Endometriosis, ovarian

Among all localizations of endometriosis defeat ovarian cancer ranks second and first in the group of external genital endometriosis. However, the value data heterotopy explained not so much by its frequency, how many role in generalization of the process. So, almost always the intestinal damage endometriosis starts from the ovaries to be a direct result of infiltrative growth or falling contained in the cells cysts brown liquid with a viable elements of endometriosis on the wall of the intestine. This way can develop pozavcherashny endometriosis and the defeat of the diaphragm with the holes in the side of the pleural cavity.
Our clinical material shows that in most cases the defeat of the ureters (the beginning at the expense of scar deformations, stenosis, and then and ingrown) also begins with ovarian endometriosis. In this way the process can be involved and bladder. It is impossible not to consider the opinion of A. I. Timofeeva (1926), who established that fried through the ovary elements endometrial gain increased ability to proliferation.
In addition, the hit of the content of such cysts in peritoneal-tion space as a result of spontaneous perforation or during surgery carries the risk of development of intestinal paresis and in the future - adhesive disease. As for possible malignancy, in this respect, endometrioid cysts are not inferior to the cysts of different histogenesis. After analyzing 990 observations of malignant custom ovaries, J.'aure et al. (1971) 9.3 % found the development of carcinoma of endometriosis. Managed to help in the early stages of tumor process in patients 30-39 years. In the later stages of this transformation impossible to trace. So there is every reason to suppose the possibility of more frequent zlokacestvennoe endometrioid cysts, than it was possible to establish histologically. J. Voight (1972) States that frequent detection of endometriosis in the malignant sistemah.
According to M. Long, N. Taylor (1964), Century Czernobilesky et al. (1970), in patients with malignizaciei sistemami ovarian endometrioid was 16, 12, 6 and 23.9 % and, in addition, it was shown that the onset of menopause does not prevent a possible zlokacestvennoe. G. Smith back in 1937 reported that 22 % of differentiated ovarian carcinomas are combined or associated with endometriosis.
The most probable implant Genesis destruction (hit elements of the endometrium to the surface of the ovaries with menstrual blood). In addition, possible hematogenous and lymphogenous way. Detection of ovarian endometriosis in young patients during operations and Perito nascopie when trying to determine the cause of algodismenorea confirms the possibility of embryonic or dysontogenetic origin. This fact is very important for timely detection of the disease, especially in families, "troubled by endometriosis". It is necessary to emphasize the variety and variability of their structure depending on the degree of malnutrition and fibrosis of the cyst wall ("age" cysts). In some cysts or chambers are well preserved endometrioidalny epithelium and stroma, but not over the entire surface, but only in some areas, in others there are flattening, partial degeneration epithelium and moderate fibrosis; thirdly, there has come death of the epithelium and well expressed fibrosis. It is interesting to note that in parts of the intestine wall, rear surface of the uterus, parametrium, in the field of fusion with cysts 3rd group (without epithelial lining and with severe fibrosis) can be found clearly visible gland with tithenai the stroma. This circumstance, from our point of view, gives the basis to consider proved endometrioid Genesis cysts 3rd group, even if at the moment of investigation in the walls could not find endometrial glands and stroma.
Deep research of different aspects of endometriosis, ovarian spent A. E. Kolosov (1985) in his doctoral thesis "Endometriosis, endometrioid cysts and endometrioid ovarian cancer". Analyzing the results 211 own observations, he set more frequent presence of endometriosis in the cortical layer - 54±7,2 %, in cortical and brain layers - 46±7,2 % of patients. Along with the ovaries, 49 patients with endometriosis was found in the uterus, tubes, navel, a large glandthat confirms the role of endometriosis, ovarian to spread into other organs and tissues. In the direction of development A. E. Kolosov (1977, 1985) distinguishes several types of ovarian endometriosis: growing (proliferative), stable (fibrous), regressive (dystrophic) and malignancy.
Endometriosis, ovarian up to a certain time may be asymptomatic until the start of micro cameras and involvement in the process of pelvic peritoneum or adjacent organs. Patients receive complaints dull aching pain in the lower abdomen and lumbar-sacral region. At one-way process, pain localized to one or the other side. During the month (more often in the last days of menstruation or after graduation) pain worsens. In 66-70 % of patients dysmenorrhoea [B. N. Baskakov, 1966; Shukurova S. B., 1969, and others]. The clinical picture and the objective of the study is similar to chronic relapsing adnexitis and periodicita. However, despite anti-inflammatory treatment, periodically (usually in the last days of the month, but not every cycle) acutely associated with spontaneous perforation of the cyst. Suddenly appear severe attacks of abdominal pain accompanied by nausea and vomiting. You may experience loss of consciousness. Symptoms of peritoneal irritation, and developed pattern of acute abdomen, very similar to ectopic pregnancy or an ovarian apoplexy. Intestinal peristalsis stops growing bloating. Unlike adhesive obstruction when bloating there are no periods of rapid intestinal peristalsis and cramping.
In addition violated ectopic pregnancy, ovarian apoplexy, twist legs cysts and adhesive intestinal obstruction, some patients with spontaneous rupture of endometrioid ovarian cysts are diagnosed destructive appendicitis, perforation of gastric ulcer or duodenal ulcer, destructive calculous cholecystitis.
Objective data in endometriosis, ovarian (and the clinic of the disease) similar to those seen in chronic adnexitis and periodicity. On one or both sides palpable plotnosti, enlarged and painful ovaries or conglomerates of the uterus. The mobility of them is lost from the beginning. Pain on palpation is expressed distinctly. Before and during menstruation is the size of the conglomerate of the uterus several increase and the pain increases.
The body temperature and the results of blood tests do not show signs of inflammation.
Half of the patients despite chronic adnexitis and periodicit, come pregnancy. After abortion alleged adnexitis sharply aggravated, but pregnancy come again. The presence of such a "adnexitis" history and offensive when they repeated pregnancies or the preservation of patency of the fallopian tubes in chronic adnexitis should prompt the idea of a possible ovarian endometriosis.
Gradually dimensions cystic-altered ovarian increase periodically repeated attacks of pain. Union with rear leaves wide uterine ligaments, uterus and rectum are saved and become even stronger. Often the uterus and endometrioid ovarian cysts are a single conglomerate, taken for the fibroids.
As the progression of the disease may develop pozavcherashny endometriosis, and there are typical for his complaints (the radiation of pain in the rectum, and so on). However, probing tuberosity in the area of maternal-pryamokishechnye deepening the lower pole of the cyst may prompt the idea about possible malignancy of cistemy ovary. Differentiation help carefully assembled history (duration of the disease), tuberosity pain on palpation, recurrence of symptoms, the absence of ascites , etc.
The essential help in the diagnosis of endometriosis, ovarian have a laparoscopy and ultrasound. The latter turns out to be more informative in cystic form the defeat of the ovaries and is characterized by heterogeneity internal echoes with numerous internal echoes. Implementation in everyday practice laparoscopy and ultrasound was significantly reduced the frequency of application of gas rentgenografii and Chrismation venography for the purpose of diagnosis of endometrioid cystadenoma ovaries.