Polyps, cysts and other benign changes in the cervix, vagina and vulva. Polyps of the cervix
Pathologies of internal organs are not such a rare occurrence. These include various formations that often appear as a result of a violation of the hormonal background or the immune status of the body. In order to determine what is the cause of their occurrence, it is necessary to undergo an examination, take tests and consult with your doctor. Today we will try to figure out on our own what is the difference between a polyp and a cyst. Both of these formations are often found in the human body.
What is a polyp and a cyst
Polyp- This is an overgrowth of tissue that rises above the mucosa. Most often, polyps form in hollow organs: in the uterus, in the stomach, in the rectum and in the colon.
Cyst- this is a kind of cavity, which is a liquid content enclosed in a shell of connective tissue. Cysts are congenital and acquired, they can form in any organ.
Difference Between Polyp and Cyst
Polyps are subject to mandatory removal, they are sent for histological examination to determine the cause of such growth. Most of them are due to hormonal or allergic disorders in the body, and therefore they often have a predisposition to relapse.
Cysts are congenital and acquired. It is desirable to remove them, because they tend to become infected and grow. Functional cysts are subject to observation for several months. If they start to grow, then they need to be removed.
TheDifference.ru determined that the difference between a polyp and a cyst is as follows:
A cyst is a liquid content in a connective tissue sac. A polyp is an overgrowth of the mucous membrane that protrudes into a hollow organ, such as the uterus, stomach, or intestines.
Cysts can be observed, polyps should be removed in any case.
Pathology of the endometrium and cystic neoplasms in the uterine appendages may be interrelated: hormonal imbalance provokes changes in the reproductive system, creating conditions for the appearance of benign tumors. Endometrial polyp and - it is far from always possible to understand what is primary, but regardless of the reasons Both diseases need to be treated..
Rice. Ovarian cyst
The main causes of combined pathology
A polyp, in most cases, is a benign neoplasm from the uterine mucosa, which, like with an ovarian cyst, most often occurs against the background of endometrial injury, inflammation, or endocrine disorders. The main factors of the simultaneous formation of a polyp and an ovarian cyst include:
- any option for terminating an unwanted pregnancy;
- chronic infectious and inflammatory process in the reproductive organs (uterus, appendages);
- metabolic syndrome (obesity, arterial hypertension, diabetes mellitus);
- diseases of the endocrine organs (thyroid gland, adrenal glands, pituitary gland);
- infertility with prolonged unsuccessful treatment;
- operations and injuries of the female genital organs.
For each specific woman, external and internal factors can be individual: having detected pathological changes, the doctor will offer therapy options.
Polyp and cyst - what to do
After a complete examination, the gynecologist will prescribe an operation. The optimal type of removal of the endometrial polyp and ovarian cyst is the use of the following endoscopic methods of treatment:
- Polypectomy under hysteroscopy control;
- Removal of the cyst with maximum preservation of healthy ovarian tissue under the control of laparoscopy.
Rice. Polypectomy
Both procedures allow the most effective removal of tumors by performing a combined operation under general anesthesia. Histological examination of the polyp and cyst is mandatory (it is important to identify the structure of the tumors in order to choose the best option for postoperative treatment). The doctor always takes into account the importance of the reproductive system for a woman, so he will use the safest endoscopic methods of surgical treatment. Upon receipt of favorable results of histological examination, 2-3 months after the operation, a woman can begin pregravid preparation by planning the desired pregnancy.
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Zhumanova Ekaterina Nikolaevna has certificates of an obstetrician-gynecologist, a doctor of functional diagnostics, a doctor of ultrasound diagnostics, a certificate of a specialist in the field of laser medicine and in the field of intimate contouring. Under her leadership, the Department of Laser Gynecology performs about 3,000 operations per year. Author of more than 50 publications, including guidelines for doctors.
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A polyp is a growth on the mucous membranes of a hollow organ. The pancreas does not have cavities, mucous membranes, which means that polyps cannot appear in it, by definition. In this case, what do doctors mean when they talk about polyps in the pancreas?
Sometimes real polyps appear in the duct of the gland, then they do not manifest themselves in any way, and they are difficult to diagnose even with ultrasound. As a rule, doctors habitually call it a pancreatic cyst. This neoplasm is a liquid, which is limited to a capsule created from the tissues of the gland.
Causes and types of pancreatic cysts
There are morphological features and nuances of the origin of the cyst:
- Congenital or ontogenetic. Such cysts are multiple and may be in the body together with polycystic disease of other organs, such as the kidneys, lungs or liver.
- Proliferative. The formation of formations of this type is associated with the proliferation of the epithelium of the ducts, as well as with fibrosis of the glandular tissue. Usually such cysts are multi-chambered.
- Retention, as a result of compression of the ducts of the gland by a tumor, scar or enlarged organ. These cysts are solitary and large. But sometimes patients have small, multiple retention cysts. Some doctors believe that increases the rate of development of such cysts lymphostasis.
- Pseudocysts or false cysts appear in people who have had severe types of hemorrhagic pancreatitis in areas of tissue necrosis.
How are polyps different from cysts?
There are times when doctors consider a pancreatic cyst to be a polyp. Education here is an accumulation of fluid, where along the perimeter there is a restriction from the tissues of the organ. "Cyst" is a collective term here because:
The number, localization and size of cysts can be very different, as well as their clinical manifestations. The key signs of the appearance of a pancreatic cyst are:
- pain in the left upper abdomen;
- frequent thirst;
- feeling of weakness;
- increase in body temperature;
- polyuria.
Very often, the symptoms of the disease appear after the cyst reaches a certain size, starting to squeeze neighboring organs. That is why small cysts are rarely found, except in cases where the diagnosis is carried out for other pathologies.
Sometimes the cyst may even bulge above the level of the skin, and attract the attention of a person. In this case, it is strictly contraindicated to postpone a visit to the doctor. Such a cyst can be very dangerous, since its sudden breakthrough is fraught with the most unpredictable consequences. However, a breakthrough sometimes leads to temporary relief.
If you do not pay attention to the appearance of a cyst, then over time it can grow to an impressive size. In this case, the patient may appear:
- Severe and almost incessant pain;
- Indigestion;
- Total weight loss, depletion of the body;
- Failures in the work of all organs against the background of a decrease in the volume of monosaccharides, amino acids, saturated fatty acids, vitamins, and other important elements for the normal functioning of the body.
For the life and health of a person, the appearance of a cystic lesion of the pancreas in the diagnosis of "diabetes mellitus" is extremely dangerous.
Complications
Cysts, in essence, are just cavities filled with fluid, but they are fraught with danger to the human body. Pancreatic polyps can cause complications. For example, a fluid breakthrough into a hollow organ will cause:
- peritonitis;
- bleeding;
- exacerbation of pancreatitis;
- the appearance of mechanical subhepatic jaundice or cholestasis;
- suppuration;
- fistula formation;
- cyst suppuration;
- heavy bleeding;
- rupture of the spleen;
- anemia.
Treatment
Pancreatic polyps are treated with surgery. As a rule, patients are prescribed resection of the affected area of the organ.
Resection is possible only when the polyp is localized in the organ and is formed by its tissues. In other cases, the choice of method for removing a cyst depends on its location and basic characteristics.
Surgery is the only way to save health in the presence of a pancreatic cyst.
However, even the complete elimination of the cyst does not guarantee that it will not reappear. In order to detect a relapse in a timely manner, you need to be regularly examined by a doctor and take preventive measures, otherwise we can say that even a complete one may be required.
If for some reason the patient neglects treatment, then such irresponsible behavior can eventually lead to death.
Preventive measures
To reduce the risk of cysts, doctors recommend:
- Eat well and regularly
- Quit smoking
- Do not take large amounts of alcohol and drugs.
In our time, very often there are a variety of pathologies of internal organs. Such formations often appear due to hormonal imbalance or weakened immunity. To find out the cause of the appearance of such formations, specialists send their patients for testing and then draw conclusions and prescribe treatment. Popular formations of the body: polyp and cyst. In this article, we will consider in detail these formations, their cause of occurrence and how they differ from each other.
A polyp is a tissue growth localized on the mucous membrane. The most common places they appear are the stomach, rectum, female uterus, and colon.
A cyst is a fluid-filled cavity surrounded by a connective tissue sheath. The place of appearance can be very different. According to the type of acquisition, there are: congenital and acquired.
"Kista" is translated from Greek as a bubble. The sizes of the formation are different - from 3 to 17 cm. According to the composition and structure, the cysts are divided into true and false. They differ in their structure - the true ones have a layer of cells inside, and the false ones do not have a cell layer.
Causes of occurrence:
It happens both as a separate neoplasm and in combination with other formations. Usually other formations are polyps. This is their main difference. A polyp, unlike a cyst, is formed on the mucous membrane, taking the form of a small protrusion on the leg or without it. Unlike it, they are also not hollow, but may have hollow formations inside in the form of the same cyst.
What is the difference between the symptoms and treatment of a polyp and a cyst?
Typically, the symptoms of a cyst appear only when it reaches a significant size. Therefore, just like polyps, it is asymptomatic. You can detect education after examinations.
Clinical symptoms in conjunction with the diseases that caused such a formation:
There are only 2 ways to treat such a gastric formation:
In the course of the facts found out, it is possible to answer with accuracy how polyps and cysts differ from each other:
Polyp in the stomach
Polyposis of the stomach is a benign epithelial formation that poses a danger to human life, since it tends to degenerate into malignant cancerous tumors. The symptoms and causes of the disease are not very pronounced while the cell hyperplasia is benign, and therefore extremely dangerous - in the early stages, a person does not even think about diagnosis. Fortunately, medicine does not stand still, new types of research and treatment appear. What to do if you suspect you have symptoms of the disease? Of course, consult a doctor and undergo a routine examination! The consequences of delay or ignoring are dangerous to health.
Causes and classification
According to the International Classification of Diseases (ICD), this disease has the code K31.7 (diseases of the esophagus, stomach and duodenum) - polyps of the stomach and duodenum, D13.1 (benign and formation of an indefinite or unknown nature) - adenomatous polyp.
Why do tumors appear? The reasons that favorably affect the appearance of polyps inside the body are not fully understood and therefore especially dangerous. However, there are a number of diagnosed prerequisites for development:
Polyp progression.
The classification of gastric polyps into species occurs according to morphological features and is divided into two types: neoplastic (adenomatous, glandular, cardiac, antral) and polyps not associated with neoplasia (hyperplastic, hyperplasiogenic). Also, the classification of the ICD includes a quantitative character - single, multiple. Neoplastic polyps include adenomatous and glandular polyps of the stomach:
Tumors not associated with neoplasia are divided into: non-associated and associated with polyposis types:
- Hyperplasia that is not associated with polyposis often has a benign genesis. This group includes:
- A hyperplastic polyp is characterized by the proliferation of stomach epithelial cells and is a benign tumor on a wide process or stalk. Rarely, a hyperplastic polyp grows larger than 2 cm in diameter. They occur most often, develop due to chronic gastritis.
- Hyperplasiogenic polyp of the stomach. In structure, this is hyperplasia, similar to a cauliflower inflorescence. The development of such a polyp leads to a violation of the functions of the glands of the gastric mucosa. Hyperplasiogenic polypoid neoplasm is solitary, more common in the body of the stomach, the size does not exceed 2-3 cm. Malignancy is rare, only 20% of patients with gastric cancer found hyperplasiogenic polyps.
- Inflammatory fibrous polyp - fibrous pseudopolyp. Localized near the pylorus or prepyloric region, the size of the polyp often does not exceed 1.5-2 cm in diameter. The body is delimited, located on a wide bed or a distinct stalk in the submucosal layer. Accompanied by ulceration of the epithelium.
- Hypertrophic polyposis gastritis - characterized by single or numerous growths on the mucosa of the prepyloric stomach.
- Neoplasms associated with polyposis are hereditary, and line the inner surface of the gastric mucosa. Types of such tumors: Gardner polyposis, Peutz-Gigers polyposis, juvenile polyposis syndrome.
Symptoms
Symptoms of the disease are not very pronounced, making it difficult to diagnose and reduce the likelihood of treatment in the early stages. The reasons why tumors appear are also poorly understood. This is very dangerous for health. You can list rare signs that a person has polyposis:
It is dangerous to wait for the painful manifestations of the disease, the consequences can be disappointing.
Diagnostics
Types of polyposis diagnostics include questioning the patient about hereditary diseases, complaints about well-being, endoscopic examination of internal organs and laboratory examination of the samples found. Based on the results of the study, the causes of the disease are established.
Endoscopy is a method of examining the organs of the gastrointestinal tract, in which an endoscope is inserted through the mouth opening. Endoscopy is a harmless and almost painless method of examination.
Fibrogastroscopy (endoscopic examination) is performed. Using an endoscope (a long, thin tube with a camera at the end), the doctor examines the upper gastrointestinal tract. If a polypoid neoplasm is detected during the examination, ultrasonography is prescribed as an additional study.
Endoscopic ultrasonography helps the doctor determine how deep the polyp has grown into the lining of the stomach. In addition to the camera, the endoscope is equipped with an ultrasonic sensor. The advantage of ultrasonography is the ability to visually distinguish between benign and tumor formations.
Fluoroscopy - allows you to examine the walls of the stomach after exposure to a contrast agent (usually a suspension of barium). This research method is used when large polyps or their scattering are found.
Endoscopic examination is accompanied by a biopsy of the polyp of the stomach - a mandatory procedure that is carried out during endoscopy. A small part is cut off from the polyp and mucosa in order to analyze for histology and cytology. In this way, the benignity/malignancy of the polyp is determined. If it is less than 1 cm in diameter, it is removed during a biopsy. Endoscopy of this kind eliminates the possibility of cancerous degeneration, dysplasia and helps in determining the type of polyp.
First of all, the treatment of a polyp of the stomach is to follow the advice of a gastroenterologist. How to treat polyps in the stomach? Should it be removed? There are two directions - conservative and surgical operation (endoscopy), depending on the nature and severity of the disease.
conservative
The choice of conservative treatment is effective for small hyperplastic polyps of the stomach and intestines, since they do not degenerate into cancer. Also, medication can affect the work of the cardia, reducing the likelihood of the appearance of new tumors, and stabilizing the work of the prepyloric section of the stomach.
Medications are prescribed mainly to stabilize the acidity of the stomach in order to reduce and avoid further epithelial damage to the cardia. If the acidity is increased, drugs are prescribed that block the production of hydrochloric acid. In the presence of Helicobacter pylori, antibacterial agents are used. Following a certain diet affects the healing process.
Medically formed polyps are treated only if an operation is to be performed.
Should it be removed?
It is easy to cope with the disease surgically - just remove the formation. An endoscopic polypectomy, an operation to remove a tumor, or laser burning comes to the aid of a person and doctors. Types of surgical intervention:
With polyposis (the appearance of many polyps), polypectomy is performed repeatedly, affecting the intestines, in order to avoid bleeding, perforation, or worsening of the patient's condition. Often, cauterization and plastic surgery of the cardia are used for treatment. A hyperplastic polyp is most often not removed. The operation takes place once every 2-8 weeks, during which time the mucous membrane is restored.
Given the tendency of polyps to re-form, after surgery, it is imperative to undergo regular examinations with a doctor. And only after making sure that the polyp has disappeared, you can return to normal life.
Folk remedies
If polyps are found in the stomach, treatment takes into account alternative methods. The basis of such methods is primarily a diet to normalize the functioning of the stomach and intestines. Exclusion from the diet of certain foods (pickles, smoked, alcohol, hot spices and vinegar-based marinades) will help inhibit the development of polypoid growths. However, traditional doctors suggest using:
It is important to remember that the use of traditional medicine is carried out under the supervision of the attending physician. Alternative methods only help, but do not eliminate the symptoms, so it is worth combining them with traditional medicine methods, following the treatment plan presented by the doctor.
The diet for polyps in the stomach and intestines depends on the level of acidity, how severe the operation was, whether the work of the cardia was affected, and the general condition of the patient. Everything is worth doing, as the doctor said. First of all, you have to say goodbye to salty and spicy foods, alcohol, strong tea and coffee - they are now dangerous for the stomach:
Nutrition in the postoperative period should consist of:
With reduced acid production, the patient needs to replenish the diet with meat and mushroom broths, pasta, cheese and boiled sausage, ham. If the production of acid, on the contrary, is increased, then vegetable soups, cereals, mashed potatoes will be included in the diet. In this way, bowel function can be normalized.
It is important not to force yourself to eat through force, it is better to drink more water or juices. It is recommended to use berries or juice of viburnum, sea buckthorn. Hazelnuts have a beneficial effect on the functioning of the stomach and intestines.
Prevention
As you know, the disease is easier to prevent than to treat. In the case of polyposis, the first part of the catchphrase is rather unrealistic, but there should be no problems with the second. Removing stomach polyps is the first step to recovery.
Preventive measures are primarily aimed at preventing gastritis or treating it; detection and treatment of Helicobacter pylori. That is, antibiotic therapy, a therapeutic diet and vigilant monitoring of the appearance of new polyps will help to monitor the correct condition. To avoid recurrence of the disease will help:
Compliance with the indicated recommendations will not give a 100% guarantee of remission, but it will help the stomach to better cope with the disease, eliminate negative consequences, and prevent pathological changes in existing tumors. Over time, you will realize that they have disappeared.
The first 8 weeks after the operation is the most important for further recovery. At this time, the mucous membrane of the stomach is restored, so it is dangerous to break the diet, you should monitor the daily routine, emotional state.
The consequences of gastric polyps
With complete removal of polyps, the prognosis is generally favorable, despite the fact that the likelihood of recurrence of tumors is high. Regular monitoring increases the chances of recovery, moreover, it allows you to identify new formations, conduct surgical treatment. After a polypectomy, a person fully restores his ability to work, the negative symptoms of the disease disappear.
The nuances of prediction depend on the type of polyps found, the number and size, and the degree of germination in the stomach tissue. Information about why they appeared has a positive effect on treatment.
If the patient has chronic or hypertrophic gastritis, then the removal of neoplasms will still lead to their reappearance. The same prognosis for Helicobacter pylori infection, if complex treatment is not carried out. An unfavorable prognosis for hereditary polyposis (Gardner, Peitz-Gigers, juvenile polyposis), since their pathogenesis leads to frequent relapses. The hyperplastic subspecies has the best prognosis for recovery, to the extent that it disappears.
Stomach cyst
Stomach cyst(Greek kystis? bubble) ? a pathological neoplasm that has a "body", hollow inside, walls and contents. Arises due to doubling of this body. In children, as a rule, it is a deviation from the normal development of the digestive tract, often in conjunction with other developmental defects. The size of the cyst varies between 3-17 cm (with a tendency to grow), the content and location in the stomach depends on the cause of the pathology. According to its composition and structure, the cyst can be either false (without an inner lining layer) or true (lined from the inside with a layer of cells).
With the ineffectiveness of conservative treatment of gastric cysts, surgery is indicated.
A cyst can be either an isolated neoplasm in the stomach, or it can form inside polyps. A polyp, unlike a cyst, is an overgrowth of mucous tissue that looks like a small protrusion on a leg or without it. The polyp is not hollow inside, but small cavities can appear in it? cysts.
Factors in the growth of gastric cysts
Symptoms of a stomach cyst appear, as a rule, in the case of its large size, or if the presence of the above diseases is a factor in the occurrence. In other cases, the appearance of a cyst may be asymptomatic.
To exclude the presence of a cyst in the stomach, the patient is sent for ultrasound and gastroscopy. On ultrasound, the cyst is found as a hypoechoic formation (that is, a structure with fluid) with clear, even contours, oval or round in shape. Gastroscopy allows you to examine the internal organs in more detail and take a sample of mucous tissue for examination (biopsy). A biopsy will determine whether the tumor is benign or malignant. The gastroscopy method involves the study of the esophagus, stomach and duodenum using a special flexible instrument with a light bulb at the end (gastroscope) inserted through the mouth.
Treatment
Treatment of gastric cysts is carried out in two ways:
Stomach cyst, symptoms and treatment
A stomach cyst is a rare pathology, which is a benign neoplasm that forms a cavity filled with cystic contents. It occurs as a result of an anomaly - duplication (doubling) of the stomach. Often this disease develops in childhood against the background of other developmental defects. However, the cyst can also be observed in adults. As a rule, these are rather large (3-15 cm in diameter) intramural cysts localized in the pylorus, which can cause gastric outlet obstruction. Most often, cystic contents and location in the stomach depend on the factors contributing to the disease.
According to its contents, the cyst happens:
Reasons for the formation of cysts
Congenital abnormalities in the development of the gastrointestinal tract;
Disorder of the secretory function of the stomach, in which there is an embolism of the glands that produce gastric juice;
The necrosis of the tissues of the gastric mucosa due to the systematic consumption of strong alcoholic beverages. In this case, alcohol causes a mucosal burn, after which a cyst forms.
Inflammatory processes;
Injuries of the soft tissues of the stomach.
In this case, a cyst can occur in the stomach separately or inside polyps, which are hyperplasia of the mucous tissue, and have the appearance of a small outgrowth on a stalk or on a wide base. Despite the fact that the polyp is not a hollow neoplasm, small cavities - cysts - can still form in it.
Factors Contributing to the Occurrence of a Cyst
Clinical manifestations of the disease
Usually, a stomach cyst does not cause any painful manifestations in a patient, most often it is asymptomatic. However, with large cysts or in the presence of concomitant disease factors, the cyst causes:
Diagnostics
As a rule, if a gastric cyst is suspected and in the presence of specific symptoms, the patient is prescribed an ultrasound scan, which detects a tumor as a hypoechoic neoplasm with clear, even edges, often round or oval. In order to examine in more detail the internal organs of the digestive tract, and in time to detect the presence of pathology, gastroscopy is prescribed. This procedure allows you to take a sample of mucosal tissue for examination. Analysis of the biopsy will determine the etiology of the tumor, and if the presence of malignant cells is detected, the patient is prescribed appropriate treatment.
Treatment Methods
Large cysts require surgery. As a rule, this is the drainage of a cyst, in which the cystic contents are removed, or a partial or complete resection of the stomach. With a partial resection, the part of the stomach where the tumor is localized is removed. Replacement reconstruction is performed to regenerate digestive function in the rest of the stomach. In a complete resection, the esophagus is connected directly to the small intestine. Most often, the outcome of such an operation is positive. In the vast majority of cases, after resection of the stomach, the patient lives a normal life, adhering to some food restrictions.
As a result of sinusitis, especially chronic sinusitis, cysts and polyps appear.
In recent years, X-ray diagnostics of cystic diseases of the mucous membranes of the maxillary sinuses has found some reflection in the literature (I. Ya. Rabinovich, 1940; V. G. Ginzburg and M. I. Volfkovich, 1951 and N. P. Tsydzik, 1953).
I. V. Korsakov, studying the origin of mucous nasal polyps, came to the conclusion that serous exudate in hyperplastic inflammatory disease of the mucous membranes does not accumulate in the cavity itself, as is usually the case in the body (with pleurisy, peritonitis, etc.), and in the tissue gaps of the mucous membrane of the adnexal cavities, which subsequently leads to polypogenesis. IV Korsakov classifies nasal polyposis as a group of allergic diseases. In his opinion, this is evidenced by the widespread nature of swelling of the mucous membrane of the nose and sinuses, usually bilateral lesion, the onset of relapses, similarity with Quincke's edema and vasomotor rhinitis, often combined with bronchial asthma, the frequency of local eosinophilia in the nasal secretion, in polyposis tissue and in the blood .
According to our observations and literature data (V. G. Ginzburg and M. I. Volfkovich), cysts of the mucous membranes of the maxillary sinuses are most often formed as a result of hyperplastic sinusitis.
V. G. Ginzburg and M. I. Volfkovich write in their work: “The formation of cysts of the maxillary sinus, apparently, is based on edema, which can arise from various causes, mainly with nervous and vascular disorders. A certain role is played by intoxication, metabolic disorders, allergies, etc. The cyst arises from the compression of the mouth of the mucous gland with a tissue infiltrate or the formation of connective tissue around it.
Common to cysts and polyps is that these diseases usually occur in the maxillary sinuses and affect both sinuses at the same time.
I. V. Korsakov writes: “Very often polyps are bilateral, and with one-sided almost always, when it comes to the formation of clearly visible polyps on one side, there are also phenomena of serous inflammation of the nasal mucosa and adnexal cavities on the other.”
The presence of bilateral cysts should also be considered a relatively common occurrence (V. G. Ginzburg and M. I. Volfkovich). This is also confirmed by our material: in 17 patients out of 48, cysts were found in both maxillary sinuses.
There is much in common in the clinical picture with cysts and polyps of the maxillary sinuses, since these formations usually occur against the background of serous inflammation of the nasal mucosa and its paranasal sinuses. Patients usually complain of "stuffiness" of the nose, accompanied by temporary improvements. Sometimes nasal breathing is not disturbed.
Headaches occupy a prominent place in the complaints of patients. The latter are especially common with cysts, even when there are no objective reasons for this.
When examining the nasal cavities, swelling of the lower and middle turbinates is noted with an accumulation of serous or serous-purulent secretions in the nasal passages, and this is more typical for polyps than for cysts. With cysts, the absence of any objective signs is possible, which was noted in some patients who were under our supervision. Therefore, radiodiagnosis of cysts and polyps of the maxillary sinuses is of great importance for clinical research.
The most favorable projection for determining cysts and polyps is a picture in the chin-nasal position. In some cases, it is necessary to take additional images in the fronto-nasal, axial, and rarely in the lateral position.
If tomographic images are beneficial for clarifying cysts that are invisible on conventional images, then radiographs with contrast of the maxillary sinuses are more valuable for clarifying polyposis changes in the mucous membranes.
Consider first the radiological signs of cysts of the maxillary sinuses.
Usually, the cyst of the maxillary sinus is detected on the images as a single, semicircular shadow of medium density, with clear and even contours (Fig. 40). Cysts are more often solitary and unilateral, but there are also bilateral, symmetrically located in the sinuses.
Multiple cysts in one sinus are rare. We observed only three such patients. The operation, however, was not performed on these patients. On fig. 41 the roentgenogram of one of these patients is resulted.
Most often, cysts come from the lower walls of the sinuses. We have established such localization in 32 patients. On other walls of the sinus, cysts are rarely located. We have identified 9 patients with cysts on the outer wall, 3 - on the upper wall, 2 - on the back wall of the sinus and 2 - on the medial wall of the sinus.
According to the observations of V. G. Ginzburg and M. I. Volfkovich, cysts on the walls of the sinuses are distributed in approximately the same way.
Cysts grow slowly, but in pictures taken at intervals of several months. usually still noticeable increase in the size of the cyst (Fig. 42).
Rice. 42. Enlargement of the cyst.
a - scheme of the image from 3/4 1950: above the shadow of the pyramid of the temporal bone, a semicircular, clearly contoured shadow of the cyst is determined in the lumen of the left maxillary sinus; the right sinus is partially obliterated; b - scheme of the picture from 8/5 1951: the shadow of the cyst occupies half of the sinus lumen; c - scheme of the image taken on October 26, 1951: the shadow of the cyst occupies 2/3 of the sinus lumen; d - scheme of the picture from 28/12, 1951: the sinus appears to be homogeneously darkened; the cyst filled the lumen of the sinus. During the operation, it was found that the cyst occupied the entire maxillary sinus..
With an increase in the size of the cyst, the image on the radiograph loses its characteristic features, and the affected sinus then appears uniformly darkened, as in sinusitis with effusion. However, if for one reason or another a cyst of the maxillary sinus is suspected, when it is not detected on the image in the chin-nasal projection, additional images in the frontonasal and axial projections should be taken. Sometimes on one of these pictures a light area of the sinus is still free from the cyst, and against this background, the rounded contours of its edge are noted.
In the initial phase of development, sometimes a cyst may also not be detected on a typical picture in the chin-nasal projection, if it comes from the lower wall and is covered by the shadow of the pyramid of the temporal bone. This kind of cyst, however, can be detected in the picture in the chin-nasal projection when centered at the height of the superciliary arch, i.e., in a special picture of the paranasal cavities. At the same time, the shadow of the pyramids of the temporal bone shifts down in the picture and the bottom of the maxillary sinus is clearly visible.
The characteristic picture of the cyst in the picture disappears when it spontaneously ruptures. Then the sinus is filled with the contents of the cyst and in the picture the sinus lumen appears uniformly shaded. In such cases, new cyst formation is often observed.
We observed 2 patients who had a spontaneous rupture of the cyst. One of them, in our opinion, is of particular interest.
Rice. 43. Patient V. A cyst emanating from the lower wall of the right maxillary sinus was detected on 1/4 1952. In the left sinus of the same name, parietal layers caused by a chronic process.
Patient M., aged 18, came to us about a frequently aggravated sinusitis. In the picture 1/4 of 1952, a cyst was found emanating from the lower wall of the right maxillary sinus, covering 1/3 of its lumen. The pneumatization of the left maxillary sinus was reduced due to parietal layers caused by a chronic process (Fig. 43).
3/4, i.e. A day later, the picture was taken again. In this case, the cyst of the right sinus was not detected. There was a reduced pneumatization of it with some enlightenment of the upper medial angle, as happens with sinusitis in the effusion phase. Consequently, in this patient, a day later, a spontaneous rupture of the cyst occurred with an outpouring of the contents into the maxillary sinus (Fig. 44).
Rice. 44. The same patient. In the picture of 3/4 1952, the cyst is not detected. There was a spontaneous rupture of the cyst with the outpouring of the contents into the maxillary sinus.
In the picture taken on October 29, 1952, the shadow of an oval-shaped cyst is again clearly visible, almost half filling the sinus. In the left maxillary sinus, despite some restoration of pneumatization, parietal layers remained due to the chronic process (Fig. 45).
Rice. 45. The same patient. The picture was taken on October 29, 1952. The shadow of the cyst is again visible, almost half filling the sinus.
In the next picture, dated January 23, 1953, the right maxillary sinus is completely shaded. Based on this, a repeated rupture of the cyst was suggested. At the same time, the patient had a picture of the usual subacute sinusitis.
After some time, the patient's condition improved and in the picture taken on 2/3 1953, the shadow of a spherical cyst was again revealed, filling 1/3 of the sinus lumen.
Comparing this shadow with the cyst shadow from 29/10, one could assume the formation of a new cyst for the third time.
Since the patient was out for a long time, the next x-ray was taken only on 11/12, 1955. At the same time, a cyst was found almost the same size as in the picture from 2/3, 1953. Therefore, it is difficult to say whether there have been more than two years any dynamic changes. Possibly it was the same cyst, since the last picture, dated June 7, 1956, showed a cyst of the same size in the right sinus, but somewhat flattened compared to the previous two (Fig. 46).
Rice. 46. The same patient. The picture was taken on June 7, 1956. The cyst is almost the same size as in the previous picture..
As already mentioned, if a cyst fills the lumen of the sinus, then its x-ray picture loses its characteristic features and then it is difficult, and sometimes impossible, to distinguish a cyst from a sinusitis in the stage of effusion formation. However, some symptoms soon appear on the part of the bone walls of the sinus in the form of thinning and osteolysis. The larger the cyst becomes and the more it goes beyond the sinus, the more clearly these changes are visible on the pictures. If the radiologist does not have clinical data, then he may erroneously interpret this kind of radiological symptoms as a consequence of a malignant tumor emanating from the mucous membrane of the maxillary sinus, which destroys the bone wall. However, in most cases, it is possible to radiologically differentiate a cystic lesion of the bone walls of the maxillary sinus from similar destruction by malignant tumors, since in cystic disease not only osteolysis of the bone wall of the sinus is detected, but usually the sinus is stretched. This symptom is characteristic only of a slowly growing neoplasm and is not observed in malignant tumors of the sinuses. On the tomogram (Fig. 47 - 48), made about the cyst, the sinus extension and thinning of its walls are clearly visible. Osteolysis, apparently, begins with the outer wall of the maxillary sinus and extends to its posterior wall. Thinning, sagging and, finally, the “rupture” of the contour of the posterior bone wall of the sinus are specified on the axial image.
Rice. 47. The stretching of the right maxillary sinus and some thinning of its walls on the basis of the cyst (tomogram).
In addition to the described radiographic symptoms, clinical data also contribute to clarifying the nature of the disease in sinus deformities. The patient's indication of the duration of the disease is typical for cysts. Along with this, it should be noted that under our supervision there were patients in whom no growth of cysts was noticed during a serial X-ray examination for 6 months or more. In most cases, the patients under our supervision were examined in detail by X-ray examination, and not only conventional images in different projections were used, but also the tomographic method was used. Tomograms were usually made in any one projection, most often in the fronto-nasal, at various depths (up to 4-5 images).
Rice. 48. Cystic lesion of the bone walls of the maxillary sinus.
a - scheme of the picture taken on September 27, 1951: the left maxillary sinus is enlarged in size, its pneumatization is sharply reduced, the bony outer wall of the sinus is absent; b - scheme of the axial image from 28/11, 1951: enlargement of the left maxillary sinus is confirmed; there is no Ginzburg cross due to the destruction of the posterior outer wall of the sinus.
It should be noted the importance of the tomogram for clarifying the nature of the processes developing from the maxillary sinuses, including mucous cysts. Since we began to widely use tomographic studies in diseases of the accessory cavities of the nose, the timeliness of recognized cystic diseases has increased significantly. Let us give one example.
Patient R., aged 12, 18/8, 1954, was sent for an X-ray examination from the eye clinic of the Kazan State Institute for Postgraduate Medical Education because of retrobulbar neuritis in both eyes due to ontochiasmal arachnoiditis. Complaints about a sharp drop in visual acuity, growing since June 1954.
An x-ray of the skull revealed a decrease in pneumatization of the lower outer third of the right maxillary sinus. It was not possible to clarify the nature of the shadow in a regular photograph.
The tomogram (depth 1 cm) clearly revealed the shadow of the cyst and massive parietal layers near the walls of the sinuses.
Contrast examination of the paranasal sinuses also contributes to the clarification of intra-sinus cysts, but, in our opinion, it is inferior to the tomographic method in significance, since it is more difficult to perform (associated with sinus puncture) and does not always provide correct diagnosis.
A schematic representation of cysts in contrast and tomographic x-ray examination of the maxillary sinuses is shown in and 69.
Recognition of polyps in the pictures is possible in cases where they are contoured against the background of pneumatized sinuses. If the inflammatory process is accompanied by an accumulation of secretions in the adnexal cavity or massive parietal layers on the basis of a hyperplastic process, then polyps cannot be detected on the pictures. Most often, polyps are located on the lower wall of the sinus. Less commonly, we detect them at the medial wall.
With polyposis of the maxillary sinuses, polyps in the nasal cavities are often determined with the help of fluoroscopy, sometimes prolapsing from the sinus cavity; but such polyps are not detected on radiographs.
Polyps of the mucous membrane of the maxillary sinuses in the pictures have the appearance of irregular semicircular formations with clear but uneven contours against the background of a pneumatized sinus and an altered mucous membrane.
Polyps are most often multiple, rarely solitary, but usually appear to be more intense shadow formations than cysts, and do not reach large sizes. In photographs, they are usually the size of a pea; in rare cases, large polyps are also found (when serous fluid accumulates in polypous edematous formations). In such cases, they are difficult to differentiate from cysts. However, dynamic observation on radiographs taken at intervals of several months helps to clarify the nature of these shadow formations, since polyps, unlike cysts, grow slowly or do not increase in size at all. It is also necessary to resort to dynamic observations in cases where there are multiple, small sizes, rounded shadows with clear boundaries, suspicious of cysts. Although multiple cysts are rare, the possibility is not ruled out.
It is also necessary to distinguish polyposis-altered mucosa from multiple polyps. If the identification of multiple polyps in conventional images is not an easy task, then it is perhaps even more difficult to determine the polyposis-altered mucous membrane. However, in rare, skiologically favorable cases, in our opinion, it seems possible to identify such forms. Polyposis-modified mucous membranes are more often determined in the presence of massive parietal layers (hyperplastic process). At the same time, the light, so-called free areas of the sinuses are also distinguished by a slight decrease in pneumatization. If you look closely at this area, you can see the heterogeneity of the picture. Against the background of a slight decrease in pneumatization due to thickening of the mucous membranes, small focal shadows with millet grain are visible, which differ in intensity due to their high density. In these cases, we consider it possible to write about the polyposis-altered mucosa.
We do not undertake to present such delicate changes in reproduction; schematic sketches would also be too rough.
As can be seen from the foregoing, the radiological symptoms of polyps are not particularly distinct in conventional images. However, based on the listed signs and clinical data, it is still possible to recognize or, in some cases, suspect the presence of polyps. This question is of clinical importance. Undoubtedly, it is necessary to take into account the observation of S. A. Vinnik: “Nasal polyps and hyperplasia can be tumor reborn. Chronic inflammatory processes in the nasal cavities are, with known constitutional and biological characteristics of the body, a pre-tumor state.
I. V. Korsakov, in a work specially devoted to polyps, notes that with serous (hyperplastic) inflammation of the accessory cavities with polyposis, there are thinning of all bone walls of the maxillary sinuses. This feature is important for radiographic observation and to some extent may be of diagnostic value. However, it should be noted that in the picture of the skull in the chin-nasal projection it is difficult to ascertain the thinning of the bone walls of the maxillary sinuses. Therefore, in cases of suspected thinning of the walls of this sinus, an axial image of the skull should be taken with the parietal-chin course of the rays. Then, to some extent, it seems possible to judge the thickness of the anterior and outer-posterior walls of the sinus, comparing them with the healthy side. However, it should be noted that in a number of cases, with radiographically visible polyps, skull images in the chin-nasal projection show large sinuses on both sides, even with a clearly unilateral course of the inflammatory process. The thinning of the bone walls of the sinus with serous inflammation of its mucous membrane, perhaps, should be explained, without going into the details of this issue, by neurotrophic changes.
Polyps of the maxillary sinuses radiologically have to be differentiated, in addition to cysts, with parietal edema of the sinus mucosa, which is the result of a subacute inflammatory process. The picture of edema on the radiograph was described by us earlier. This picture bears some resemblance to polyposis.
Differential diagnosis between inflammatory mucosal edema and polyposis is difficult in some cases, but is simplified with dynamic observation. Edema of the mucous membrane, as was said, is on the wane in the treatment of the patient, sinus polyps usually do not respond to conservative therapy. In general, differential radiodiagnosis between polyposis and mucosal edema is as follows.
| polyps | Mucosal swelling |
| Shape tends to be round | Semi-oval shape, wide base |
| The contours are clear but uneven | Contours are clear and even |
| It is located in groups, most often on the lower wall | It is located singly on each of the walls or on several walls |
| More often in the amount of two, three or more. Arranged in groups | More often on each of the walls |
| The size of a millet grain, and very rarely more than a pea | The size of the base of the edematous mucosa corresponds to the extent of the visible part of the sinus wall |
| Repeated images taken at intervals of several weeks usually do not show dynamic shifts. | On repeated images taken at intervals of several days, if anti-inflammatory therapy is prescribed, a decrease in the process is usually noted. |
| The pictures are not detected in the presence of effusion or with a decrease in pneumatization on the kidney of a grossly altered mucous membrane | The pictures are not detected in the highest stage, when the swelling of the mucous membrane occupies the lumen of the entire sinus |
If the images in the lumen of the maxillary sinuses reveal semicircular shadow images, it is usually necessary to make a differential diagnosis between two chronic processes: a cyst and polyps.
We use the following data for this purpose.
| cysts | polyps |
| Semicircular shape | The shape is irregularly semicircular |
| Contours are smooth and clear | The contours are clear but uneven |
| The value may be different | Size up to a pea, rarely more |
| Often solitary, rarely multiple | More often multiple, less often solitary |
| Found on one side, but often in both sinuses | More often unilateral, but often in combination with sinusitis in the other sinus |
| They are located in the lower wall of the sinus, less often on other walls | Usually located on the lower wall, less often on the medial wall of the sinus |
| Repeated x-rays taken at intervals of several months usually show an increase in the size of the cyst. | On repeated images taken at intervals of several months, dynamic shifts are usually not detected. |
As already mentioned, polyps can be single and multiple. In addition, it should be especially noted polyposis-altered mucous membrane as a chronic condition. In this case, the surface of the mucous membrane is covered with papillomatous protrusions. This condition seems to correspond to an infiltrative or granular form of chronic inflammation of the mucous membrane of the paranasal sinuses. We have observed such changes in the mucous membrane in some cases with chronic sinusitis in ordinary images. More often this was stated in the study of the maxillary sinuses after the introduction of contrast masses. Single, multiple polyps, especially polyposis-altered mucosa, are clearly identified only with a contrast study of the sinuses. However, the success of obtaining fine details of the altered mucosa on radiographs depends on the degree of filling of the sinuses with a contrast mass. If there is mucus in the sinus, the latter should be sucked out. If there is a thick secret in the sinus, it is necessary to first rinse the sinus with warm saline and completely free it from the liquid contents. In all cases, we used iodolipol as a contrast mass.
The amount of contrast agent injected is very important. L. F. Volkov and A. V. Khokhlov consider the introduction of 2–3 ml of iodolipol to fill one maxillary sinus. L. R. Zak and L. D. Lindenbraten injected the contrast agent through a needle until it entered the middle nasal passage. These authors do not indicate the amount of contrast agent they injected, but it must be assumed that a large amount of it is probably required to carry out such a “tight sinus filling”, since the average maxillary sinus volume is 10.5 cm3, generally ranging from 5 up to 30 cm³ (V. O. Kalina).
We cannot agree with the opinion of L. R. Zack and L. D. Lindenbraten and believe that the average amount of contrast agent for the study of the maxillary sinus should not exceed 5 - 6 ml. The fact is that with the introduction of a large amount of a contrast agent into the sinus, it is not possible not only to obtain a relief pattern of the mucous membrane, but polyps also “sink” in the contrast mass.
After the introduction of a contrast agent, before taking a picture, it is necessary to lay the patient on the right and left sides, on his back and face down. After that, a more distinct image of the relief of the sinus mucosa is obtained on the pictures. The polypous mucosa is characterized by many small defects (see Fig. 36, III, c). A single polyp gives a rounded defect, the size of which does not exceed the size of a pea (). Multiple polyps are marked by the presence of marginal semicircular, semi-oval defects near the walls of the maxillary sinuses (see Fig. 36, III, a, b and Fig. 66).
Emphasizing the importance of a contrast study of the maxillary sinuses for the detection of polyps, it should be noted that the tomographic study in such cases does not play a big role, in any case it is inferior to the contrast study method.
We described cysts and polyps of the maxillary sinuses and tried to make a differential diagnosis between them. Cysts and polyps of the frontal sinuses are not mentioned by us for the simple reason that they are rare and do not differ in the nature of the shadow from the cysts and polyps of the maxillary sinuses.
