follicle enlargement
Introduction
Introduction Ovarian cysts, as the name implies, can be called "Ovarian mass" directly. Ovarian masses include Ovarian Cyst and Ovarian tumor or Ovarian neoplasm. Ovarian tumors are divided into benign and malignant, both called "ovarian tumors." Ovarian cysts are sometimes non-neoplastic, while ovarian tumors with some solid tissue are Neoplastic. The former are all benign and the latter are about 20% vicious. The most common ovarian cysts are functional cysts, including Follicular cysts and Corpus luteum cysts, which account for the majority of ovarian cysts. Others include Theca-lutein cyst, pregnancy luteoma and Polycystic Ovary, also known as Stein-Leventhal syndrome, polycystic The ovary is actually not a tumor, but the ovary is larger than the average, and contains many small vesicles. The problem of its combination is obesity, infertility, rare menstruation, etc. The ovarian capsule of these patients is thickened. . These are all functional cysts, and endometriotic cysts are also a type of ovarian cyst, not a true neoplastic ovarian tumor. A functional cyst is a ovarian that does not ovulate in a certain cycle, and causes the follicle to continue to increase, called a cystic follicle. When the follicle is larger than 3.5 cm, it is called a follicular cyst. Because they are all benign. If there is ovulation, a corpus luteum will form when it is normal, but the internal corpus luteum will form an abnormal growth of the cyst and become a corpus luteum cyst. Follicular cysts and corpus luteum cysts usually last a few days to two weeks, and most of them will disappear automatically.
Cause
Cause
Ovarian cysts are a type of ovarian tumor in a broad sense. The morphological complexity of ovarian cysts exceeds that of any organ because:
1 The ovarian tissue structure has potential developmental pluripotency;
2 The ovary is very close to the urinary system during embryogenesis, and part of the renal tissue can be lost into the ovary;
3 ovaries come from embryonic genital warts, male and female homologous, with rear differentiation. Therefore, the cause of ovarian cysts is very complicated, many times beyond the normal cause. Below we will make an overview of how ovarian cysts are produced and its clinical classification.
There are eight aspects to how ovarian cysts are produced:
1, endometrial implantation theory: Sampson first proposed menstrual period shedding of endometrial debris, with menstrual blood flow through the fallopian tube into the abdominal cavity, planted in the ovary and adjacent pelvic peritoneum, and followed by long and spread, developed into endometriosis A disease. Women with genital malformations or obstruction often have endometriosis, suggesting that menstrual blood flow can cause endometrial implantation. Repeated or too rude gynecological double-consultation, the endometrium is squeezed into the fallopian tube, causing abdominal cavity planting. The operation rules of the fallopian tube patency test (ventilation, fluid) and angiography are not standardized, and the endometrial fragments are pressed into the abdominal cavity through the fallopian tube to cause abdominal cavity implantation. Abdominal wall endometriosis or endometriosis occurs in perineal wounds after delivery. It is the iatrogenic implantation caused by the operator bringing the endometrium to the incision. During caesarean section and cesarean section, the uterine cavity overflows into the abdominal cavity. When the uterine incision is sutured, the suture passes through the endometrium caused by the endometrium.
2. Lymphatic and venous dissemination theory: The presence of endometrial tissue found in pelvic veins or lymph nodes supports this argument. It is believed that endometriosis that occurs in organs and organs such as the lungs, hands, and thighs away from the pelvic area may be the result of lymphatic or venous dissemination.
3, body cavity epithelial metaplasia: female reproductive system epithelium, ovarian reproductive epithelium and pelvic peritoneal pleura originate from the body cavity epithelium, when affected by inflammation, trauma, estrogen too high and other factors, or body cavity epithelium, repeated by menstrual blood, hormones Or the stimulation of chronic inflammation can metamorphose into endometrioid tissue, forming endometriosis. 80% of endometriosis occurs in the ovaries and is associated with the metaplastic potential of the ovarian epithelium. However, many scholars believe that peritoneal stimulation combined with endometriosis is a fruit rather than a cause, and peritoneal stimulation occurs in areas other than ectopic
4, immunology: Some people believe that in the case of women's immune function, the menstrual period through the fallopian tube into the peritoneal cells of the intimal cells of the local immune system to kill, if the local immune function is insufficient or the number of endometrial cells in the peritoneal cavity When too much, the immune cells are not enough to kill, that is, endometriosis occurs. It has also been reported that patients with endometriosis who have a history of lupus erythematosus or other autoimmune disease are twice as likely as those without the disease. The experimental results show that in the serum of patients with endometriosis, IgG and anti-endometrial autoantibodies are significantly increased compared with the control group, and the deposition rate of lgG and complement C3 in the endometrium is higher than that of normal women. Endometriosis may be an autoimmune disease. It is currently believed that patients with endometriosis can have humoral immunity, that is, B cell response is enhanced, and cellular immunity, that is, T cell immune function is insufficient. The abnormality of the above immune function is the cause of endometriosis, and the result of endometriosis remains to be determined.
5, genetic theory: some patients with endometriosis, the incidence of the same disease in their families is more than the average woman, it is speculated that there may be genetic genes.
6, Koninckx and other doctrine: Recently Koninckx et al proposed in patients with endometriosis often associated with luteinized unrupted follicle syndrome (LUFS). Due to LUFS, the follicles are not ruptured, and the concentration of estrogen and progesterone in the ascites is low, which is conducive to endometrial cell implantation and prone to endometriosis. This theory remains to be confirmed.
7, hypothalamic-pituitary-ovarian axis dysfunction said: hypothalamic-pituitary dysfunction is mainly manifested in patients with excessive LH secretion, no periodic changes and LH peak, and FSH secretion is normal or slightly lower, thus LH / The ratio of FSH increases, and LH directly acts on the ovarian follicular cells. By increasing the activity of intracellular branches to cleave P450c17a, the ovarian follicular cells produce excessive androgen. The basic pathophysiological changes in many patients with ovarian cysts and polycystic ovary syndrome in clinical practice are that the ovaries produce too much androgen, and the excessive production of androgens is the result of the synergistic effects of multiple endocrine system functions in the body.
Examine
an examination
Related inspection
Gynecological ultrasound examination gynecological examination ovarian function examination ovarian examination
1. Ultrasound performance:
(l) The volume is small, the wall of the capsule is smooth and thin, and the sound is good, often single, protruding from the surface of the ovary. There is an anechoic zone inside, and the back wall and rear echoes have an enhancing effect.
(2) During regular follow-up, it can be found to shrink or disappear by itself.
2. CT performance:
(1) The edge is clear, the wall is thin, and the round is low-density mass.
(2) CT value is generally 0 ~ 20HU, CT value can be increased when there is bleeding or infection.
(3) Sometimes there is stratification or separation in the capsule.
(4) After the enhancement, the edge of the cyst is strengthened and there is no enhancement inside.
3. MRI performance:
(1) The ovarian cyst is a low signal on the T1-weighted image and a high signal on the T2-weighted image.
(2) Follicular cysts often occur frequently, and can also be single-shot, which is a round or oval thin-walled mass with clear and sharp borders.
(3) The internal structure of the follicular cyst is uniform, and the internal structure of the corpus luteum cyst is not uniform.
Diagnosis
Differential diagnosis
Functional cysts: This is the most common cyst. In women of childbearing age who occur during the ovulation cycle, abnormal amounts of fluid accumulate in the follicles or in the corpus luteum, forming follicular cysts or corpus luteum cysts. This functional cyst can sometimes be large, but it usually disappears within three months, regardless of medication.
1, hemorrhagic cysts: sometimes follicular cysts and corpus luteum cysts grow too fast, causing ovarian tissue involved and cracked bleeding. These blood are accumulated in the ovaries because they are not exported. They are called hemorrhagic cysts. This cyst usually disappears on its own but takes longer. If the symptoms of physical discomfort are more obvious, you can take the medicine to slow down the symptoms. In a few cases, the patient needs to be removed if the patient presents with more severe symptoms.
2, serous epithelial cysts and mucinous epithelial cysts: after three months of observation, the cysts still exist may be epithelial ovarian cysts, rather than functional cysts. This is because the serous cells and mucous cells with secretory function are embedded in the ovary after ovulation, and the liquid is continuously secreted to form cysts. This cyst does not disappear and requires an internal resection.
3, chocolate cyst (endometrioma): refers to endometriosis in the ovary, forming a large number of sticky brown color like chocolate in the ovary. Because endometrioid tumors become larger with time, gradually eroding normal tissues, causing irreversible damage to ovarian tissue. After assessing its severity, it may be necessary to open the knife.
4, teratoma: This is a very special cyst, may have a problem in the cell differentiation of the embryonic period, after a long time to show. It produces hair, teeth and some oily accumulations in the ovaries. Because the teratoma itself does not disappear on its own, and it is possible to continue to grow, another 15% chance will cause ovarian torsion, so it is best to remove it early. In general, the ratio of malignancy is less than one thousandth.
5, ovarian cancer: the probability of suffering from ovarian cancer is quite low, but because it is located in the pelvic cavity, it is not easy to find early. The malignant tumors of the ovary have a wide variety and their prognosis is different. In general, middle-aged and older women are more likely to have epithelial cell carcinoma, which has a higher risk of recurrence and a poorer prognosis.
Germ cell carcinoma is prone to women under the age of 30. Because of this kind of cancer, there are usually some clues, such as pelvic pain or pressure on the abdomen, so the cure rate can be found early.
1. Ultrasound performance:
(l) The volume is small, the wall of the capsule is smooth and thin, and the sound is good, often single, protruding from the surface of the ovary. There is an anechoic zone inside, and the back wall and rear echoes have an enhancing effect.
(2) During regular follow-up, it can be found to shrink or disappear by itself.
2. CT performance:
(1) The edge is clear, the wall is thin, and the round is low-density mass.
(2) CT value is generally 0 ~ 20HU, CT value can be increased when there is bleeding or infection.
(3) Sometimes there is stratification or separation in the capsule.
(4) After the enhancement, the edge of the cyst is strengthened and there is no enhancement inside.
3. MRI performance:
(1) The ovarian cyst is a low signal on the T1-weighted image and a high signal on the T2-weighted image.
(2) Follicular cysts often occur frequently, and can also be single-shot, which is a round or oval thin-walled mass with clear and sharp borders.
(3) The internal structure of the follicular cyst is uniform, and the internal structure of the corpus luteum cyst is not uniform.
