Ovarian cyst

Introduction to ovarian crown cyst An ovarian crown cyst is a cyst located in the broad ligament near the fallopian tube or ovary. The name ovarian coronary cyst does not involve histology, but only some cystic masses between the fallopian tubes and the ovaries between the two lobe of the wide ligament. Ovarian coronary cysts are benign non-neoplastic cysts, but there are also reports of a few ovarian crown cysts. Can occur in any age group, women of childbearing age are more common. Ovarian coronary cysts are not ovarian cysts and are tumor-like lesions. basic knowledge The proportion of the disease: the incidence rate of women is about 0.01% - 0.03% Susceptible people: women Mode of infection: non-infectious Complications: Infertility Acute abdomen

Ovarian crown cyst

(1) Causes of the disease

Ovarian coronary origin refers to the cranial side of the middle kidney tube of the embryonic period, including the longitudinal tube and 10 to 15 short transverse tubes connected thereto. The source of the tissue is currently considered to be: the source of the middle kidney tube (noon tube), the source of the secondary kidney tube (Miller tube), and the mesothelium source. The middle kidney tube tissue may be intermittently or partially residual in the female embryo development, and cysts will occur later. The cysts derived from the secondary renal tube are generally larger, and such cysts have little malignant transformation, but can develop into a borderline ovarian crown cyst.

(two) pathogenesis

From an embryological point of view, the genitourinary system includes the middle kidney system, the accessory kidney system, the kidney structure, and the gonads. Female fetuses have no testiculars and no endogenous androgen support. The middle kidney tube is gradually degraded, and the secondary kidney tube is uninhibited and develops into the female internal genitalia. In fact, the middle kidney system is not completely degenerated, such as the ureter, the bladder triangle and the adjacent urethra are derived from the middle kidney tube. The small tube of the middle kidney tube is in the wide ligament of the adult woman and the side of the cervix. The side of the vagina and other parts become remnants and are retained. Most of the remnant tissue can remain stable for a long time without change, but a few of the renal tubular remnants can develop into cysts, ie, middle renal cysts.

The deputy middle kidney tube is formed by inward depression of the body cavity at 5 to 6 weeks of the embryo. The tail is fused, cavityd to form the uterus, the cervix and the upper part of the vagina, and the segment that opens into the abdominal cavity, then forms the fallopian tube. In this process, there may be a sub-lumen or a diverticulum. According to the opinion of woodruff et al, it is believed that there is an incidence of 5% to 10%, and these sub-lumen often have no openings, so the secretion of the epithelium in the lumen cannot be discharged, accumulates in the cavity, and gradually expands to form a cyst. This type of cyst is actually a tubal effusion, not the source of the middle kidney tube but the source of the secondary kidney tube.

Mesothelial cells may also become cysts in the paraneoplastic epithelium through metaplasia. In the ovarian coronary cyst, a small part is malignant papillary serous cystadenocarcinoma, which has the histological features of the fallopian tube. This is a strong evidence that these cysts are derived from the accessory renal tubular system or mesothelial cells. .

(3) Pathological changes

The middle kidney system is lined with a small cavity of a single-layered cuboidal epithelium, surrounded by a clear layer of muscle tissue. The epithelium in the cavity is relatively lack of secretory activity, so there is no rapid cystic expansion, poor cell secretion, no cilia, and small volume. . If the cyst grows up, the wall of the capsule is thin, round or oval, and the fallopian tube is also elongated, which seems to climb above the cyst. If the fallopian tube is cut open, the cyst is easily peeled off. The cyst is cut and the section is a single room. The capsule is filled with a low specific gravity clear solution. If the cyst is over-expanded, the squashed epithelium of the lining can become a flat epithelium.

The secondary renal tubular cyst is often large, and its intraluminal epithelium has a secretory function, or is a ciliated epithelial cell, like the ovum or endometrial epithelium, with obvious secretion, no obvious basement membrane, and fibrous tissue. There are papillary folds in the cavity, and a thin annular muscle layer around the wall. In short, if a cyst has a secretory component similar to the fallopian tube epithelium, which causes a large cyst in the lumen, it is often the source of the secondary renal tube.

The epithelium in the mesothelial cell capsule is a squamous epithelial cell with fibrous tissue or a fat-like envelope around the wall of the capsule.

(4) Pathological differentiation

Gardner et al. distinguish the tissue source according to the following criteria: 1 The tissue type of the epithelium, if there are ciliated cells or secretory cells (clear and neutral cytoplasm), it is the source of the secondary kidney system, otherwise it is the source of the middle kidney system. 2 Whether there is a basement membrane, a cyst derived from the middle kidney system, a basement membrane under the epithelium, and a cyst derived from the kidney in the secondary kidney often lacks the basement membrane. 3 Whether there are wrinkles in the lumen, wrinkles, it is mostly from the source of the secondary renal system, and the wall of the middle renal cyst is less flat and wrinkles less. 4 The reactivity of the epithelium to hormones, in fact, also depends on whether the cells have a secretory response. As for the cysts derived from mesothelial cells, the lining epithelium is basically the same as the cysts derived from the accessory kidney system. The difference is to observe whether the wall of the capsule is connective tissue or muscle tissue, and the muscle tissue is the source of the accessory kidney system, otherwise it is a cyst of mesothelial cells.

Ovarian crown cyst prevention

Menstrual period and postpartum women should pay special attention to adoption, prohibition of sexual intercourse, keep the vulva and vagina clean, feel comfortable and stable, try to reduce the various competitive pressures in life, avoid worry and anger, learn to adjust, keep warm, avoid being affected Cold, rain and wading, or cold water, swimming, etc.

In the past, menopausal people began to suffer from dysmenorrhea or dysmenorrhea. The previous regular menstruation became irregular. If you have the above symptoms, you should pay attention to early treatment and rule out. Regular gynecological examinations, early detection of early diagnosis, early treatment, if abnormal ovarian findings can not be diagnosed, regular follow-up.

Ovarian crown cyst complications Complications, infertility, acute abdomen

Infertility and acute pedicle torsion produce acute abdomen. Cysts are a cause of infertility and are not directly related to the size of the cyst. The patient has abdominal distension, a sense of falling, and severe abdominal pain. Because the torsion is mostly in the oviductal mesenteric, fallopian tube isthmus or ovarian ligament, the pelvic funnel ligament containing the ovaries and arteriovenous trunk is often outside the torsion site, so the blood circulation of the cyst is not completely Blocking, tissue necrosis is also mild, so the symptoms are not serious.

Ovarian coronary cyst symptoms Common symptoms Ovarian cyst cystic mass pain abdominal pain pelvic mass

When the cyst is small, there is usually no symptom. It may be at a young age. As the endocrine function begins, the secretion activity of the intraluminal epithelial cells is strengthened, and the cystic dilatation occurs after puberty.

Gynecological examination:

More than found in gynecological census or B-ultrasound. The cysts are small and generally rarely exceed 10 cm in diameter. Due to gynecological examinations such as infertility and early pregnancy, the cystic mass can be rounded or oval in the upper left or upper right part of the uterus. Cysts can occur from the broad ligament along the uterus, from the cervix to the vagina. Generally unilateral, bilateral is rare, the wall is thin and smooth, a few cavities can have nipple hyperplasia, become a benign serous papillary cystadenoma, some cases may have malignant transformation, and even form a substantial cancer .

Acute abdominal pain:

Ovarian coronary cysts are rare compared with common ovarian cysts, and their size is obviously different. The smaller ones are 1~2cm in diameter, the larger ones can reach 20cm, and the general diameter is about 8cm. Generally, the ovarian crown cyst is in the broad ligament, and the activity is small, so there is no twisting, but a few cysts with pedicles in the umbrella have severe pain. The general lesion is unilateral, and the bilateral patients have malignant changes in a very small number of cases, eventually forming a substantial cancer.

Compression symptoms:

A huge cyst can compress adjacent organs, such as compression of the bladder, colon, and ureter to produce the corresponding symptoms.

Examination of ovarian crown cyst

1. Laparoscopy: After the abdominal cavity is inflated, the intestines are moved up and the pelvic organs can be clearly exposed. If you see a cyst in the broad ligament, and see the ovaries and fallopian tubes, the diagnosis can be clear.

2. B-mode ultrasonography: If the image of the uterus and ovary is seen in the ultrasound imaging, the mass of the block next to it is mostly an ovarian crown cyst. This method is indirectly speculated. The normal ovary can be detected on the affected side of the ovarian crown cyst, which can be distinguished from the ovarian cyst.

3. Pneumoperitoneal angiography: X-ray film is taken after inflating the abdominal cavity. If the shadow of normal uterus and ovary is seen in the film, the remaining block shadow may be an ovarian crown cyst. This method has the same shortcomings as the B-mode ultrasound examination. It cannot directly see the nature of the mass, nor can it exclude cysts derived from the fallopian tube.

4. Ovarian section: If the cyst is large and has a papillary projection into the lumen, a cryosection histological examination is required.

5. Gynecological routine palpation: in the upper left or upper right uterus, the cystic mass is round or oval, and can be active.

Diagnosis and differentiation of ovarian coronary cyst

diagnosis

Ovarian crown cysts <3cm in diameter, generally have no clinical symptoms, and are not easily touched by gynecological examinations, so they are often missed. Larger ovarian coronary cysts, often due to their location close to the ovary, are often misdiagnosed as ovarian cysts or accessory inflammatory masses. Therefore, clinically, there are not many diagnoses before surgery. For example, B-mode ultrasound, laparoscopy, and laparoscopic angiography can improve the diagnosis rate. If B-ultrasound finds normal ovarian tissue under the cyst, the diagnosis can be confirmed.

Ovarian coronary cysts and ovarian cysts are almost impossible to differentiate before surgery. There are obvious differences in the specific specimens during or after surgery. The characteristics are as follows: 1 The ovaries are completely separated from the cysts. When the cyst is large, the ovary is thinned by being squeezed and is close to the wall. The cyst wall is thin and translucent. 2 The fallopian tube is expanded by the expanded cyst, surrounded by the upper or the rear of the cyst, and can form a cyst pedicle with the posterior lobe of the broad ligament.

Differential diagnosis

It should be differentiated from ovarian endometriosis cyst, ovarian inclusion cyst, ovarian simple cyst and inflammatory cyst.

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