| Chocolate cyst of ovary | |
|---|---|
| Classification and external resources | |
| ICD-10 | N80.1 |
| ICD-9 | 617.1 |
An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst of ovary is a condition related to endometriosis.
Contents |
Pathophysiology
It is caused by endometriosis,[1] and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between.
Treatment
Treatment for endometriosis can be medical or surgical.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively (excision and biopsy) established. The goal of directed medical treatment is to achieve an anovulatory state. Typically, this is achieved initially using hormonal contraception. This can also be accomplished with progestational agents (i.e., medroxyprogesterone), danazol, gestrinone, or gonadotropin-releasing hormone agonists (GnRH), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. GnRH can be combined with estrogen and progestogen (add-back therapy) without loss of efficacy but with fewer hypoestrogenic symptoms. These medications are often ineffective in treating endometriomas and any relief is short lived while taking the medications. Hormonal treatment has a large number of sometimes permanent side effects, such as hot flashes, loss of bone mass, deeping of voice, weight gain, and facial hair growth.
Surgery
Laparoscopic surgical approaches include excision of implants, excision of adhesions, and excision of endometriomas. They frequently require surgical removal, and excision is considered to be far superior in terms of permanent removal of the disease, pain relief and improving fertility. Laser surgery, cautery and endometrioma drainage are considered to be far less effective and only burn the top layer of endometrial tissue, allowing for the endometrioma and endometriosis to grow back quickly. Conservative surgery can be performed to preserve fertility in young patients. Operative laparoscopic surgery provides pain relief and improved fertility over diagnostic laparoscopy. Radical surgery is a hysterectomy and bilateral oophorectomy, however this does not cure endometriomas or endometriosis, contrary to popular myth. [2][3]
References
- ^ "Female Genital Pathology". http://library.med.utah.edu/WebPath/FEMHTML/FEM071.html. Retrieved 2009-05-12.
- ^ "What You Need To Know About Ovarian Cysts, Common Types". Health Square. http://www.healthsquare.com/fgwh/wh1ch09b.htm.
- ^ Endometrioma/Endometriosis at eMedicine
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