What Is a Chocolate Cyst?

Ovarian chocolate cyst (chocolate cyst of ovary), also known as ovarian endometriosis cyst, is a lesion of endometriosis. Under normal circumstances, the endometrium grows in the uterine cavity, and the effects of female hormones in the recipient fall off once a month to form menstruation. If the endometrial fragments that fall off during the menstrual period enter the pelvic cavity with menstrual blood flowing backward through the fallopian tubes, they are planted on the surface of the ovary or other parts of the pelvic cavity, forming ectopic cysts. This ectopic endometrium is also affected by sex hormones, and repeatedly falls off with the menstrual cycle Bleeding, if the lesion occurs on the ovary, there will be local bleeding during each menstrual period, which will enlarge the ovary and form a cyst containing old blood. This old blood is brown and sticky like a paste, like chocolate. Also called "chocolate cyst". This cyst can grow gradually and sometimes rupture during or after menstruation, but rarely with malignant changes. Although ovarian chocolate cysts are benign diseases, they have malignant behaviors such as proliferation, infiltration, metastasis, and recurrence. This type of ovarian cyst is one of the most common diseases of women of reproductive age between 25 and 45 years of age, with an incidence of 10% to 15%. Endometriotic lesions become larger with time, gradually eroding normal tissues, causing irreversible damage to ovarian tissues. Severe cases require surgery.

Basic Information

nickname: Endometriotic cyst
English name: chocolate cyst
English alias: chocolate cyst of ovary

Visiting department: Gynecology
Common causes: Endometriosis
Common symptoms: Dysmenorrhea, pain during intercourse, infertility
Contagious: no

Causes of chocolate cysts

There are three main theories of endometriosis: implantation theory, metaplasia theory and epithelial origin theory. In the study of ovarian endometriosis, the doctrine of implantation is the most respected. Implantation Doctrine: Sampsan first proposed the doctrine in 1921. According to this theory, the ectopic endometrium originates from endometrial tissues, which are transferred to sites outside the uterine cavity for implantation and growth. Common transmission routes include menstrual reflux, iatrogenic implants, lymphatic spread, and blood vessel spread. There is also the theory of immunology.

Clinical manifestations of chocolate cysts

Dysmenorrhea

Dysmenorrhea is the most obvious symptom of endometriosis, but it is the easiest sign to ignore, and it often gets worse.

2. Pain during intercourse

This is also an obvious signal, and may be accompanied by a bit of bleeding, and the symptoms of ovarian chocolate cysts are not very obvious.

3. Infertility and menstrual disorders

Among infertile women, infertility caused by endometriosis accounts for a high proportion.

Chocolate cyst examination

Medical history

Focus on inquiring about menstruation history, motherhood history, family history and surgery history. Pay special attention to the relationship between the occurrence and development of pain or dysmenorrhea and menstruation and cesarean section, abortion, tubal drainage and other operations.

2. Gynecological examination

In addition to double consultations, special attention must be given to the need for triple diagnosis. In patients with ovarian endometriosis, cystic masses adhering to the uterus or broad ligament and pelvic wall can be touched in the appendage area. They have poor mobility and often have mild tenderness. The diameter of the cyst is generally less than 10 cm.

3. Laparoscopy

Laparoscopy is currently the best clinical method for diagnosing ovarian chocolate cysts, mainly by peeping the pelvis with the help of laparoscopy, which can accurately find the location and cause of endometriosis, and accurately diagnosis.

4. Other auxiliary inspections

(1 ) Imaging examination B-mode ultrasound of the vagina and abdomen is the most simple and easy diagnostic method. It is an important method to identify ovarian endometriosis cysts. Its diagnostic sensitivity and specificity are more than 96%, but the diameter is less than 1cm. B-mode ultrasound can determine the location, size, shape and contents of the ovarian endometriosis cysts, the presence or absence of nipples in the sac, indicating cystic or solid, and the relationship with surrounding organs, especially the uterus. Ultrasound images generally show that the cysts are oval or round. The cysts can be single- or multi-chambered. They have adhesions to the surrounding tissues, especially the uterus. The cyst walls are thick and rough, and there are small, flocculent light spots in the cyst. The size of the cyst may change with the menstrual cycle. Since the echo image of the cyst is non-specific, it cannot be diagnosed solely based on the ultrasound image. The diagnostic value of pelvic CT and MRI for intrapelvic anomalies is equivalent to B-mode ultrasound, but the cost is more expensive. MRI is useful for the diagnosis and evaluation of ovarian endometriosis cysts.

(2 ) Determination of serum CA125 The serum CA125 value of patients with moderate or severe endometriosis may increase, but generally it is slightly elevated, and is generally less than 100IU / L. However, the specificity and sensitivity of CA125 are limited, and there are cross-positive reactions with various diseases. At present, no tumor marker is unique and unique to a tumor, so it cannot be used for diagnosis or differential diagnosis alone. For those with elevated CA125 values, serum CA125 levels can be used to monitor the activity of ectopic endometrial disease, which decreases when treatment is effective, and increases when relapsed.

Chocolate cyst diagnosis

It is not difficult to make a diagnosis based on the patient's medical history and related auxiliary examinations, and the final diagnosis still needs surgical exploration.

Chocolate cyst treatment

It can be treated with medication or (and) surgery (conservative or radical). So far, there is no ideal method of radical cure other than radical surgery. Whether it is drug treatment or conservative, there is a very high recurrence rate. Therefore, it should be selected according to the patient's age, symptoms, signs, extent of lesions, and fertility requirements, subjective wishes of the patient and other factors, and emphasize individualized treatment. It is advocated to choose the right drug for active treatment combined with close follow-up review, pay attention to the changes in the nature of ovarian cysts, and then take corresponding measures. For mild or asymptomatic mild lesions, expectant treatment should be selected. Mild patients with fertility requirements should be treated with drugs after a clear diagnosis, and those with severe conditions should undergo fertility-preserving surgery. Young, severe patients with no fertility requirements can undergo ovarian function-preserving surgery. Complemented by medication; patients with severe symptoms and lesions who have no fertility require radical surgery.

There are two surgical methods: open surgery and laparoscopic surgery. Laparoscopic surgery is the best treatment for this disease. At present, it is considered that the laparoscopic diagnosis, surgery + drugs are the gold standards for the treatment of endometriosis. Laparoscopic surgery should be the preferred treatment for endometriosis in conditional hospitals. However, the choice and effect of laparoscopic surgery depends to a large extent on the equipment, instruments and the experience and skills of the operator. Open surgery can be used for laparoscopic conditions that are not available or very complicated, such as severe adhesions and those with multiple surgical history.

Chocolate cyst prevention

The etiology is unclear and its histology is complicated and cannot be completely prevented. According to possible etiology and epidemiological results, prevention can be carried out from the following aspects: prevention of menstrual reflux; drug contraception; prevention of iatrogenic endometrial planting.