Chocolate cysts, a very nice name, are a nightmare for many women patients. Infertility, dysmenorrhea, heavy menstruation, sexual discomfort, chronic pelvic pain a series of discomfort plagued the beautiful women. However, many women still do not pay enough attention to it.
What is a chocolate cyst?
“Chocolate cyst” refers to the endometriosis lesion on the ovaries, local bleeding during menstruation, so that the ovaries increase in size, forming a cyst containing old blood, this old blood is brown, sticky like paste, like chocolate, so also known as “chocolate cysts “The medical term for this is endometriosis cyst. Although endometriosis is a benign lesion, it has the biological characteristics of malignant tumors, such as extensive adhesions, distant metastases and easy recurrence. The malignant rate of endometriosis is 0.7% to 1% on average, and some scholars have reported that it is as high as 2.5% and becomes “endometrium-associated ovarian cancer” after malignant transformation. In recent years, with the increasing incidence of endometriosis, the number of cases of endometriosis malignancy is also increasing year by year, and the prevention and treatment of endometriosis malignancy are receiving more and more attention.
The ovary is the most frequent organ of endoheterozygosis and its malignant transformation, and the malignant transformation into ovarian cancer accounts for 76%-85% of all cases, and the main pathological types are endometrioid adenocarcinoma (11%-33%) and clear cell carcinoma of the ovary (33%-53%). Malignant lesions of extra-ovarian endometriosis can be found in the intestine, pelvis, vaginal rectal septum, vagina, and cesarean scar, with adenocarcinoma predominating.
Currently, the internationally accepted criteria for the diagnosis of endometriosis malignancy are the three conditions proposed by Sampson.
(1) Cancerous tissue and ectopic endometrium coexist in the same lesion.
(2) Histological correlation between the two.
(3) The presence of other primary tumors is excluded. Scott added to this the diagnostic criterion of microscopic histological evidence of malignant migration of the ectopic endometrium.
What are the discomforts of women with chocolate cysts?
The clinical presentation of endometriosis-associated ovarian cancer is nonspecific. Early diagnosis is difficult. 43% to 70% of patients have abdominal pain symptoms and 10% to 28% of patients are seen because of the discovery of pelvic masses. In late stage, when the mass is large, it can squeeze the surrounding organs and cause various symptoms, such as difficulty in urination or dyspareunia if it compresses the bladder; constipation or dyspareunia if it compresses the rectum; once it is combined with ascites or metastasis, gastrointestinal symptoms such as abdominal distension, dyspepsia, loss of appetite, belching, etc.; if the amount of abdominal water squeezes the diaphragm upward or is accompanied by pleural fluid, chest tightness, dyspnea, panic, etc. can occur. Late stage patients commonly suffer from wasting, anemia and cachexia, and may also have swollen lymph nodes in the supraclavicular, axillary and even inguinal areas.
Which patients are prone to malignant transformation?
Patients with the following high-risk factors for endo-malignancy should be monitored and followed up closely to be alert for the occurrence of endo-malignancy.
(1) Women of menopausal age >50 years.
(2) The duration of endometriosis is more than 8 years.
(3) Women with high estrogen levels or receiving estrogen replacement therapy, especially those with obesity.
(4) Those treated with Danazol.
(5) Early menarche, short menstrual cycle, late menopause, and low maternal frequency.
(6) Those with a history of exposure to dioxin-contaminated environment should be alerted to the possibility of malignant transformation.
Malignant change has more or less precursors
Patients with endometriosis should be aware of the possibility of malignancy when the following clinical manifestations occur.
(1) Ovarian endometriosis cysts >10 cm in diameter or with a tendency to increase significantly.
(2) Recurrence after menopause, change in pain rhythm, progressive dysmenorrhea or persistent abdominal pain.
(3) Imaging reveals solid or papillary structures within the ovarian cyst, or the lesion is rich in blood flow.
(4) High serum CA125 level (>200kU/L).
(5) The contents of the ovarian endometriotic cyst become thin (fewer fine light spots) on ultrasound.
Prevention is the big
The following management options for patients with endometriosis may help to reduce the occurrence of malignancy: (1) Surgery should be chosen when the ectopic cyst is ≥4 cm in diameter.
(1) Use puncture and aspiration methods with caution.
(2) Indications for radical surgery are appropriately relaxed in high-risk groups according to age and reproductive requirements.
(3) If atypical hyperplasia or endophytic lesions are found in conservative surgically resected specimens, they should be followed up closely for a long time.
(4) For postmenopausal patients, radical surgery is the appropriate choice.
In conclusion, for women of childbearing age, the first choice is minimally invasive surgery after the discovery of coeliac disease! This will not only eliminate the lesion, improve the quality of life and fertility, but also reduce the chance of malignant transformation.