Ovarian fibroma: causes, symptoms, treatment. Ovarian fibroma: is a benign tumor dangerous and how to remove it? what is ovarian fibroadenoma

- connective tissue, hormonally inactive tumor of the ovary of a benign nature. Symptoms of ovarian fibroma develop when the tumor reaches a significant size and is manifested by ascites, anemia, less often hydrothorax (Meigs' syndrome). In the diagnosis, a gynecological examination, ultrasound, CT are used; A clarifying diagnosis of ovarian fibroma is made based on the results of a histological examination of tumor tissues. Treatment of ovarian fibroma - operational - removal of the tumor, sometimes together with the affected uterine appendage.

General information

Causes of ovarian fibroma

The causes of ovarian fibroma have not been precisely established, but the patient's unfavorable premorbid background, including endocrine pathology (menstrual and reproductive dysfunction), reduced immune defense, inflammation of the appendages and ovaries (adnexitis, oophoritis) may be a risk factor. Ovarian fibroma can be combined with uterine fibroids, ovarian cysts and, most likely, has common etiological factors of development with them.

Symptoms of ovarian fibroma

With small fibroma sizes (up to 3 cm) and preservation of ovarian function, clinical manifestations may be absent for a long time. With the growth of the tumor, signs of Meigs syndrome develop (ascites, anemia, pleurisy), manifested by bloating, pain, shortness of breath, general weakness and fatigue, tachycardia.

Ascites is a common symptom of ovarian fibroma, occurs when a transudate is released from the tumor into the abdominal cavity. Hydrothorax is caused by the ingress of ascitic fluid through the gaps of the diaphragm from the abdominal cavity into the pleural cavity. In some cases, ovarian fibroma may be accompanied by polyserositis and cachexia (as a rule, with malignant degeneration of the tumor). The severity of the disease is largely determined by the compression of neighboring organs by fluid, especially with polyserositis.

Severe symptoms of peritoneal irritation appear with hemorrhages and necrosis in the ovarian fibroma, as well as with torsion of the tumor stem. The menstrual cycle is usually not disturbed. When ovarian fibroids are combined with other diseases of the genitals, the clinical picture is characterized by a combination of their symptoms: for example, in the presence of uterine fibroids, menometrorrhagia may join.

Diagnosis of ovarian fibroma

Ovarian fibroma is asymptomatic for a long period and may be discovered incidentally during examination or surgery for another disease. The diagnosis of ovarian fibroma is possible on the basis of the existing clinical manifestations, examination by a gynecologist with a mandatory two-handed examination; laboratory diagnostics (complete blood count, tumor markers CA-125, HE 4); instrumental methods (ultrasound, MRI, CT of the pelvic organs) and histological examination of the tissue of the removed tumor.

Treatment of ovarian fibroma

Conservative (drug) treatment of ovarian fibroids is not carried out; surgical removal of the tumor is mandatory. The volume of surgical intervention and the nature of the access are determined by the size of the tumor, the age of the patient, the condition of the other ovary and uterus, and the presence of concomitant pathology.

In young women with a small size, ovarian fibromas are limited to laparoscopic removal (husking) of the tumor itself, while maintaining menstrual and generative functions. In premenopausal women, oophorectomy or removal of the appendages is appropriate; with bilateral damage to the ovaries, they try to leave part of one of them.

Forecast and prevention of ovarian fibroma

The prognosis of ovarian fibroma is favorable, the probability of malignancy is 1%. Pregnancy can be planned only after the end of the course of rehabilitation treatment.

There are no specific ways to prevent ovarian fibroma; it is necessary to visit a gynecologist at least once a year and conduct an ultrasound of the pelvic organs in order to timely detect this disease.

Or ovaries.

Ovarian fibroma, like fibrous tumors in other organs, usually develops asymptomatically, however, upon reaching a significant size, characteristic symptoms of the pathological process appear.

Concept and statistics

The share of fibrous formations in gynecology accounts for approximately 10% of the total.

Women of premenopausal and menopausal age (40-60 years old) are most susceptible to such neoplasms. Ovarian fibroma is a tumor formation that does not have hormonal activity.

In appearance, such tumors are rounded seals with a nodular or smooth surface. Such ovarian formations can grow up to 12 centimeters or more and are predominantly unilateral. Such tumors, as a rule, have a stalk, so they are mobile.

On the cut, the fibrous formation has a whitish-gray or white color, the tumor is poor in the vascular network.

If the fibroma was formed quite a long time ago, then in its middle there are dead areas with ischemia, hemorrhages, degenerative lesions. From a morphological point of view, the tumor is formed from connective tissue cells.

Forms

Specialists distinguish several fibrous varieties:

1. diffuse fibroma - affects the entire ovary;
2. Limited tumor form - is a capsule with contents that separates it from the rest of the ovarian tissue.

Fibrous formations often swell and have cystic cavities with liquid contents inside, then they are called cystadenofibromas.

Usually, fibrous formations grow slowly, however, under the influence of dystrophic changes, they begin to grow very quickly. Often, such tumors are accompanied by cystic processes in the ovarian tissues, which are formed for similar reasons.

The insignificant size of fibrous formations usually does not affect ovarian functionality, and does not prevent conception, pregnancy and successful delivery.

Reasons for development

As in the case of uterine fibroma, an ovarian tumor has an uncertain etiology, however, the risk of pathology increases in the presence of an unfavorable state of health of the patient, contributing to the development of various diseases (premorbid background).

These include pathologies of the endocrine system, including violations of reproductive and menstrual functions, pathologically low immune status, inflammatory processes in the ovaries or appendages (adnexitis, oophoritis, etc.).

In general, among the probable causes of fibroids in the ovaries are:

• Reduced immune status;
• Pathological processes in the genitourinary system and genital organs;
• Inflammatory lesions of the appendages or ovaries of chronic origin;
• The presence of endocrine pathologies;
• genetic predisposition;
• Age features;
• Menstrual irregularities, etc.

Often, ovarian fibroma is accompanied by pathologies such as ovarian cystosis or. Therefore, many experts believe that these diseases have common etiological factors.

Symptoms of ovarian fibroma

Usually, ovarian fibroma develops hidden. With sizes less than 3 cm, ovarian functions are usually not impaired, and therefore there are no symptoms.

When the mass begins to grow, the patient experiences the onset of symptoms such as Meigs' syndrome, which includes the presence of pleurisy (an inflammatory lesion of the lung membrane), anemia, and (accumulation of fluid in the peritoneum).

Similar conditions appear:

1. General weakness of the body;
2. Tachycardia manifestations;
3. Bloating in the abdomen;
4. soreness;
5. Excessive fatigue;
6. Shortness of breath.

If the tumor releases transudate into the retroperitoneal space, then ascites occurs. In exceptional clinical situations, ovarian fibroma is accompanied by (extremely severe exhaustion) or polyserositis (inflammatory lesions of the serous membranes), but this picture is usually observed when the tumor process is malignant.

Usually, menstrual changes and cycle disorders are absent in ovarian fibroma. If the pathology is combined with other genital diseases, then the clinical picture is a complex of their signs.

Diagnostics

Fibrous ovarian masses are usually found during random physical examinations at the gynecologist, since the tumor develops latently for a long time.

After a gynecological examination, the patient is sent for laboratory tests, instrumental procedures such as ultrasound diagnostics, magnetic resonance or pelvic organs, etc.

If necessary, a histological examination of the biomaterial obtained from the tumor through laparoscopic diagnostics is additionally performed.

Treatment

Treatment of fibrous formations in the ovary is carried out using surgical methods. Since such neoplasms are not able to resolve, conservative therapy is meaningless.

In accordance with the size of the fibroma, the presence of complications, the age and organic characteristics of the patient, the type of surgical intervention is selected.

To get rid of small formations, it is usually used when the fibroma is husked, and the ovary is completely preserved, as well as its functionality.

If the fibroma has reached a large size, then it is removed along with the ovary. If at the same time the age of the patient has approached the premenopausal period, then it is recommended to remove the appendages as well.

If the fibroma is bilateral, that is, the tumor process affects both ovaries, then a part of the one that is less affected by the formation is necessarily left.

Forecast and prevention

In general, the prognosis of ovarian fibroids is positive, the probability of a malignant process is minimal - only 1%. Only pregnancy will have to be postponed until complete recovery and the end of postoperative rehabilitation.

There is no specific prevention of ovarian fibromas, so the main measure is an annual visit to the antenatal clinic with an ultrasound examination of the pelvic organs. This is the only way to timely detect the development of a pathological fibrous process in the ovaries.

The video shows the operation to remove ovarian fibroma by laparoscopic method:

Benign neoplasms of the ovaries are a common pathology. It is 10% of cases of its occurrence that occur in fibromas. The main age range of patients who have been diagnosed with this disease ranges from 40 to 60 years. The tumor can cause significant harm to the female body. This is due to the secrecy of symptoms in the initial stages and the appearance of obvious signs of the disease only when the fibroma grows to a large size.

general characteristics

Ovarian fibroma is a benign tumor consisting of connective tissue cells. Its features include the fact that it does not show hormonal activity and rarely becomes malignant.

A hallmark of ovarian fibroma is the absence of specific hormones produced by the tumor.

Fibroma is characterized by slow growth, but sizes can reach up to a couple of tens of centimeters in diameter.

As a rule, the tumor affects only one ovary. A bilateral process was recorded in 5% of cases.

The surface of the fibroma may be smooth or nodular. According to the consistency, a soft and hard (with calcification) tumor is distinguished. Ovarian fibroma is mobile, as it is located on a pedicle prone to torsion. When cut, white or grayish-white connective tissue with few blood vessels can be seen. An old fibroma that has formed over the years will be distinguished by the presence of areas of ischemia, necrosis and brown petechial hemorrhages. Histological examination reveals bundles of spindle-like connective tissue cells, randomly intertwined with each other.

The main functions of the ovaries - video

Tumor types

Classification of ovarian fibromas is based on the localization of the tumor and its structural features. Kinds:

• fibroma of the left ovary;
• fibroma of the right ovary.

According to the nature of growth, there are:

1. diffuse. The tumor spreads throughout the ovary and is not provided with a capsule.
2. Delimited. Fibroma is covered with a connective tissue membrane, has a clear localization. In the presence of such a tumor, part of the normal tissue of the ovary is preserved. Occurs rarely.

Causes and risk factors

The true etiology of the disease is not fully understood. An increase in cases during premenopause and menopause has been established. Possible causes that can provoke the formation of fibroids:

• changes in the processes of hormonal regulation (both age-related and due to any disease);
• the presence of inflammatory pathology of the ovaries (more often we are talking about chronic adnexitis, oophoritis);
• genetic predisposition.

An additional impetus to the formation of a tumor are abortions, stress, infections of a viral and bacterial nature. A frequent combination of ovarian fibroma with myoma has been established. This is probably due to the fact that they have a similar etiology.

Symptoms and signs of fibroids

Fibroma of the ovary is often diagnosed in the later stages, when it becomes so large that it compresses the surrounding tissues. With sizes not exceeding 3 cm in diameter, the symptoms are practically absent, the patient is even able to become pregnant. With the growth of a fibroma to a large size, a clinical picture appears, characteristic of Meigs' syndrome. It includes:

1. Ascites. Caused by the accumulation of serous effusion in the abdominal cavity. The abdomen noticeably increases in diameter, can take a spherical shape. Bloating and pain syndrome join.

   A symptom of ascites is the presence of at least one liter of fluid in the abdominal cavity.

2. Pleurisy (inflammation of the serous membrane surrounding the lungs). Initially, it begins with hydrothorax - accumulation of fluid in the pleural cavity. Manifested by shortness of breath, rapid heartbeat.

   Pleurisy in the form of an independent disease is extremely rare, usually this process is a complication of ovarian fibroma

3. Anemia. The decrease in hemoglobin level is secondary, it can reach an average and even severe degree.

   Anemia is based on a decrease in the amount of hemoglobin, red blood cells and impaired blood supply to tissues.

Ultimately, the patient develops signs of general exhaustion. In the presence of a giant tumor, cachexia (extreme exhaustion) sometimes occurs, similar to that in malignant neoplasms. The menstrual cycle, as a rule, does not suffer.

Diagnostics

Detection of ovarian fibroma presents difficulties in the early stages. This is due to the absence of obvious clinical symptoms. Diagnostic search is built on the following stages:

Differential Diagnosis

Fibroma during gynecological examination is non-specific in its manifestations, so it can be confused with other neoplasms. The collection of complaints also cannot help to reliably exclude a particular diagnosis. A decisive role in establishing the exact type of disease is played by ultrasound and histological examination. Differential diagnosis is carried out with the following pathologies:

1. Ovarian cyst. It is a true tumor, consisting of epithelial cells.
2. Subserous myomatous node of the uterus. Due to the peculiarities of the location, it can mimic an ovarian tumor during a two-handed examination.
3. Tekoma. Benign tumor with hormonal activity. Its existence can be suspected with significant changes in the hormonal background of a woman:
   • menstrual (presence of uterine bleeding or, conversely, amenorrhea);
   • reproductive (infertility, miscarriage).
4. Sarcoma. A malignant neoplasm derived from connective tissue. Histological examination is necessary for differential diagnosis.

Treatment: why surgery is needed

Ovarian fibroma is a pathology that can only be eliminated surgically. Unlike some tumors, no amount of drug therapy can make it disappear or shrink. Refusal of radical treatment is possible only if there are absolute contraindications for general health. A number of patients ask the question why fibroma must be operated on, because it grows slowly and practically does not bother? Surgical treatment is necessary for the following reasons:

1. It is impossible to predict how a fibroma will grow. Its dimensions can remain the same for many years, but, sooner or later, some provoking factor is able to start active division of connective tissue cells.
2. Without surgery, it is impossible to exclude the malignancy of the neoplasm. Donating blood for tumor markers is not a 100% accurate diagnostic method.
3. Fibroma of the ovary cannot be eliminated with conservative therapy. This type of tumor never resolves.

The type of surgical intervention directly depends on the size of the tumor and the degree of involvement of the surrounding tissues in the pathological process. Types of surgical intervention according to operational access:

Factors that determine the type of operation:

1. Mobility of the tumor, the presence of a long stem. Fibroids with such properties are operated on using a sparing laparotomy - a Pfannenstiel incision (along the suprapubic skin fold).
2. The presence of excess weight, dense subcutaneous fat, large tumors. In such situations, a laparotomy with a median longitudinal incision is indicated.
3. Detection of a clearly demarcated tumor of small size. In this case, laparotomy can be avoided by replacing it with a less invasive laparoscopy.

To remove the ovary completely during the operation or not - the attending physician decides. As a rule, in patients of reproductive age, they try to leave as much healthy tissue as possible. In postmenopausal women, it makes sense to remove the ovary completely - this will help eliminate the likelihood of malignancy (malignancy) of its tissues in the future.

The preparatory period for surgery and preliminary procedures differ little from the standard ones. They include:

• taking a shower the day before the intervention, shaving off pubic hair;
• refusal to eat a day before the operation, performing a cleansing enema before it starts;
• sedation (taking sedatives);
• bladder catheterization before surgery.

Stages of surgical treatment of fibroma of the left or right ovary

The principles of operations to remove ovarian fibroma, as well as other benign formations of this localization, are largely similar. The surgical process includes the following steps:

1. Providing operational access. The appropriate cut is selected.
2. Assessment of the general state of the operational field. Determine the true size of the tumor, if necessary, separate adhesions.
3. Removal of neoplasm from the abdominal cavity. With the help of additional tools, the fibroma is gently pushed into the surgical wound without capturing the capsule, which is easy to break.
4. After the tumor is removed, the surgical field is isolated. For this purpose, sterile wipes are used.
5. Isolation of the tumor stem. It is clamped with Kocher clamps. On the site selected by the instruments, the leg is crossed, thereby disconnecting the tumor from the ovary. In places where the clamps are used, ligatures are applied (sterile threads from medical materials).
6. Inspection of the remaining organs. Sometimes removal of uterine appendages is required.
7. Peritonization of the stump. It consists in covering it with the peritoneum.
8. Removal of instruments, completion of the operation. After examining the results obtained, the wound is sutured.

Laparoscopic intervention is less traumatic. Access is through a system of small incisions. With the help of thin tubes-conductors, the instruments enter the abdominal cavity, the progress of the operation is controlled using a small camera (the image is displayed on the screen).

Prognosis and complications

As a rule, in uncomplicated cases, a favorable outcome is possible. If the tumor is not large, there is a high probability of maintaining reproductive function.

The risk of recurrence of ovarian fibroma is minimal, but this does not eliminate the need for regular examination after surgery.

Complications of the disease occur, as a rule, only with late detection of fibroids and non-compliance with medical recommendations. Possible adverse effects:

• the formation of adhesions with the abdominal organs;
• torsion of the fibroma pedicle followed by necrosis;
• accession of purulent inflammation leading to the melting of the tissues of the affected ovary;
• peritonitis (inflammation of the sheets of the peritoneum);
• internal bleeding (with detachment of the leg, violation of the integrity of the capsule).

Fibroma of the ovary is an insidious disease. A “harmless”-looking tumor is fraught with dangerous, sometimes life-threatening consequences. A simple way to avoid them is to regularly visit a gynecologist, follow all his recommendations, and also remove the tumor as early as possible.

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The word "cyst" came to medicine from Greece (its meaning is "bubble"). So it is customary to call a neoplasm, inside which there is a liquid (or other substance). This benign ovarian tumor is a common occurrence in young women. However, occasionally it occurs in women over 50 years old. The "uninvited guest" in a woman's body does not manifest itself only as long as the size of the tumor is tiny. Further, there are several options for continuing the story.

If the neoplasm arose due to minor disturbances in the functioning of the ovary, doctors are usually very optimistic. After all, the "bubble" can disappear in a couple of months, even without drug exposure. If the cyst is not functional, then it simply will not resolve. After all, a fibrous-type tumor is distinguished by a rather dense capsule and can eventually grow so that not only the ovary, but also other organs will suffer.

What causes tumors?

Of course, medicine does not give a definite answer, what is the reason for the appearance of a cyst. After all, there are very contradictory hypotheses and extraordinary cases. It can confuse a gynecologist, for example, the occurrence of a tumor in a teenage girl (and such situations are not uncommon). The cysts found in pregnant women are also alarming, because these neoplasms can cause a miscarriage. So, not a single doctor will be able to indicate the exact scheme why the disease “sticks” to some women and girls, but bypasses others.

However, there are several factors that can lead to unwanted changes in the ovary:

• hereditary factor. Many women complaining of cystic formation, close relatives also encountered this disease.
• Irregularity of menstruation, too "long", or abnormally short menstrual bleeding.
• Prolonged inflammation of the appendages. It happens that in order to eliminate inflammatory processes, a lady takes medication for more than one year. But instead of the desired recovery, an unpleasant “surprise” may lie in wait for her: a cyst on the right or left ovary.
• Disorders in the work of hormones.
• Overweight or abnormal thinness.
• Endocrine problems.
• Diseases of the immune system.
• Operations "in a feminine way", which were done in the recent past.
• Disorders of the thyroid gland.
• Chronic illnesses, injuries.

Some doctors, trying to determine why the lady had a fibrous tumor on the ovary, are inclined to believe that eating habits play one of the negative roles. To be more precise, problems arise when these habits are taken to extremes. Fatty foods, meat, smoked meats, consumed in large quantities, can lead to excessive production of certain hormones. As a result, an ovarian tumor occurs. Of course, the appearance of this "guest" is not a reason to despair. After all, a cyst can turn into a malignant formation only in rare cases.

What types of neoplasms can be considered fibrous?

Cystic formations that can occur on the ovary are of several types. Specialists in the classification of "vesicles" first of all pay attention to the tissues from which the cyst was formed. The least problematic gynecologists consider tumors of functional origin. They are loose in composition, so they can disappear in a short period of time. However, sometimes the follicular cyst begins to grow rapidly, and then there is a risk of its rupture or twisting of the leg.

As for non-functional neoplasms, they can cause a lot of trouble to the patient. Since a fibrous tumor consists of a fairly dense tissue, it is simply naive to expect it to disappear. Even a small cyst can "ruin the weather" for women who want to get pregnant. In addition, hormonal changes in the body of a lady can lead to the rapid growth of the tumor.

Fibrous formations include:

• Mature teratoma (another name is dermoid cyst). The tumor is unusual in that its "origins" begin with the period of intrauterine development of the girl. Inside this cystic formation, fragments of bone, cartilage, hair, even sweat glands can be found. Teratoma grows very slowly, a woman usually does not suspect the presence of such a tumor until some “fateful” moment (pregnancy, routine examination). It is possible that a large dermoid will become inflamed or twist on the leg. Such complications will certainly manifest as a sharp weakness, pain in the abdomen. The woman will need to urgently prepare for the operation.
• papillary cystoma. Such formation rarely grows to a solid size. But a cystic formation of this type is considered a considerable threat to the well-being and life of the patient. The reason is that the tumor becomes malignant in almost half of the cases. Naturally, it is impossible to eliminate the degree of danger without surgery.
• Pseudomucinous cyst. This "guest" is also capable of turning into cancer.
• cystic adenoma. Already the name of the tumor suggests that such a formation combined both the signs of an adenoma and a cyst. The "building material" for such a cyst is the ovarian tissue. What is the danger of a tumor? The fact is that the cyst tends to grow excessively (up to 30 centimeters). Its negative effect on nearby organs - the intestines, the bladder - can be very pronounced.

A polycystic ovary is a kind of borderline variant between fibrous changes in the ovary and a “failure” in its functioning. With this disease, an increase in the ovary occurs. In addition, many small cysts are “hidden” in its thickness. A similar disease refers to hormonal diseases. It is eliminated with the help of medications or surgery.

Be that as it may, it is worth listening to the doctors. If a cyst has already disturbed your peace and began to affect your health, the main thing is to choose the right strategy for its destruction as soon as possible.

Manifestations of the disease

It is almost impossible to detect a cyst in the early stages of its occurrence. Typically, the tumor begins to manifest itself when its size is already large enough. This is where you should be alert and go to the doctor. After all, a cyst can seriously affect the reproductive functions of a lady and significantly worsen her well-being.

Consider the main signs of this disease:

• discomfort (or pronounced pain) in the lower abdomen;
• frequent bouts of nausea;
• discharge with blood, which can be seen not on the days of menstruation;
• frequent urination for no reason;
• pain during intimacy;
• changes in the nature of menstruation (for example, menstruation has become very painful, come with a delay of 10-15 fifteen days);
• a large weight gain (despite the fact that eating habits have not changed);
• feeling of heaviness in the pelvis;
• disproportionate protrusion on one side of the abdomen;
• constipation;
• inability to conceive a child.

If a cystic tumor was detected in a woman already in a neglected state, it may be necessary to eliminate not only the “guest”, but also the problems provoked by it. Infection of the cyst and twisting of the pedicle of this tumor are very common pathologies. It is worth remembering a few characteristic signs indicating a complicated course of a cyst:

• sudden rise in temperature;
• pain in the abdomen;
• confusion, fainting;
• heart palpitations.

To eliminate the consequences of the twisting of the cyst, an operation will be needed to remove the ovary. Even if you do not have severe ailments, but you suspect that you have a cyst, the most reasonable solution would be to sign up for an examination. In addition to a gynecological examination, you will need to do an ultrasound. And, of course, you should not be scared to the point of fainting if your guesses are confirmed. With small, timely detected tumors that have formed on the ovary, laparoscopy can easily cope.

Anxiety of women of "autumn age"

Many are sure that an ovarian tumor is a warning signal only for “blooming” women who want to become pregnant in the future. And mature ladies can “not faint.” But, if we think objectively, a cystic formation on the ovary of an aged woman is a dangerous sign.

Functional ovarian cysts in women undergoing menopause simply do not happen. This circumstance is dictated by the extinction of the reproductive function. But for women older than 50 years, cystic formations from epithelial tissues are characteristic. Unfortunately, these tumors can become malignant. It becomes clear why gynecologists often advise older women to remove not only the cyst that has appeared, but also the ovary itself. Such an operation is also performed by laparoscopy, which means that large incisions and subsequent scars on the abdomen can be avoided.

Naturally, after any surgical intervention, the patient needs a recovery period. Under the ban will be nervous loads, carrying heavy loads. The gynecologist will advise the lady, after eliminating the cyst, to strengthen the immune system, cure chronic ailments that previously seemed frivolous. After all, “autumn age” is by no means a sad burden for a woman. He can be calm or active, full of creative accomplishments. The main thing is that not a single disease becomes an obstacle to the implementation of your plans!

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Ovarian fibroma is a benign formation consisting of fibrous (fibrous) tissue and muscle elements. It differs from other neoplasms of the gonad in that the tumor does not show hormonal activity at all. Fibromyoma is diagnosed in about 4% of cases among all ovarian diseases. Statistics show that pathology is more common in women after 40 years.

Causes of ovarian fibroma

Despite the rapid development of medicine in general and gynecology in particular, the exact reasons why this pathology develops are still not clear. Previously, it was believed that the tumor is formed only from the stroma of the gonad (connective tissue, which includes blood vessels). However, sometimes it begins its growth from fibrous tissue of a non-specific nature.

The following factors can provoke the appearance of a pathological neoplasm:

• menstrual irregularities;
• menopause;
• excess weight;
• diabetes;
• prolonged use of oral contraceptives;
• endometriosis;
• infertility;
• prolonged abstinence from sexual activity;
• acute and chronic diseases of the genitourinary system;
• reduced immune defense of the body;
• hormonal disruptions;
• complicated pregnancy;
• tumor diseases of the reproductive system.

Quite often, gonadal fibroma is determined along with concomitant diseases - and uterine fibroids.

ICD code 10 for ovarian fibroids is D28.

Symptoms of the disease

Formations that do not exceed 4 cm in size most often do not give any clinic and can only be detected by chance on ultrasound. As it increases, the fibroma begins to compress nearby organs, which may disrupt their normal functioning and cause symptoms:

• Meigs syndrome: ascites - accumulation of transudate from a tumor formation in the abdominal cavity, pleurisy - inflammation of the pleural sheets, anemia;
• violation of urination (frequent urge) and the act of defecation (constipation, or vice versa - diarrhea);
• a feeling of heaviness in the lower abdomen (sometimes only on the side of the lesion), a feeling of fullness;
• failures in the menstrual cycle (rarely);
• pain syndrome (aching or stabbing pains without a clear localization, which are aggravated by physical exertion);
• general fatigue;
• shortness of breath, palpitations.

The clinic for fibromyoma of the right and left ovaries is no different. It can only be distinguished that on the right side the tumor occurs more often due to the more intense blood supply to this gonad.

If a hemorrhage occurs in the tumor capsule (if any), or (which happens quite often - in 13-34% of cases), the patient has the following clinical symptoms:

• pallor of the skin:
• general weakness, dizziness;
• decrease in blood pressure;
• severe pain in the lower abdomen, usually more pronounced on the side of the lesion;
• confusion;
• heartbeat.

In the presence of complications, it is urgent to visit the clinic for emergency surgical treatment.

Good afternoon. I am 43 years old and yesterday they found a fibroma of the left ovary with a diameter of 5 cm on ultrasound. What should I do, and is this pathology dangerous? (Zinaida, 43 years old).

Hello Zinaida. Fibroma of the ovary is a benign tumor on the gonad. However, a “harmless” neoplasm can give complications at any time, or continue its growth, reaching a rather large size. In your case, it can still be removed by laparoscopy. Fibroma cannot be cured medically.

Types of ovarian fibromas

There are two main types of ovarian fibromas:

1. Limited - the tumor has a connective tissue membrane that separates it from healthy ovarian tissues.
2. diffuse. In this case, the neoplasm completely affects the gonad. Unfortunately, this type of fibroma is much more common - in about 90% of cases.

Fibromas also differ in their consistency, they can be:

1. Hard, to the touch like a stone. Fibroma "stones" in case of its complete calcification.
2. Soft. Softening occurs due to swelling of the tissues.
3. Elastic, tight. Meet most often. In their cavity, as a rule, there are multiple cysts. Cystic cavities can be filled with liquid contents - serous or hemorrhagic.

Fibroids can be ovoid or round in shape. Due to the fact that the formation is on the leg, it is mobile. The tumor grows extremely slowly, but due to dystrophic changes in the tissues, the growth process can be accelerated.

General and differential diagnosis of ovarian fibroma

As mentioned earlier, a small fibroma does not make itself felt. When examined on a gynecological chair, a specialist can “see” an enlarged ovary, on the one hand. Also, palpation may show the presence of a mobile dense formation. To make the correct diagnosis, in addition to the usual examination, the following diagnostic methods are used:

• taking a smear from the vagina, a tank of sowing secretions. Studies can reveal whether there are infections or an inflammatory process in the vagina;
• blood sampling for hormones. With the help of screening, the hormonal background of the patient is assessed;
• blood test for the ovarian window marker (CA 125). Increased rates will serve as an excuse for a possible malignant process. However, high numbers of CA 125 do not always indicate cancer, there is a high probability of its increase in ascites (which is a frequent companion of fibroma);
• ultrasound. The study will allow you to study the echostructure of the tumor, its exact location and shape. A doppler will be able to visualize blood flow;
• MRI and CT;
• puncture of the abdominal cavity through the posterior fornix of the vagina. Performed when ascites is suspected. After puncture, the transudate is sent for histological examination to the laboratory;
• laparoscopy. The surest way to find out the nature of the tumor. Under general anesthesia, a woman undergoes a minimally invasive operation, during which 3 incisions are made on her anterior abdominal wall, through which, using special tools equipped with a camera, the doctor will perform the intervention. During the study, the surgeon has the opportunity to take a piece of the affected tissue for further study. In some cases, diagnostic laparoscopy can immediately go into treatment (complete removal of the fibroma).

Fibroma, when viewed on a chair and on ultrasound, has no specificity, and therefore it is quite easy to confuse it with other similar pathologies.

Ultrasound and histological examination of pathological tissues play a decisive role in making the correct diagnosis. Among cystoma-like neoplasms, there are:

1. - a true benign tumor of the gonad, often multi-chamber, filled from the inside with liquid contents. Cystoma consists of epithelial cells.
2. Myoma of the uterus. The subserous node (growing towards the abdominal cavity), due to its unusual location, can mimic an ovarian neoplasm.
3. ). A tumor that is very similar to a fibroma, but, unlike it, exhibits hormonal activity. In the presence of a thecoma, a woman very often experiences disruptions in the menstrual cycle, intermenstrual bleeding (or vice versa - the complete absence of menstruation), and infertility.
4. Lipofibroma is a tumor composed of fatty tissue. Lipomas are quite rarely found in the ovarian zone, since there is almost no fat.
5. Serous adenofibroma. A benign formation is an epithelial bladder filled with exudate. Also, a serous cyst tends to grow into nearby organs.
6. . Only the histology of the affected tissues can differentiate a sarcoma from a benign tumor.

ovarian fibroma and pregnancy

Before becoming pregnant, every expectant mother should visit her attending physician for examination and proper preparation. However, many of the fair sex do not follow this rule, letting everything take its course. It is in this case that during the bearing of a child, ovarian fibroma can be detected.

A tumor rarely interferes with the conception of a baby, but it can complicate its bearing with a high probability. Quite rarely, a neoplasm of the gonad occurs already during pregnancy.

During the gestation period, fibroma can give various undesirable consequences: the threat of abortion, uterine tone, bleeding, impaired development of the baby, etc.

The task of the doctor in the management of such a patient is to closely monitor the tumor. If the risks of developing fetal pathology and termination of pregnancy due to it are too high, the specialist may decide on surgical treatment, which can be performed from the 16th week of gestation. Fortunately, fibroids rarely grow during pregnancy, and due to changes in hormone balance, they often slow down their growth and may even regress slightly.

Treatment of ovarian fibroma

Therapy for ovarian fibroids can be only one - radical. Under the influence of medicines, the neoplasm will never resolve and not decrease in size. Therapy with folk remedies will also not give positive results, and therefore resorting to it to get rid of fibroids is a waste of time. In addition, cases of deterioration of the tumor under the influence of "useful" decoctions and tinctures are not uncommon.

There are 2 surgical interventions to get rid of the pathology:

1. Laparoscopy (minimally invasive access to the abdominal cavity through several small sizes). The preferred and most commonly used treatment for fibroids. Laparoscopy is done when the neoplasm has not reached a large size. Also, this technique is better for women who plan to realize their reproductive function in the future.
2. Laparotomy (the size of the anterior abdominal wall). Laparotomy is done if the size of the tumor exceeded 6-7 cm, and also if it is on a long movable leg.

How long the intervention will last depends directly on the neglect of the pathology (usually no more than 1 hour). After removal of the tumor after a couple of days, women are shown to move a lot, but exclude heavy physical exertion. In order to prevent the formation of an adhesive process, as well as to prevent inflammation, drug therapy is still being carried out for some time, which is prescribed by the doctor individually for each patient. After some time (usually 3-4 months) after the intervention, a woman can try to get pregnant.

Hello. I have a 4 cm fibroma on my right ovary. Can I get pregnant? (Evangelina, 37 years old)

Hello Evangeline. Of course, it is possible to get pregnant with your diagnosis, but I would not advise. No one knows how the tumor will behave during the bearing of the child. The most correct tactic is to remove the fibroma, and then prepare to conceive a baby. Treatment of pathology is only surgical.

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