Cyst of the corpus luteum of the ovary
The content of the article:
- Causes and risk factors
- Forms
- Symptoms of the cyst of the corpus luteum of the ovary
- Features of the course of the disease in children
- Diagnostics
- Treatment of the cyst of the corpus luteum of the ovary
- Possible complications and consequences
- Forecast
- Prevention
The cyst of the corpus luteum of the ovary, or the luteal cyst, is a functional retention tumor-like formation that occurs as a result of the accumulation of fluid in the place of the corpus luteum, which has not undergone involution. According to statistics, the disease occurs in 2–5% of women of reproductive age.
The exact causes of the cyst of the corpus luteum of the ovary are not established
The corpus luteum is a cyclically formed glandular organ that forms at the site of the ovulated follicle in the second phase of the menstrual cycle. The name is dictated by the yellowish color of tissues, due to the content of lipochromic pigment in the cells. The biological task of the corpus luteum is the production of sex hormones, especially progesterone, which has a relaxing effect on the smooth muscles of the endometrium, facilitating the implantation of a fertilized egg. If fertilization does not occur, the corpus luteum regresses, disappearing on the 24-28th day of the menstrual cycle, in case of pregnancy, it continues to increase in size and persists for 18-20 weeks, and the placenta takes over the hormone-producing functions.
In violation of the natural course of involution of the corpus luteum, blood supply and lymph flow in the glandular tissue are disrupted. Multiple punctate hemorrhages and accumulation of serous effusion lead to cystic degeneration of the corpus luteum. As a result, a single-cavity neoplasm is formed, enclosed in a capsule, the walls of which are formed by granular luteal cells. The location of the cysts, as a rule, is one-sided, and the cyst of the corpus luteum of the right ovary is more common - in 60% of cases.
Causes and risk factors
The reasons for the cystic degeneration of the corpus luteum have not been completely clarified. A certain role is played by hereditary predisposition and constitutionally determined dysfunctions of the pituitary gland, which cause disorders of the humoral regulation of the reproductive cycle.
The provoking factors for the development of a luteal cyst include:
- inflammatory diseases of the ovaries and appendages of an infectious and non-infectious nature;
- abortion;
- use of emergency contraceptive drugs;
- taking medications that stimulate ovulation;
- early onset of menstruation;
- diseases of the thyroid gland;
- unbalanced diet, excessive dieting.
The influence of intense physical and emotional stress, harmful working conditions and other stress factors is not excluded. It is noticed that in women who smoke, cystic anomalies of the ovaries are diagnosed almost twice as often as in non-smokers.
Smoking a woman is a risk factor for the development of a cyst of the corpus luteum of the ovary
Forms
In gynecological practice, luteal cysts, which appeared in the absence of fertilization and developed during pregnancy, are differentiated. In the first case, the question arises about the need for treatment; in the second, medical intervention is required only in case of risk of complications - by the second trimester of gestation, when the formation of the placenta ends, the neoplasm usually disappears along with the corpus luteum.
Symptoms of the cyst of the corpus luteum of the ovary
With a small cyst, the disease is asymptomatic. Sometimes a woman feels mild discomfort or a feeling of heaviness and distension in the lower abdomen and in the area of the appendages on the right or left, which are aggravated by pressure, playing sports, intercourse, urination or defecation. With a cyst of the corpus luteum of the ovary, the symptoms are more pronounced with a tumor size of more than 6 cm or a concomitant infectious process.
Due to excessive production of progesterone in the presence of a cyst of the corpus luteum, a woman experiences a malfunction of the menstrual cycle
The active production of progesterone by luteal cells of the cyst leads to uneven endometrial rejection, which causes menstrual irregularities. Patients have premenstrual pulling pains in the lower abdomen, bleeding on the first day of menstruation, uterine bleeding, delayed menstruation, an increase in the duration and volume of discharge.
Features of the course of the disease in children
A corpus luteum cyst is often found in adolescent girls; pathology is often preceded by pituitary disorders. Since fluctuations in hormonal levels during puberty can cause rapid growth of neoplasms, regular observation by a pediatric gynecologist is recommended.
Diagnostics
A presumptive diagnosis is established during a gynecological examination, taking into account the history and complaints of the patient. A vaginal examination behind the uterus or on the side of it reveals an elastic, inactive formation more than 3 cm in size. Larger cysts are detected on a bimanual examination. It should be noted that during pregnancy, the cyst of the corpus luteum of the right ovary is often not determined the first time.
The leading role in the diagnosis of functional ovarian cysts is played by transvaginal ultrasound, which makes it possible to judge the size of the neoplasm, the thickness and structure of the capsule, the presence of growths, the nature of the contents of the cyst, etc. A luteal cyst is visualized as a homogeneous anechogenic formation of a rounded shape with smooth, clear contours, in the internal cavity suspended fine inclusions may be present. To clarify the diagnosis, a dynamic ultrasound scan is performed in the first phase of the menstrual cycle.
If a cyst of the corpus luteum of the ovary is suspected, transvaginal ultrasound is performed
In doubtful cases, additional studies are prescribed. A blood test for chorionic gonadotropin (HCT) reliably determines the presence of pregnancy. Color Doppler ultrasonography allows to immediately exclude oncopathology: the absence of vascularization of the internal structures of the neoplasm reliably distinguishes a retention cyst from a true tumor. Luteal cysts are generally not prone to malignancy, but a blood test for an ovarian tumor marker is shown to determine the degree of oncological risk.
In order to differentiate the corpus luteum cyst with an ectopic pregnancy, ovarian cystoma and tecalutein cysts with cystic drift and chorionepithelioma, laparoscopy is performed - an endoscopic examination of the abdominal organs. Since general anesthesia is required, the study is carried out in a hospital setting. After the laparoscopy, the patient should be kept in bed for 24 hours.
Treatment of the cyst of the corpus luteum of the ovary
With an uncomplicated course, corpus luteum cysts are prone to self-reduction within two to three menstrual cycles or in the fourth or fifth month of pregnancy. In the absence of clinical manifestations, the disease does not affect the woman's quality of life, does not prevent pregnancy, and, therefore, does not need urgent treatment. Medical tactics take on a wait-and-see nature; the observation of a gynecologist and dynamic ultrasound control are shown. If, for two to three months, spontaneous resolution of the cyst does not occur or new formations appear, the issue of choosing a therapeutic regimen or surgical intervention is decided.
With a small size of the cyst of the corpus luteum of the ovary, treatment is reduced to correcting the hormonal background and eliminating concomitant diseases. The gynecologist-endocrinologist draws up an individual regimen for taking oral contraceptives; if necessary, anti-inflammatory drugs and antibiotics are also prescribed. Physiotherapeutic methods can be used as auxiliary means:
- balneotherapy (vaginal irrigation and therapeutic baths);
- electrophoresis and phonophoresis of drugs;
- peloid therapy;
- laser therapy;
- magnetotherapy.
During the period of observation and undergoing conservative treatment, the patient should refrain from sexual intercourse, eat rationally and minimize the influence of stress factors, and instead of intensive training, maintain moderate physical activity and a sparing daily regimen.
With frequent relapses, a complicated course and a tumor size of more than 6 cm, its surgical removal is indicated. The most gentle method of surgery is laparoscopic exfoliation of the cyst. The use of endoscopic manipulators guarantees minimal trauma to healthy tissues, absence of scars and a quick return to active life.
When the size of the corpus luteum cyst is more than 6 cm, laparoscopic exfoliation of the cyst is shown
With multiple neoplasms and a cyst size of 7-8 cm, ovarian resection is used to preserve reproductive function. In the most advanced cases and when there is a threat to the patient's life, the ovary is completely removed.
Possible complications and consequences
According to the US Department of Health, complications of a luteal cyst are diagnosed annually in 0.2–5% of urgently hospitalized patients, the vast majority of whom have not previously been seen by a gynecologist or have not undergone systematic treatment.
With a complicated course of the cyst of the corpus luteum of the ovary, most often there is a rupture of the cyst with extensive hemorrhage into the abdominal cavity - a life-threatening condition that gives a clinical picture of an acute abdomen, which is characterized by:
- tension and severe soreness of the abdomen;
- diffuse cramping pains;
- nausea and vomiting;
- increased body temperature;
- lack of peristalsis;
- bloating and retention of stools;
- severe pain reaction on palpation of the supraclavicular region.
If, when the vessels rupture, blood is poured into the cavity of the neoplasm, a hemorrhagic cyst is diagnosed. In this case, clinical signs appear in a more smoothed form. One way or another, with the appearance of a symptom complex of an acute abdomen, the patient needs urgent medical attention. Of particular concern is a sharp drop in blood pressure, indicating extensive internal bleeding. According to statistical observations, the cyst of the corpus luteum of the left ovary is less prone to rupture.
Torsion of the legs of the luteal cyst is another common complication that, if not treated, can be fatal. Twisting the leg connecting the capsule of the neoplasm with the surface of the ovary disrupts the blood supply to the corpus luteum, provoking the formation of an ischemic zone, and subsequently the development of necrosis.
A dangerous complication of the cyst of the corpus luteum of the ovary, torsion of the leg, can be fatal
A characteristic indication of a possible torsion of the cyst leg is severe pain in the lower abdomen with irradiation to the lower extremities. When the legs of the cyst of the corpus luteum of the left ovary are twisted, the pain radiates to the left leg, when the legs of the right-sided cyst are twisted, to the right. With a slight rotation of the cyst (from 60 to 90 degrees), the clinical picture of torsion may be blurred, but this does not eliminate the danger. Therefore, it is important for any complaints of gynecological pain to immediately contact a specialist.
The risk of developing complications increases with injuries, heavy lifting, sudden movements, bleeding disorders and rough sexual intercourse. The likelihood of rupture of a luteal cyst is especially high from the 20th to the 26th day of the menstrual cycle.
Forecast
With timely treatment, the cyst of the corpus luteum of the ovary is completely cured and does not affect fertility. With the development of complications for women planning pregnancy, the prognosis is conditionally poor. With a prolonged asymptomatic course, the cyst of the corpus luteum of the ovary slowly increases in size and damages healthy tissue, which can lead to infertility.
Prevention
To prevent the formation of functional ovarian cysts, women with an established two-phase cycle are recommended to undergo preventive examinations by a gynecologist at least once a year. Timely identification and treatment of hormonal disorders and inflammatory processes allows you to prevent the development of the cyst of the corpus luteum of the ovary and prevent the occurrence of complications if the cyst is still formed.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
