{"paper_id":"d1cec19a-f65f-4d13-8d71-956ffa00aa8a","body_text":"Submit Manuscript | http://medcraveonline.com\nIntroduction\nOvarian endometriosis is a particular form of endometriosis, \nwhich is characterized by specific clinical, pathophysiological and \nhistological characteristics:\ni. Ovarian endometriosis is the most frequent localization of \nendometriosis lesions;\nii. Ovarian endometriosis adversely affects the folliculogenesis in \ngeneral and the function of yellow body in particular;\niii. Ovarian endometriosis inhibits ovarian reserve, destroying the \nfunctional tissue of the ovaries;\niv. it is believed that originally it is ovarian endometriosis, which \ncauses the development of severe complication - deep infiltrative \nendometriosis; \nv. Finally, ovarian endometriosis, in contrast to other localizations, \npresents the greatest potential threat of malignization.\nFeatures of the histogenesis of the ovarian endometriomas \n(capacity of infiltration into surrounding tissues) lead to the decrease \nof the amount of functioning ovarian tissue, regardless of the size \nof the formation. Another concept of ovarian dysfunction in cases \nof endometriosis is that endometriomas contain a huge amount of \nfree iron, which forms toxic superoxide by reaction with hydrogen \nperoxide, leading to oxidative stress and thus to disruption in the \nfunctioning of the cell. The impact of reactive oxygen species on the \nactivity of anti-inflammatory cytokines, adhesion molecules, growth \nfactors and angiogenic factors leads to inhibition of cell growth in \nthe ovary.1 Therefore the presence of endometrioma can already be \nconsidered as a damage factor of ovarian reserve.\nOne more important problem of endometriomas is oncological \nalertness. Today the risk of malignization of endometriosis is not the \nreason for the debate. However, in the discussion of this problem is \na “slipping away” important clarification: the ability to malignization \nusually has ovarian endometriosis. For ovarian endometriosis is \ntypical cellular irregularities, which are usually regarded as the phase \ntransition of benign to malignant process.2\nIt seems that the presence of such features has to establish \nabsolute indications for surgical treatment of patients with ovarian \nendometriosis. However, the question of tactics of treatment is \ndiscussed up to the present time. There is a point of view, according \nto which ovarian endometriomas with a diameter up to 3 cm may \nconduct drug therapy. The main argument of this position is the \nsharply negative impact of surgery on ovarian reserve and ovaries. It \nis impossible not to admit that this fact has a high level of confidence.\nMechanisms of loss of follicular reserve after surgical treatment of \npatients with ovarian endometriomas are different. However, the main \nreason is closely associated with morphogenesis of endometriomas. \nEndometrioma, in contrast to other tumors, is characterized by the \npresence of subepithelial dense adhesions between the cyst capsule \nand the hilus – the place of passage of major blood and lymphatic \nvessels, supplying the ovary. Therefore, cystectomy in cases of \nendometriotic cysts is a big trauma to the ovary, and the need for \nligation (coagulation) of the ovary in the area of its portal causes \nadditional disturbances in the ovarian blood supply.\nSo, on the one hand, passive observation or medical therapy \nof endometriomas is associated with the high risk of various \ncomplications (the decrease of ovarian function, an expanisve growth, \nthe threat of malignization); on the other hand, classic cystectomy is \nfraught with potential loss of ovarian reserve. Therefore, to solve this \nproblem a compromise is required. Today, the role of the “Golden \nmean” of the treatment of patients with ovarian endometriomas \nperforms aspiration (sclerosing) therapy.\nIn the literature of recent years, there are a relatively large number \nof publications on this subject. The authors of the present work carried \nout the first such intervention in 1999 in a female patient, 32 years \nold, with single ovary, which was diagnosed with a recurrence of \nendometriotic cysts after previous cystectomy. 3 The first experiment \nwas successful: after 2 years of infertility, pregnancy came and ended \nwith a normal delivery.\nFrom that period there were 118 such interventions, a retrospective \nanalysis of which helped to justify clear indications for sclerosing \ntherapy of ovarian endometriomas:\nMOJ Gerontol Ger. 2018;3(3):238‒239. 238\n© 2018 Davydov et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nOvarian endometriomas: the role of aspiration \n(sclerosing) therapy\nVolume 3 Issue 3 - 2018\nDavydov AI, Shahlamova MN\nProfessor of Medicine at the Chair of Obstetrics, Gynaecology \nand Perinatology, I.M. Sechenov First Moscow State Medical \nUniversity, Russia\nCorrespondence: Davydov Aleksandr Il’gizirovich, Professor \nof Medicine at the Chair of Obstetrics, Gynaecology and \nPerinatology, I.M. Sechenov First Moscow State Medical \nUniversity, Russia, Email al-davydov@mail.ru\nReceived: February 16, 2018 | Published: June 06, 2018\nAbstract\nThe article discusses disputable problems of aspiration therapy of ovarian \nendometriomas. A comparatively high (43.2%) incidence of relapses of endometriomsa \nwithin a 12-month follow-up after sclerosing therapy has been noted. At the same \ntime, pregnancy occurred in 37.3% of women during this period, later ending with \nchildbirth in 100% of cases. Aspiration therapy of ovarian endometriomsa presupposes \na careful selection of patients for such intervention. Its favourable outcomes in many \nrespects depend on hormone therapy compliance.\nKeywords: endometriomas, aspiration (sclerosing) therapy, ovarian reserve\nMOJ Gerontology & Geriatrics \nCase Report\n Open Access\n\n\nOvarian endometriomas: the role of aspiration (sclerosing) therapy\n239\nCopyright:\n©2018 Davydov et al.\nCitation: Davydov AI, Shahlamova MN. Ovarian endometriomas: the role of aspiration (sclerosing) therapy. MOJ Gerontol Ger. 2018;3(3):238‒239. \nDOI: 10.15406/mojgg.2018.03.00123\ni. Reproductive age (especially its beginning), with no \npregnancies in anamnesis;\nii. Recurrence of endometriotic cyst of the single ovary;\niii. Previous multiple surgeries on a single ovary;\niv. High risk of complications of abdominal surgery; \nv. Planning of IVF; \nvi. Rapid recurrence of histologically verified endometrioma.\nOf course, in each particular case should prevail individual \napproach to the choice of treatment. It should be emphasized that the \naspiration therapy for endometriomas implies the use of postoperative \nhormonal therapy. Appointment postoperative exogenous hormones \n(antihormonal) pursues the following objectives:\na. To add the sclerosing effect of ethanol;\nb. To suppress the peak emission of hormones of the anterior \npituitary, which contributes to cause a relapse of the disease.\nIn the intervening period we have completed the analysis of \n118 cases of the aspiration therapy of patients with endometrioid \novarian cysts. The frequency of relapses during the first 12 months \nof observation was 43.2%. During the same period, the pregnancy \noccurred in approximately 37.3% of women, which subsequently \nresulted in delivery of 100%. Some patients (19,5%), for various \nreasons, did not plan pregnancy (Figure 1).\nHow to treat a recurrence rate of aspiration therapy? On the one \nhand, it is high enough; on the other hand, it is not much higher than \nafter cystectomy. Furthermore, this method provides careful treatment \nof the ovarian reserve in conjunction with chemical degradation of the \ncapsule of the cyst. Considering the relatively high recurrence rate \nof endometriomas after aspiration therapy the following aspects are \nrequired: first, careful selection of patients for such an intervention; \nsecondly, the preparatory interviews with the patient, in which a \ndetailed way all the advantages and disadvantages of lean operation \nare described.\nFigure 1 Endometriotic ovarian cyst aspiration:\n(A)  Needle introduced,\n(B)  The image of the ovary after sclerosing therapy.\nConclusion\nSo, sclerosing therapy of endometriomas has its clearly localized \nniche in the complex treatment of women with ovarian endometriosis. \nIn some situations, this method can have the status of “finished” \ntherapeutic action, in the series–it is a preparatory stage for cystectomy. \nFavourable outcomes of the aspiration therapy highly depends on \ncompliance of hormone treatment.\nAcknowledgements\nNone.\nConflict of interest\nThe author declares no conflict of interest.\nReferences\n1. Goud PT, Goud AP, Joshi N, et al. Dynamics of nitric oxide, altered \nfollicular microenvironment, and oocyte quality in women with \nendometriosis. Fertil Steril. 2014;102(1):151–159. \n2. Matias GX, Stewart CJR. Endometriosis-associated ovarian neoplasia. \nPathology. 2018;(2):190–204. \n3. Davydov AI. Ultrasonic mini-surgery for the treatment of endometriotic \novarian cysts in patients with multiple laparotomies in anamnesis. New \ntechnologies in gynecology. Moscow; 2000.","source_license":"CC0","license_restricted":false}