Anechogenous formation in the ovary

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

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Causes of the anechogenous formation in the ovary

Anechogenous formation during ultrasound examination looks like a darkened structure of certain dimensions in the projection of the ovary. As a rule, this is a cavity filled with liquid, which explains the good conductivity of ultrasonic beams. Therefore, the most common cause of this symptom with ultrasound of the ovaries is the formation of cysts or cyst. This is the most common cause, which is accompanied by similar changes in ultrasound. According to statistics, ovarian cysts in women of reproductive age are very often found and account for more than 60% of all benign neoplasms of female genital organs, and more than 85% of benign formations in the ovary. The reasons for the formation of ovarian cysts can be varied, and it is very difficult to establish the exact etiologic factor. First of all, it should be noted the violation of the hormonal balance of the regulation of the ovario-menstual cycle, which affects the functioning of both the ovary itself and the cycle of the follicle. Also among the causes of the development of cysts (anechoic ovarian formations), inflammatory diseases of the ovaries, postoperative adhesions, and ovarian trauma should be distinguished. All these factors can lead to the development of cysts, but very often, in a woman's history, it is not possible to identify any factors that could affect this process.

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Pathogenesis

The pathogenesis of development of anechogenic formations in the ovary differs, depending on the type of neoplasm - cysts or cystomas.

The cyst is a benign non-proliferative neoplasm of the ovary, which has a thin wall and fluid inside. Liquid contents are formed due to secretory activity of cells and violation of excretion of this secret. Dimensions of the cyst can be from a few millimeters to several centimeters, but in comparison with the cystoma, the size of the cyst does not reach huge dimensions.

Cysts distinguish:

• Follicular is the formation of the ovary, which is characterized by a thin shell and the presence of fluid inside, and is formed due to a violation of the physiological rupture of the follicle and the accumulation of a fluid in it that is secreted. Therefore follicular cysts have their own peculiarities on ultrasound.
• Paraovarial is a cyst, located around the ovary, which is formed by the accumulation of fluid in the ovarian cellulose.
• Dermoid - a cyst, which is congenital and occurs as a result of disturbance of ontogeny processes and is characterized by the presence of disgerminogenic inclusions in the cavity in the form of hair, teeth, and skin. It does not occur very often.
• Yellow body cyst is a special kind of cyst that forms in the second phase of the menstrual cycle - luteal, when after the rupture of the follicle the yellow body of pregnancy is formed and with certain hormonal disturbances of the process of involution of the yellow body it persists with the accumulation of fluid inside. Then a thin-walled capsule forms around the yellow body and fluid is secreted internally.

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

Kistoma is a benign neoplasm of the ovary, which has distinctive features from the cyst. First, cystomas are proliferating structures that are formed not by accumulation of fluid, but by the proliferation of cells. Therefore, their structure is heterogeneous and can consist of several chambers, and can also have huge dimensions due to uncontrolled cell division. The main types of cyst:

• Mucinous is a cystoma that forms when the cells of the glandular epithelium proliferate and due to this, cavities with a content of a viscous mucus-like substance, mucin, are formed.
• Papillary or cystadenoma is a cystoma of the papillary epithelium, which has a non-uniform structure due to the number of cells that proliferate in the form of warts on the skin. This kind of cyst is the most dangerous in terms of possible complications.
• Serous is a kind of epithelial cyst that is characterized by the multiplication of cells and the accumulation of serous matter inside.

Separately it is necessary to note endometrioid cysts, which when localized in the ovary are also called "chocolate". This is one of the kind of disease - endometriosis. In this case, the endometrial areas are scattered outside the uterine cavity - both to the external and internal genital organs, and extragenital - which is accompanied by their secretion, that is, these sites are menstruating. When localized endometrioid cysts in the ovary, they also have their own characteristics, both clinically and under ultrasound.

These are the main types of anechogenous formations in the ovary and they have both specific causes of origin and special pathogenesis, and therefore the pattern varies with ultrasound.

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Symptoms of the anechogenous formation in the ovary

As described earlier, an anechoic formation in the ovary is a cyst or cystoma. This depends on the features of the clinic and differences on ultrasound.

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

Ovarian cysts can disrupt the normal ovario-menstrual cycle with a delay in menstruation, which often worries women and makes them seek medical attention. This is due to the fact that the ovarian cyst inhibits the release of the egg from the follicle and menstruation does not occur, since there is no normal level of hormones, which is maintained due to the yellow body including. This applies mainly to follicular cysts and cysts of the yellow body, which is due to their localization in the follicle area, which was supposed to burst.

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

A paravarian cyst is located between the ovary and the uterus, so a frequent clinical symptom is the torsion of the leg of the ovarian cyst, which is accompanied by the clinic of the acute abdomen. At the same time, a woman feels a sharp pain in the lower abdomen or in its lateral parts, the general condition is broken, the symptoms of irritation of the peritoneum may be positive. In this case, in the case of examination in dynamics, 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 had never previously suspected her 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. In this case, cysts can be so huge that they lead to an increase in the volume of the abdomen. This can be the first and only sign of having a cyst.

The features of the clinic have endometrial cysts, which are characterized by small blood discharges according to the type of uterine endometrium. In this case, the woman before menstruation or after there are severe pain in the lower abdomen, which is often regarded as a pre-local syndrome and women do not focus on this. This is due to the fact that the blood that is released from the endometrial cyst of the ovary 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. Anehogenous rounded formation in the ovary, especially if it is avascular - it is definitely a cyst. What does "avascular" mean is the absence of blood vessels, that is, this formation is not blood-soluble. This again proves that this is a cyst, because, differentiating with malignant formations or with a myomatous node, it should be noted that they have good blood supply.
2. Anehogenous fluid thin-walled formation in the ovary testifies in favor of the cyst, while the cavity is uniform in the form of a darkening with a clear structure. In this case, there is a thin shell, which also makes it possible to differentiate the cyst from the cystoma.
3. Anehogenous non-uniform ovarian formation is an endometrioid cyst that has a heterogeneous structure due to the presence of endometrial cells that can secrete blood. In this case, the cavity does not form, or there is a cavity of small dimensions that contains blood inside, and since blood has a higher density than liquid, a fuzzy structure of formation is determined.
4. Two-chamber anehogenous formation in the ovary - this also indicates the account of cystoma, because during the proliferation of cells can form, both single-chamber and multi-chambered formations.
5. Anehogenous formation of the ovary during pregnancy is also often a cyst. But it should be very carefully monitored for such a cyst, since its course can be different from the regress after the birth of the child, and before the occurrence of complications with the growth of this cyst and the increase in the uterus. The tactics of treatment are also slightly different.

These are the main ovarian neoplasms with differentiation of the clinic and ultrasound signs that help to clarify the diagnosis.

Complications and consequences

The main complications that can occur with asymptomatic anehogenous formations in the ovary are the conditions associated with the torsion of the ovarian cyst's leg, which is accompanied by the clinic of the acute abdomen and requires immediate surgery, as dying tissue of the cyst occurs, which can be accompanied by necrosis of ovarian tissue upon waiting. Also, one of the complications may be rupture of the cyst, which is accompanied by the release of the contents into the cavity of the small pelvis and initiates the peritonitis clinic. Since the fluid can also be with blood, a prolonged process can contribute to the formation of an inflammatory transudate. Consequences of anehogenous formation in the ovary may be a violation of the ovario-menstrual cycle, which leads to infertility or miscarriage of the child. 

Diagnostics of the anechogenous formation in the ovary

At occurrence of any signs characteristic for cysts of an ovary, the woman at once addresses to the doctor. A very important stage in the diagnosis is the collection of anamnesis with the details of the monthly cycle, the characteristics of sexual life, the symptoms of the disease and the dynamics of their origin. Complaints of a menstrual irregularity with a delay in menstruation or polymentorrhoea may lead to the idea of possible problems with the ovary, one of the causes of which may be cysts.

When a woman is examined in mirrors, there is no change, but with a bimanual vaginal examination, one-sided neoplasm of a rounded shape in the projection of the ovary can be palpated, which immediately makes it possible to suspect the ovarian cyst.

Analyzes in the ovarian cyst are not specific, therefore, conduct all general clinical examinations. Special smears from the cervical canal are also poorly informative for the diagnosis of ovarian cysts, in the absence of concomitant pathology.

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

Ultrasound is performed by a transvaginal method, while the sensor is located close to the ovaries, which allows you to better visualize the changes. This describes the exact location of anechogenous formation in the ovary, its size, structure, edges, cavity, capsule, homogeneity. This allows you to accurately identify the possible process. Also describe the condition of the uterus, its length, the height of the endometrium, which allows you to establish the phase of the cycle.

Diagnosis and accurate confirmation of the diagnosis of cysts is possible only after a post-operation histological examination of the material.

These are the main types of diagnosis of anehogenous formation in the ovary.

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Differential diagnosis

Differential diagnosis should be carried out with ovarian cancer and other malignant lesions. In this case, ovarian cancer has the appearance of unstructured formation with indistinct edges and possible spread to neighboring organs. Also, it is necessary to conduct a diffodiagnosis of the 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 subserous localization may also resemble a parovarial ovarian cyst, but with a myoma, the node is of different density and has a higher echogenicity.

Treatment of the anechogenous formation in the ovary

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

Asymptomatic cysts of small size, which were detected by chance when examined in girls of pubertal age or before the age of 20, are usually not subject to treatment, but only to close observation. This is due to the fact that such formations can regress themselves after the restoration of a normal hormonal background.

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 adversely affect the fetus. Also, surgical treatment can bring more complications, and after childbirth such education can disappear. Otherwise, after giving birth, they are considering treating such a cyst.

Medical treatment of anechogenic formations in the ovary is subject only to endometrioid and functional cysts (follicular and cyst of the yellow body). This is due to the fact that in the pathogenesis of the formation of such cysts the main role is played by the violation of the hormonal balance, therefore, hormonal medications as replacement therapy help to reduce the size of these cysts and lead to their regression.    

The main hormonal drugs that are prescribed in this case are progesterone. They allow to level the level of hormones due to the replenishment of hormones in the failure of the luteal phase.

1. Duphaston is an oral hormone drug, which is a synthetic analogue of natural progesterone. The mechanism of action of this drug, as well as others, consists in replacement therapy in the absence 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, is used according to an individual scheme with total dosages in the form of a 10 mg dose twice a day from the 5th day of the cycle or from the 11th day of the cycle. The features of the treatment depend on the type of cyst and are solved by the doctor individually, since a combination of the drug with estrogen preparations 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, violation of libido, uterine bleeding, requiring dosage changes.

2. Marvelon is a combined estrogen-progesterone drug that contains more progesterone 5 times. The principle of the drug on regression of cysts is caused by the regulation of the hormonal background, which is accompanied by a decrease in the cyst. The drug is released in tablets of 100 mg and taken one tablet per day at the same time from 1 to 21 days of the cycle. This ensures a constant normal concentration of hormones in the blood. Side effects of the drug are allergic manifestations, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, violation of libido, weight gain. Contraindications to use are acute violations of liver function, acute cholecystitis, malignant processes of any localization.
3. Janine is a low-dose, biphasic combined estrogen-progesterone drug that has a mechanism of action on anehogenous formations in the ovary the same as previous hormonal drugs. It is available in the form of pills, the number of which is 21. The reception starts from the first day of the menstrual cycle. Thanks to the content of estrogens and progesterone, the drug can regulate any hormonal imbalance. Receiving one pills a day for 21 days, then a break for 7 days, then the reception resumes. Side effects can develop in the form of dyspeptic manifestations, skin allergic reactions, changes in the breast as a pain, swelling, and bloody uterine discharge. Contraindications to the use of the drug - is diabetes, thrombosis and other problems with blood vessels, migraines, as well as pregnancy and lactation.
4. Antevin is a combined biphasic estrogen-progesterone drug that suppresses the normal menstrual cycle by regulating the hormonal background and prevents the process of ovulation. This contributes to the regress of functional cysts. The drug is available in the form of tablets of 21 pieces per pack. Among them 11 are white, and 10 - pink, respectively, the difference in composition. One tablet is taken with a 5 day cycle. Side effects can develop in the form of dyspeptic manifestations, discomfort in the mammary glands and a sense of their tension. Contraindications to taking the drug are diabetes, arterial hypertension, epilepsy, varicose veins, and smoking is not recommended at the time of taking this medication.

It is important in parallel with hormone replacement therapy to perform general strengthening and immunomodulating treatment in the form of vitamin therapy. Recommended vitamins A and E, and preferably multivitamin complexes. Among physiotherapeutic methods of treatment, ionophoresis and electrophoresis are recommended, as well as magnetic resonance therapy with asymptomatic forms of cysts. This helps to reduce them in size.

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

The operative method of treatment is more reliable and is used in older women, as the risk of malignancy of the cyst decreases. In case of complications, an operative method of treatment of anechogenous formations in the ovary is a method of choice.

Alternative treatment of anechogenous formation in the ovary

There are many alternative treatments for cysts. These include methods using many herbs, honey and other natural substances, as well as homeopathic remedies.

The main alternative recipes:

• Honey has many nutrients and trace elements that increase local immunity and stimulate regeneration. To create a medicine from honey, it is necessary to take the core of the bulb and place it in a glass with honey so that it is completely filled with it. This solution must be insisted overnight and moistened with a tampon in the given solution and introduced into the vagina at night, which should be repeated for 10 days, after which the cyst should decrease.
• Flaxseed oil regulates the broken ovario-menstrual cycle, and therefore it must be applied on a teaspoon daily in combination with carrot juice. To do this, five drops of fresh juice diluted 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 apply, like a shell of nuts, and septums. They need to pour a glass of alcohol and insist in a dark place for 3 days, after which take on an empty stomach on a tablespoon for at least a week.

Recipes with herbs are as follows:

• Prepare a herb collection of leaves of mint, nettle and currant - take them in equal quantities, pour hot water and boil for another 5 minutes, after which they cool and drink half a glass a day through the day for a month.
• Pine buds are brewed in the calculation of one tablespoon of raw material per liter of water, insist in a thermos night and drink throughout the day for half a glass 3-4 times a day for at least a month.
• The leaves of raspberries and inflorescences of the mallberry plant are steamed in hot water and take a glass of such tea in the morning and in the evening, drink for three weeks.

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

• Dysmenorm is a complex homeopathic drug that affects hormonal imbalance, including benign ovarian formations. The drug is released in the form of tablets and apply 1 tablet 3 times a day for half an hour before meals. Side effects are rare, but there may be nausea and temporary worsening of the condition. Not recommended for patients with celiac disease.
• Likopodium is a monocomponent homeopathic preparation that has efficacy in cysts of the right ovary. The preparation is released in the form of homeopathic granules of 10 g in a jar, also in the form of a tincture of 15 ml. Take between meals, dissolve under the tongue until completely dissolved by 1 granule 4 times a day. Not recommended for pregnant women. Adverse events were not detected.
• Ginekohel - a combined homeopathic preparation, which is available in the form of drops and applied 10 drops three times a day, before it must be dissolved in warm water. Side effects are noted rarely in the form of allergic phenomena. 
• Cyclodinone is a homeopathic preparation that normalizes the ovario-menstrual cycle when its second phase is inadequate. The drug is released in tablets or drops. Dosage - 1 tablet in the morning or 40 drops once a day. The course of treatment is not less than three months. Contraindication to use is pregnancy and allergic hypersensitivity to the components of the drug.

Prevention

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

Forecast

The prognosis of this pathology for life is favorable and for recovery is favorable, with timely diagnosis and correct treatment tactics. It is necessary to take into account the high risk of malignancy with ovarian cystaden, therefore such formulations should be treated promptly for a good future prognosis.

Anehogenous formation in the ovary is not a diagnosis that should be feared, but it is an ovarian cyst. It is necessary to differentiate the different types of cysts, which depends on the clinic and affects the tactics of treatment. These formations are benign and there are many methods of treating this pathology, both medicamentous and folk, and operative. Therefore, one should not be afraid of this diagnosis, but it is better to turn to the doctor for timely diagnosis and treatment, which helps to prevent various complications.