid, an unclear structure of the formation is determined.
4. A two-chamber anechoic formation in the ovary also indicates a cystoma, since in the process of cell proliferation, both single-chamber and multi-chamber formations can form.
5. An anechoic formation of the ovary during pregnancy is also often a cyst. But in this case, such a cyst should be very carefully monitored, since its course can be different from regression after the birth of the child, and up to the occurrence of complications with the growth of this cyst and the enlargement of the uterus. The treatment tactics are also slightly different.

These are the main ovarian neoplasms with differentiation of clinical and ultrasound signs, which help to clarify the diagnosis.

Complications and consequences

The main complications that may occur with asymptomatic anechoic formations in the ovary are conditions associated with torsion of the ovarian cyst stalk, which is accompanied by the clinical picture of acute abdomen and requires immediate surgical intervention, since the cyst tissue dies, which, if left untreated, may be accompanied by necrosis of the ovarian tissue. Another complication may be a rupture of the cyst, which is accompanied by the release of contents into the pelvic cavity and initiates the clinical picture of peritonitis. Since the fluid may also be with blood, a long process may contribute to the formation of inflammatory transudate. The consequences of an anechoic formation in the ovary may be a violation of the ovariomenstrual cycle, which entails infertility or miscarriage.

Diagnostics an anechogenic mass in the ovary.

If any symptoms characteristic of ovarian cysts appear, a woman immediately consults a doctor. A very important stage in making a diagnosis is collecting anamnesis with details of the monthly cycle, characteristics of sexual life, symptoms of the disease and the dynamics of their origin. Complaints about menstrual cycle disorders with delayed menstruation or polymenorrhea may suggest possible problems with the ovary, one of the causes of which may be cysts.

When examining a woman in a mirror, no changes are detected, but during a bimanual vaginal examination, a one-sided, round-shaped neoplasm can be palpated in the projection of the ovary, which immediately makes it possible to suspect an ovarian cyst.

Tests for ovarian cysts are not specific, so all general clinical examinations are carried out. Special smears from the cervical canal are also uninformative for diagnosing ovarian cysts, in the absence of concomitant pathology.

Instrumental diagnostics allows to clarify the diagnosis and establish treatment tactics. The most informative method is ultrasound of the ovaries and pelvic cavity.

The ultrasound is performed transvaginally, with the sensor positioned close to the ovaries, which allows for better visualization of changes. The exact location of the anechoic formation in the ovary, its size, structure, edges, cavity, capsule, and homogeneity are described. This allows for accurate identification of the possible process. The condition of the uterus, its length, and the height of the endometrium are also described, which allows for the cycle phase to be determined.

Diagnosis and precise confirmation of the diagnosis of a cyst is possible only after postoperative histological examination of the material.

These are the main types of diagnostics of anechoic formation in the ovary.

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Differential diagnosis

Differential diagnostics should be performed with ovarian cancer and other malignant tumors. In this case, ovarian cancer has the appearance of an unstructured formation with unclear edges and possible spread to neighboring organs. It is also necessary to perform differential diagnostics of an ovarian cyst with an ectopic ovarian pregnancy. In this case, there is a delay in menstruation, a positive pregnancy test, and a fetal egg is visualized.

A fibromatous node with a subserous localization can also resemble a paraovarian cyst of the ovary, but with myoma, the node is of varying density and has a higher echogenicity.

Treatment an anechogenic mass in the ovary.

The issue of cyst treatment is discussed in each case individually, since there are cases when only observation is necessary. Treatment can be both conservative and surgical.

Asymptomatic small cysts that were detected accidentally during examination of girls of pubertal age or under 20 years of age are usually not subject to treatment, but only careful observation. This is due to the fact that such formations can regress on their own after the restoration of normal hormonal levels.

Also, cysts during pregnancy are subject to observation, in the absence of complications. This is due to the fact that conservative treatment with medications during pregnancy can negatively affect the fetus. Also, surgical treatment can bring more complications, and after childbirth, such a formation can disappear. Otherwise, after childbirth, the issue of treating such a cyst is considered.

Only endometrioid and functional cysts (follicular and corpus luteum cysts) are subject to drug treatment of anechoic formations in the ovary. This is due to the fact that hormonal imbalance plays a major role in the pathogenesis of such cysts, so hormonal drugs as replacement therapy help reduce the size of these cysts and lead to their regression.

The main hormonal drugs prescribed in this case are progesterone series. They allow you to balance the level of hormones by replenishing hormones in case of luteal phase deficiency.

1. Duphaston is an oral hormonal drug that is a synthetic analogue of natural progesterone. The mechanism of action of this drug, like others, is replacement therapy for insufficiency of the second ovarian phase, which leads to the formation of functional or endometrioid cysts. The drug is available in the form of tablets of 10 mg, used according to an individual scheme with general dosages in the form of taking 10 mg twice a day from the 5th day of the cycle or from the 11th day of the cycle. The features of the administration depend on the type of cyst and are decided by the doctor on an individual basis, since a combination of the drug with estrogen drugs is possible.

Contraindications to the use of the drug are acute liver damage, acute heart failure and lactation. Side effects are allergic manifestations, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, libido disorders, uterine bleeding, requiring a change in dosage.

2. Marvelon is a combined estrogen-progesterone drug that contains 5 times more progesterone. The principle of the drug's action on cyst regression is due to the regulation of hormonal levels, which is accompanied by a decrease in the cyst. The drug is available in tablets of 100 mg and is taken one tablet per day at the same time from the 1st to the 21st day of the cycle. This ensures a constant normal concentration of hormones in the blood. Side effects of the drug are allergic reactions, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, impaired libido, weight gain. Contraindications for use are acute liver dysfunction, acute cholecystitis, malignant processes of any localization.
3. Zhanin is a low-dose biphasic combined estrogen-progesterone drug that has the same mechanism of action on anechoic formations in the ovary as the previous hormonal drugs. It is available in the form of pills, the number of which is 21. The drug is taken from the first day of the menstrual cycle. Due to the content of estrogens and progesterone, the drug can regulate any hormonal imbalance. Take one pill per day for 21 days, then take a break for 7 days, then resume taking. Side effects can develop in the form of dyspeptic manifestations, skin allergic reactions, changes in the mammary gland in the form of pain, swelling, as well as bloody uterine discharge. Contraindications to the use of the drug are diabetes mellitus, thrombosis and other vascular problems, migraine, as well as pregnancy and lactation.
4. Anteovin is a combined two-phase estrogen-progesterone drug that suppresses the processes of the normal menstrual cycle by regulating hormonal levels and prevents ovulation. This promotes the regression of functional cysts. The drug is available in the form of tablets, 21 pieces per package. Among them, 11 are white and 10 are pink, according to the difference in composition. Take one tablet from the 5th day of the cycle. Side effects can develop in the form of dyspeptic manifestations, discomfort in the mammary glands and a feeling of their tension. Contraindications to taking the drug are diabetes mellitus, arterial hypertension, epilepsy, varicose veins, and smoking is not recommended while taking this drug.

It is important to conduct general strengthening and immunomodulatory treatment in the form of vitamin therapy in parallel with hormone replacement therapy. Vitamins of group A and E are recommended, and better yet, multivitamin complexes. Among physiotherapeutic methods of treatment, iontophoresis and electrophoresis are recommended, as well as magnetic resonance therapy for asymptomatic forms of cysts. This helps to reduce their size.

Surgical treatment is a priority in the case of cysts, since due to their proliferation they sooner or later become symptomatic and can also become malignant. Surgical interventions are performed in the volume of lower laparotomy and resection of the ovarian cyst. In this case, postoperative material is sent for cytological examination to differentiate the type of cyst.

The surgical method of treatment is more reliable and is used in older women, since the risk of cyst malignancy decreases. In case of complications, the surgical method of treatment of anechoic formations in the ovary is the method of choice.

Traditional treatment of anechoic formation in the ovary

There are many folk methods of treating cysts. These include methods using many herbs, honey and other natural substances, as well as homeopathic remedies.

Basic folk recipes:

• Honey has many nutrients and microelements that increase local immunity and stimulate regeneration. To create a medicine from honey, you need to take the core of the onion and place it in a glass of honey so that it is completely filled with it. Leave this solution overnight and in the morning, soak a tampon in this solution and insert it into the vagina overnight, repeat for 10 days, after which the cyst should decrease.
• Flaxseed oil regulates the disturbed ovariomenstrual cycle, and therefore it should be used in a teaspoon daily in combination with carrot juice. To do this, dilute five drops of fresh juice in a teaspoon of oil and drink on an empty stomach.
• Walnuts are one of the most effective means for regulating hormonal imbalance. You can use both the shells and the partitions. They need to be poured with a glass of alcohol and infused in a dark place for 3 days, then take a tablespoon on an empty stomach for at least a week.

Recipes using herbs are as follows:

• Prepare a herbal infusion from mint, nettle and currant leaves - take them in equal quantities, pour hot water over them and boil for another 5 minutes, then cool and drink warm, half a glass every other day for a month.
• Pine buds are brewed at the rate of one tablespoon of raw material per liter of water, infused in a thermos overnight and drunk throughout the day, half a glass 3-4 times a day for at least a month.
• Raspberry leaves and meadowsweet flowers are steamed in hot water and a glass of this tea is taken in the morning and evening for three weeks.

Homeopathic remedies are also widely used to treat ovarian cysts, for this you need to contact a professional homeopathic doctor. The main homeopathic remedies are:

• Dysmenorm is a complex homeopathic preparation that affects hormonal imbalance, including benign ovarian formations. The drug is available in tablet form and is taken 1 tablet 3 times a day half an hour before meals. Side effects are rare, but nausea and temporary deterioration of the condition may occur. Not recommended for patients with celiac disease.
• Lycopodium is a single-component homeopathic preparation that is effective against right ovarian cysts. The preparation is available in the form of homeopathic granules of 10 g in a jar, and also in the form of a tincture of 15 ml. Take between meals, dissolve under the tongue until completely dissolved, 1 granule 4 times a day. Not recommended for pregnant women. No side effects have been found.
• Gynecoheel is a combined homeopathic preparation, which is produced in the form of drops and is used 10 drops three times a day, before which it must be dissolved in warm water. Side effects are rarely noted in the form of allergic reactions.
• Cyclodinone is a homeopathic drug that normalizes the ovariomenstrual cycle when its second phase is insufficient. The drug is available in tablets or drops. Dosage: 1 tablet in the morning or 40 drops once a day. The course of treatment is at least three months. Contraindications for use are pregnancy and allergic hypersensitivity to the components of the drug.

Prevention

Prevention of the formation of anechoic structures in the ovary is non-specific: rules of intimate hygiene, hygiene of sexual relations, timely preventive examinations, pregnancy planning with prevention of abortions, timely referral to a doctor in case of problems.

Forecast

The prognosis for this pathology is favorable for life and favorable for recovery, with timely diagnosis and correct treatment tactics. It is necessary to take into account the high risk of malignancy of ovarian cystadenomas, therefore such formations must be treated surgically for a good further prognosis.

An anechoic formation in the ovary is not a diagnosis to be afraid of, but an ovarian cyst. It is necessary to differentiate between different types of cysts, which depends on the clinical picture and affects the treatment tactics. These formations are benign and there are many methods of treating this pathology, both medicinal and folk, as well as surgical. Therefore, you should not be afraid of this diagnosis, but it is better to see a doctor earlier for timely diagnosis and treatment, which allows you to prevent various complications.