Ovarian endometriosis

Ovarian endometriosis. Most often, ovarian endometriosis is localized in the cortical layer of the ovaries; common endometriosis also affects the medulla. Endometrioid heterotopies are pseudocysts with a diameter of up to 5-10 mm, filled with a brown mass. The walls of heterotopia consist of layers of connective tissue.

Several histological types of ovarian endometriosis are distinguished: glandular, cystic, glandular-cystic and stromal. At the confluence of foci of endometriosis, endometrioid or “chocolate” cysts are formed, the walls of which are lined with a cylindrical or cubic epithelium.

Endometrial glands are often found in the cytogenic stroma and tissue of the affected ovary. This form of ovarian endometriosis corresponds to the truth of an epithelial tumor – the ovarian endometrioma. Glandular and glandular-cystic endometriosis has the greatest ability for proliferative growth and malignancy.

Clinical picture. Endometriosis of the ovaries to a certain time may not manifest. During menstruation, microperforations may occur in endometrioid heterotopies or endometrial cysts. When the endometriotic contents get into the abdominal cavity, the parietal and visceral peritoneum is involved in the pathological process, further spread of endometriosis foci and adhesions are formed. There are complaints of dull aching pain in the abdomen, aggravated during menstruation. Adhesions and the spread of foci of endometriosis in the peritoneum increase pain during physical exertion and sexual contact. In 70% of patients with ovarian endometriosis, algodimenorrhea and dyspareunia are noted.

Diagnostics. External painful endometriosis with ovarian involvement in the early stages of the disease is indicated by chronic pain syndrome. Small cystic heterotopies of endometriosis do not lead to a marked increase in the ovaries and are almost not diagnosed during a gynecological examination. With the formation of adhesions, motility of the uterus may be limited, often the ovaries are palpable in a single conglomerate with the uterus. Data of gynecological examination and additional methods of research are more informative when endometrioid transudate accumulates and endometrioid cysts form. The volume of endometrial formations varies depending on the phase of the menstrual cycle: their size before menstruation is less than after it.

In case of small endometrioid ovarian heterotopies, the cystic cavity is not formed and, therefore, their ultrasound imaging is difficult. During the formation of the endometrial formation, the information content of the ultrasound increases to 87–93%. Endometrioid ovary masses have a rounded shape with a pronounced echo-positive capsule, contain a finely dispersed echo-positive suspension on the background of liquid contents, are more often bilateral, localized posterior to the uterus. The internal relief of the walls may be uneven due to the wall sediment. The size of endometrial cysts can reach 15 cm in diameter. In the wall of the endometrioma at the CDC, a high-resistance blood flow is recorded. For the differential diagnosis of endometriosis and malignant tumors, it is important to determine the following onco-antigens: CA 19-9, CEA and CA 125, which are analyzed by ELISA. In patients with endometriosis, the concentration of CA 19–9 was found to be on average 13.3–29.5 U / ml, CA 125 oncoantigen — on average 27.2 U / ml, and in 95% of cases it does not exceed 35 U / ml. The content of cancer embryonic antigen (CEA) is 4.3 ng / ml. For a more complete and accurate screening, as well as to control the treatment of endometriosis, it is advisable to use testing with three tumor markers.

The greatest diagnostic value in endometriosis of the ovaries is laparoscopy, in which inclusions in the stroma of the small size (2-10 mm) are bluish or dark brown in color, sometimes with dark blood leaking. Endometrial formations have a whitish capsule with a pronounced vascular pattern and a smooth surface. The capsule of endometrial formations is often intimately soldered to the posterior surface of the uterus, fallopian tubes, parietal peritoneum, and the serous cover of the rectum. The contents are degtepodobnoe, thick, painted in chocolate brown.

Endometriosis fallopian tube. Its frequency is from 7 to 10%. Endometriotic foci affect the mesosalpinx, may be located on the surface of the fallopian tubes. The concomitant adhesive process often contributes to the violation of the functional usefulness of the pipe.

The main method for diagnosing endometriosis of the fallopian tubes is laparoscopy.

Endometriosis peritoneum of the small pelvis. There are two main variants of peritoneal endometriosis. In the first case, endometriotic lesions are limited to the pelvic peritoneum; in the second variant, endometriosis affects the ovaries, uterus, fallopian tubes, and the pelvic peritoneum in the form of foci.

Small forms of endometriosis do not manifest themselves clinically for a long time. However, the frequency of infertility in isolated small forms of endometriosis can reach 91%.

With the spread and invasion of foci of endometriosis in the muscular layer of the rectum, pararectal fiber, pelvic pains, dyspareunia appear, more pronounced on the eve of menstruation and after it.

Diagnostics. The main diagnostic method is laparoscopy, which allows to identify pathological changes. More than 20 types of superficial endometrial foci on the pelvic peritoneum have been described. Red and ogneiform foci, hemorrhagic vesicles, vascularized polypoid or papular foci, shrinking black inclusions, scar tissue with pigmentation or white foci, as well as other types of heterotopies that can be histologically confirmed are distinguished. Red foci by morphological and biochemical properties represent the most active stage of endometriosis development. Petechial and wolf-like foci are more often diagnosed in adolescents and may spontaneously disappear at reproductive age. In premenopause, the red foci are replaced by pigmented and fibrous heterotopias, and in the postmenopausal black and white cicatricial foci predominate.

local_offerevent_note March 18, 2019

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