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Ovarian cyst: diagnosis and natural treatment

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  • On 21/08/2020
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The diagnosis of ovarian cysts is usually made by chance during an ultrasound exam on the patient or when the patient has a routine pelvic exam. Most patients with ovarian cysts have no symptoms (asymptomatic). However, some cysts can also cause severe symptoms.

One of the investigations needed to diagnose ovarian cysts is imaging such as ultrasound, CT scan, and MRI . Although not specific, examining the CA-125 marker is a blood test that can be done to determine the possibility of ovarian cancer . A histological examination is performed to determine the type of ovarian cyst (definitive diagnosis of ovarian cyst).

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INTRODUCTION   

Ovarian Cysts - Global Women Connected                                                                      

The history of the disease that can be explored includes the presence of risk factors and complaints experienced by patients. The complaints that may be felt are pain or an uncomfortable feeling in the lower abdomen, especially on the side of the ovary where the cyst is located. Complaints will be severe if the size of the cyst is enlarged, complications arise such as ovarian torsion or rupture of the cyst , and if the malignant ovarian cyst has reached an advanced stage.

 In addition, the following clinical signs and symptoms may occur in patients with ovarian cysts:

  • Pain or discomfort appears in the lower abdomen. This pain may be dull or sharp, may also be constant or go away.
  • The patient may experience discomfort during coitus , especially during deep penetration.
  • Irregular menstrual cycles and abnormal vaginal bleeding can occur; intermenstrual intervals may be lengthened, followed by menorrhagia.
  • Patients may experience fullness and bloating.
  • In patients with endometriosis , dysmenorrhea and dyspareunia may occur.
  • In patients with polycystic ovarian disease, hirsutism, infertility , oligomenorrhea, obesity, and acne may occur.
  • Some patients may suffer from tenesmus .
  • If there is an ovarian torsion, severe pain may be accompanied by nausea, vomiting, and hyperprexia .
  • Bleeding from a ruptured cyst can cause tachycardia , hypotension, and signs of peritonitis.
  • In children, precocious puberty and early onset of menstruation can be observed.

Physical examination

Examination of vital signs is very important, especially if there are complications from ruptured cysts and ovarian torsion. This examination is performed to rule out the possibility of shock (hemorrhagic / neurogenic) in patients.

On palpation, a large cyst can be palpated in the abdomen. However, in obese patients it is difficult. Normal ovaries can be felt in thin young women, but should be careful of abnormalities if the ovaries are palpable in postmenopausal women. Signs of peritonitis, such as abdominal tenderness or a tense abdomen, may also be examined in cases of massive bleeding due to a ruptured cyst.

Differential diagnosis

The differential diagnosis of ovarian cysts and their complications includes the following:

  • Reproductive system: ectopic pregnancy (KET), pelvic inflammatory disease, ovarian abscess, tubo-ovarian abscess, endometriosis, salpingitis , hydrosalpinx , PCOS, impending abortion, and primary tubal cancer
  • Gastrointestinal system: acute appendicitis, abdominal abscess, diverticulitis
  • Other: peritoneal cysts, kidney stones. The investigation in the form of imaging is the most important to know the presence of ovarian cysts.

Laboratory examination

Laboratory tests that can be performed include:

  • Complete blood test: Focus on hematocrit and hemoglobin to assess the presence of anemia caused by acute bleeding
  • Pregnancy checks: Urine or blood tests for pregnancy are often done in premenopausal women with ovarian cysts. Ovarian cysts can occur during pregnancy.
  • CA-125: is a test that is sometimes done on women with ovarian cysts. However, ovarian cancer cannot be diagnosed based on the results of the CA-125 exam. Many women with early stage ovarian cancer will have normal levels of CA 125. CA-125 increases abnormally in about 80% of women with advanced ovarian cancer. In addition, non-cancerous conditions can increase CA-125, including endometriosis, uterine fibroids , pelvic infections, heart failure, and liver and kidney disease. Therefore, CA-125 measurements are not recommended in all cases.
    • CA-125 is often recommended in postmenopausal women with ovarian cysts
    • CA-125 may be recommended for premenopausal women with very large ovaries or suspected cancer based on ultrasound results
    • CA-125 is not always recommended for premenopausal women with small ovarian cysts and does not appear suspicious of cancer

Imagery verification

Ultrasound is the modality  imaging  (  imaging  ) the most important. This examination can confirm the morphological characteristics of an ovarian cyst. Ultrasound can be performed both transvaginally and transabdominally.

Besides ultrasound, other imaging modalities that can be used are computed tomography and MRI. CT scans are more sensitive, but are less specific for detecting ovarian cysts compared to ultrasound. However, CT scans give a good picture of hemorrhagic ovarian cysts or hemoperitoneum due to a ruptured cyst. Due to its radiation, the use of the CT-Scan is avoided by pregnant women. MRI is more specific for ovarian cysts than CT scan, but it is also safer for pregnant women, but MRI examination requires low cost.

Histological examination

The definitive diagnosis of all ovarian cysts is based on histological analysis. Each type of cyst has a unique histological picture. Among them:

  • In dermoid cysts , the main constitutive tissue is ectodermal tissue. Tumor constituents are made up of mature cells (hence these cysts are also called mature teratomas). The tumor wall contains numerous sebaceous glands and ectodermal derivatives.
  • In cystadenoma serum , focal proliferation in the cyst wall causes papillomatous projections in the center of the cyst which can be transformed into cystadenofibromas. These papillomatous projections must be carefully examined to distinguish them from atypical proliferation.
  • In cystadenoma musinosum, the tumor wall is composed of an elevated collateral epithelium with a dark colored cell nucleus located in the basal part. The wall of cystadenoma musinosum in 50% of cases is similar to the structure of the endocervical epithelium and the remaining 50% is similar to the structure of the colonic epithelium where the mucous fluid in the cystic loci contains goblet cells. examination that can also be done in cases of ovarian cysts is a diagnostic laparoscopic examination.
 
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