Eierstockzysten (Ovarialzysten) sind mit Flüssigkeit gefüllte Hohlräume, die aus Eierstockgewebe entstehen. Eierstockzysten sind die häufigsten gutartigen Eierstocktumoren. Sie kommen in allen Lebensaltern der Frau vor, besonders aber in der generativen Phase. Meist sind Eierstockzysten gutartig und bilden sich von allein wieder zurück.

Ursachen
Häufigste Ursache für eine Zyste ist ein Eibläschen (Follikel), das beim Eisprung nicht wie normal geplatzt ist, oder wenn sich Gelbkörperzysten, die in der zweiten Zyklushälfte eine Rolle spielen, nicht wie üblich zurückbilden. Zysten können jedoch auch durch wucherndes Eierstockgewebe zu Geschwülsten anwachsen. Da die Zysten mit der Funktion der Eierstöcke unmittelbar zusammenhängen, werden sie auch als funktionelle Zysten bezeichnet. Manche Eierstockzysten können faustgroß werden. Rauchen erhöht das Risiko für funktionelle Zysten um das Doppelte. Neben Endometriosezysten finden sich auch Zysten beim sogenannten Polyzystischen-Ovar-Syndrom.

Entstehungsweisen von Zysten
Teer- oder Schokoladenzysten: Die Zyste kann von im Eierstock angesiedelten Fremdgewebe ausgehen, am häufigsten durch eine Endometriose = versprengte Schleimhaut aus der Gebärmutterhöhle. Diese reagiert wie die Gebärmutterschleimhaut, wird also auf- und abgebaut. Die dabei entstehende Blutung füllt den Hohlraum aus und vergrößert ihn. Die Blutabbauprodukte haben eine braune Farbe. Deshalb werden solche Gebilde auch als Teer- oder Schokoladenzysten bezeichnet.
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Dermoidzysten: Es gibt auch Zysten, die direkt vom Keimgewebe ausgehen. Ihr Inhalt besteht aus allen 3 Keimblättern, wie Haare, Zähne, Talg und Flüssigkeit. Sie nennt man Dermoidzysten. Auch sie sind Retentionszysten = durch Sekretverhaltung entstanden und keine Gewebsneubildungen.

Diagnostik und Therapie
Oft machen die Zysten keine Beschwerden und werden zufällig bei gynäkologischen Untersuchungen entdeckt. Es wird zunächst sonografisch entschieden, ob es sich um eine Zyste oder einen soliden Tumor handelt. Das kann sehr schwierig sein, weil auch echte Tumoren mit Flüssigkeitsbildung einhergehen können. Zysten bis zu einer Größe von etwa 5 cm können zunächst belassen und beobachtet werden, wenn keine Beschwerden vorhanden sind. Nicht selten bilden sich solche (Follikel- oder Gelbkörper-) Zysten wieder zurück. Beschwerden treten vorwiegend auf, wenn eine bestimmte Größe überschritten wird: Druckgefühl im Bauch bis Atemnot, häufiges Wasserlassen (Polakisurie), Beschwerden beim Geschlechtsverkehr. Fallen sie dadurch auf oder kann sonografisch nicht sicher entschieden werden, ob es sich womöglich um einen soliden Tumor handelt (bei Schokoladen- und Dermoidzysten möglich), werden sie laparoskopisch entfernt. In vielen Fällen kann dabei der Eierstock erhalten werden.

Stieldrehung
Komplikationen sind bei diesen Zysten möglich durch Stieldrehung, wenn sich durch ihre Größe der Eierstock um seine Achse dreht. Dann kann eine solche Zyste platzen und der Zysteninhalt sich in die Bauchhöhle ergießen, was mit starken Blutungen einhergehen kann. So können ganz akute Krankheitsbilder entstehen, die unverzüglich behandelt werden müssen. Manchmal werden in den Zysten auch Hormone gebildet, die zu Regelstörungen führen können.

Bösartig?
Eierstockzysten werden nur ganz selten bösartig. Dennoch bedürfen auch die Zysten sorgfältiger Überwachung.

http://frauen.qualimedic.de/Eierstockzysten.html

Eine Anzahl von 484 Ovarektomien bei Patientinnen unter 40 Jahren (2006) erscheint zu hoch! Insgesamt schätzt die BQS-Fachgruppe „Gynäkologie“ auf der Bundesebene die Versorgungs situation im Jahr 2006 als verbesserungsfähig ein und betont, dass von einer Überbzw. Fehlversorgung aus gegangen werden muss. Zystische Ovarialtumore können mit hoher, aber
nicht mit letzter Sicherheit sonographisch/endos - kopisch in ihrer Dignität beurteilt werden.

2006 wurden in Deutschland 20 775 Frauen ovarektomiert. In 21.08 % der Patientinnen (n = 4379) handelte es sich um funktionelle Zysten oder Ovarien mit Normalbefund. Bei Patientinnen unter 40 Jahren wurde in 485 Fällen das Ovar wegen funktioneller Zysten oder Normalbefund entfernt. Fast jedes zweite Krankenhaus (206 von 421) überschreitet den geforderten Referenzwert von max. 20 % funktionellen Zysten oder Normalbefund bei den Ovarektomien als alleinigem Eingriff. Das organerhaltende Vorgehen bei Frauen im reproduktionsfähigen Alter sollte zum Standard werden.

http://www.frauenheilkunde-aktuell.ch/frauenheilkunde-d/PDF-Ordner-FHA-Frauenheilkunde-aktuell/Frauenheilkunde-Aktuell-Ausgabe-08-02/FHA-Arikel_04_12_thema_zur_Problematik.pdf

WHAT ARE OVARIAN CYSTS?
An ovarian cyst is simply a collection of fluid within the normally solid ovary. There are many different types of ovarian cysts, and they are an extremely common gynecologic problem. Because of the fear of ovarian cancer, cysts are a common cause of concern among women. But, it is important to know that the vast majority of ovarian cysts are not cancer. However, some benign cysts will require treatment in that they do not go away by themselves, and in quite rare cases, others may be cancerous. The good news is that almost all ovarian cysts will go away by themselves without any treatment.

CAN A CYST CAUSE PAIN?
Although many cysts cause no symptoms at all, pressure or pain in the pelvic area is a common problem that may cause a woman with an ovarian cyst to see her doctor. As fluid collects in a cyst and can weigh the ovary down, causing a pulling sensation when a woman moves. In very rare cases, the covering of the ovary tears opens, or ruptures, releasing the cyst fluid into the abdominal cavity. This ruptured ovarian cyst usually results in the sudden onset of pain.

HOW ARE OVARIAN CYSTS DIAGNOSED?
At the time of a pelvic exam, your doctor will feel off to the sides of the uterus, where the ovaries are located. The ovaries are normally no larger than a small walnut. But if a cyst forms, the ovary can swell to a few inches or more. The doctor is often able to feel a cyst as a soft, movable lump.
If you are not menopausal and the cyst is not bothersome, a repeat examination can be scheduled in two or three weeks to make sure that the cyst is going away. If the cyst has dissolved by that time, no further treatment or follow-up is needed. If the cyst is still present at the follow-up visit, I will usually order a pelvic sonogram.

WHAT CAN A SONOGRAM SHOW?
The most accurate way to get a picture of the ovary and cyst is with a vaginal sonogram. This test uses a small instrument, which is comfortably passed into the vagina. This instrument bounces harmless sound waves off your uterus, fallopian tubes, and ovaries, forming a picture on a monitor. A sonogram allows the doctor to accurately determine the size of the cyst and to "see" inside it in order to detect whether it is filled with fluid or solid areas. Certain types of ovarian cysts, depending on which cells in the ovary are overgrowing, will make fairly reliable patterns on a sonogram.

WHAT ARE THE DIFFERENT TYPES OF OVARIAN CYSTS?
Ovarian cysts can be divided in two ways - those that go away by themselves vs. those that need treatment, and those that are benign vs. those that are cancer. Most cysts are benign and will go away by themselves. The distinction that is most important to your health and well-being is whether the cyst is cancerous or benign. Cancerous cysts should, obviously, be removed as soon as possible. However, some benign cysts are of the type that will not go away by themselves and may also need to be removed to prevent further problems. The following chart may be helpful.

USUALLY GO AWAY BY THEMSELVES
BENIGN CYSTS CANCEROUS CYSTS
follicular cysts none
corpus luteum cysts
hemorrhagic cyst

DO NOT GO AWAY BY THEMSELVES
BENIGN CYSTS CANCEROUS CYSTS
endometriomas epithelial cancers
epithelial cysts-serous, mucinous germ cell cancers
dermoid cysts

DO BENIGN OVARIAN CYSTS BECOME CANCEROUS?
Research shows that benign cysts do not turn into cancerous cysts, so if you have an ovarian cyst that seems to be benign upon exam and on a sonogram, waiting for it to go away for two months or so is not risky. Research also shows that women who form benign ovarian cysts are not any more likely to develop ovarian cancer than women who have not had cysts.

HOW ARE OVARIAN CYSTS TREATED?
The appropriate treatment for an ovarian cyst depends on the type of cyst present, the symptoms you have, and whether you are premenopausal or postmenopausal. If you are premenopausal, if you are not having bothersome symptoms, and if your cyst appears benign on sonogram, watchful waiting will often allow the cyst to dissolve by itself within 4-10 weeks. If, however, your symptoms are very bothersome, or the cyst appears suspicious for malignancy, then it should be removed.

WHEN IS SURGERY NEEDED FOR AN OVARIAN CYST?
Surgery may be considered necessary if a cyst appears suspicious for cancer on the sonogram, if it causes severe pain, if it continues to grow, or if it does not go away in 8 weeks. A number of studies show that cysts that persist longer than eight weeks without decreasing in size have a greater likelihood of being abnormal. This does not mean cancer, but rather an abnormal growth of cells within the ovary that will never go away. If left in place, these cysts may continue to grow and cause discomfort or twist the ovary around and destroy it. Also, in very rare instances (less than 5%), these cysts may be cancerous, and early detection and removal are important.

CAN LAPAROSCOPIC SURGERY BE USED TO TREAT AN OVARIAN CYST?
Instruments are now available that enable the gynecologist to remove a cyst through small incisions in the abdomen , while preserving the normal, healthy ovary . The type of procedure, known as laparoscopic surgery, provides the benefits of outpatient surgery and a quick recovery.
Removing a cyst, called a cystectomy, is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device. The cyst now looks like a deflated balloon and can easily be removed through the small laparoscopy incision.
Rarely, if a cyst has destroyed all the normal ovarian tissue, it may be necessary to remove the entire ovary and it is possible to do this, as well, with the laparoscope.
For more information about laparoscopic surgery, as well as photographs of the procedure, please visit http://www.parkermd.com/oc-treatment.htm

WHEN IS MAJOR SURGERY NEEDED FOR AN OVARIAN CYST?
If a cyst is suspicious for being a cancer based on the exam and the sonogram, there is no reason to subject a woman to the added time, risk and expense of a laparoscopy only to find that it is necessary for the doctor to switch, while the patient is asleep, to the standard abdominal surgery. Therefore, if there is a possibility that a cyst is cancer based on the examination and sonogram, abdominal surgery should be performed.

IF YOU ARE PREMENOPAUSAL, DO YOU NEED TO HAVE YOUR ENTIRE OVARY REMOVED IF YOU HAVE AN OVARIAN CYST?
Almost always, the answer is no. If you are premenopausal, the ovary contains eggs that make the female hormones estrogen, progesterone and testosterone and also allow you to get pregnant. So, as long as there is healthy ovarian tissue remaining, it is a good idea to leave the ovary in place and just remove the benign cyst. In very rare instances, the cyst destroys all the normal ovarian tissue, and there is nothing left to save and removing the entire ovary is necessary.

CAN AN OVARIAN CYST FORM AFTER MENOPAUSE?
The ovary no longer produces eggs after menopause, but benign ovarian cysts can still occur after menopause. In fact, after menopause the most likely types of ovarian cysts are still benign cysts. However, because the incidence of ovarian cancer increases with age, any cyst or growth in the ovary after the menopause should be evaluated right away with a sonogram. Once again, the sonogram can be helpful in predicting whether the cyst is benign, or if it is suspicious for cancer. In addition, if you have a cyst after menopause, the blood test CA-125 should be done. As previously noted, the test is inaccurate in pre-menopausal women, but it is more accurate in postmenopausal women. If the sonogram shows a benign pattern and the CA-125 test is normal, then the ovarian cyst is probably benign.

A very interesting recent study found benign ovarian cysts to be much more common in post-menopausal women than anyone had realized. Ultrasounds were performed on 7,700 healthy post-menopausal women as part of a study designed to find early ovarian cancers. Small ovarian cysts, 2-inches or less, were unexpectedly found in 450 of these women. Because these cysts were benign-appearing on ultrasound, and CA-125 tests were normal, the women had the ultrasound repeated in two months. Surprisingly, half of the cysts had already disappeared by that time.

Half of the women with persistent cysts chose surgery and NONE of them had cancer found at the time of surgery. Also, NONE of the women who had repeated ultrasounds and were followed over the next few years were found to have ovarian cancer. Women and doctors still have varying degrees of comfort about not removing an ovarian cyst. But, based on this study and others, a discussion about options should take place. Some women may choose surgery and others may choose careful follow-up. At this point, both options are reasonable.

IS A HYSTERECTOMY NEEDED IF YOU HAVE AN OVARIAN CYST?
In the past, if a woman had completed her family and had a benign cyst that needed to be removed surgically, a hysterectomy was routinely performed at the same time. This practice has recently been questioned by a scientific study that showed the risks of surgery were greater if, in addition to removing the ovary, a hysterectomy was also performed to remove a normal uterus. This only makes sense - more surgery leads to more risk of blood loss, more risk of injury to other organs, and more time under anesthesia. Hopefully the idea of limiting surgery to just the problem area will be adopted by more gynecologists. If you have an ovarian cyst and your doctor is recommending hysterectomy, ask why they think that it is necessary. If you are not satisfied with the answer, you should consider getting a second opinion.

Copyright © 2005 OvaryResearch.com

http://www.ovaryresearch.com/media-responses.htm

 http://www.thedoctorschannel.com/video/2904.html

NEW YORK (Reuters Health) - In women over 55, simple ovarian cysts are common, usually resolving or persisting without progression, according to data from the prospective Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).

The presence of simple cysts, often found incidentally during transvaginal ultrasound (TVU) exams, did not affect the risk of ovarian cancer, according to lead author Dr. Robert T. Greenlee and colleagues -- bolstering recent recommendations that unilocular simple cysts in postmenopausal women be followed without intervention.

Dr. Greenlee, from the Marshfield Clinic Research Foundation, Wisconsin, and associates followed 15,735 postmenopausal women through 4 years of annual TVU screening. All were between 55 and 74 years old at enrollment, and all had CA-125 measurements and TVU studies at baseline. Both tests were repeated annually. In addition, for a woman to be included in the study, both ovaries had to be visualized at least once by TVU.

Simple cysts were defined as having a volume < 10 cm3 and with no solid areas, septae, or papillary projections within the cyst cavity.

In a paper published online January 25 in the American Journal of Obstetrics and Gynecology, the investigators report that the prevalence of at least 1 simple cyst detected during the first fully visualized TVU screening was 14.1%. Potential correlates of prevalent simple cysts were younger age (55 to 59), education past high school, and early menopause. The odds were also higher in women with a history of benign ovarian cysts, menopause before age 40, and a first pregnancy at or beyond age 30.

Among women without a cyst of any kind on their first fully visualized TVU screening, the incidence of simple cysts was approximately 8% per year, remained fairly constant, and did not vary by age.

One-third of ovaries with simple cysts were cyst-free the following year. Even when 2 or more cysts were present, all resolved a quarter of the time. Only 6% progressed in complexity from 1 year to the next.

Women with and without simple cysts were at similar risk of invasive ovarian cancer after nearly 8 years of follow-up evaluation, the authors write. Furthermore, traditional ovarian cancer risk factors, such as increasing age, family history of breast or ovarian cancer, nulliparity, and infertility, were not associated with simple cysts. Finally, changes in average CA-125 were not correlated with increases in the number or progression of simple cysts.

Thus, Dr. Greenlee and his group conclude, “Simple cysts are not likely cancer precursors or markers of increased risk and can be followed conservatively.”

Reference:
Am J Obstet Gynecol 2010.

http://www.thedoctorschannel.com/video/2904.html