Cystic formations in the human body. What can we do about them?
What is a cyst? It is a cavity, with its own lining, that is filled with fluid created by the epithelial cells of the lining. However, there are also “pseudocysts” that have no lining, and the fluid – not secreted by cells – is only retained there.
Indications and causesCysts are actually pseudotumours. They can affect practically all organs; in some they are rare, in others frequent. If there are a lot of cysts in an organ, this is called cystic degeneration. An example is familial polycystic kidneys, where age-growing cysts completely suppress healthy tissue and result in insufficient kidney function. Cysts can be either solitary or multiple, ranging in size from millimetres to (very exceptionally) tens of centimetres. It should be noted that cystic formations produce both benign tumours (called cystomas) and malignancies. These need to be confirmed or excluded by careful examination.
Doctors in all fields come across cysts in their patients. These tend to be random finds during examinations using imaging methods, most often ultrasound (liver, kidney). In the vast majority of cases, surgery is not required. An exception could be a parasitic cyst, e.g. caused by echinococcosis.
In a gynaecological surgery, cyst diagnosis is a daily reality. Cysts most commonly affect the ovaries, but also occur in the breast, the cervix as retention mucous cysts – the ovula Nabothi, the uterine mucosa (endometrium) during glandular hyperplasia, or in a mucosal polyp. There may also be cysts in the lesser pelvis around the uterine appendages.
Ultrasound is best for diagnosis purposes. palpation examination can be unreliable and only spots larger formations with a stiffer wall and pain in the pelvis and breast. These days, modern powerful ultrasound devices enable us to provide very precise differential diagnosis and they are more informative than CT or magnetic resonance imaging. To exclude gynaecological malignancies, blood is also tested for tumour markers.
Cysts in female organs may be completely symptomless, or may cause pain or bleeding disorders. Ovarian cystomas may sometimes grow to considerable dimensions and cause abdominal cavity distension and digestive problems.
Cyst types and solutions
Ovarian cysts These formations are most common on the ovaries. Gynaecologists encounter them in their clinics on a routine basis. In a few cases, women make an appointment because they are in pain. Much more frequently, though, they identify menstrual disorders – they either bleed more frequently or not at all. Occasionally, cysts are detected incidentally during an ultrasound examination for another problem or as an obscure palpable finding during a preventive examination.
The most common cysts are those arising from ovarian follicles that do not crack and then fill with fluid. They may be hormonally active and sometimes cause tension and pain in the mammary gland. Mostly symmetrically.
In addition, cysts from the corpus luteum often occur. These cysts contain a yellowish fluid or mucus content, sometimes with blood from a cracked blood vessel – which makes them easily distinguishable in an ultrasound examination. We often detect the presence of fluid from a cracked cyst behind the uterus. If a cyst cracks, this may not cause any problems, but sometimes it results in severe pain and fainting. Such symptoms are often addressed by laparoscopic surgery.