Ovarian Crown Cyst

　　The ovarian crown originally refers to the cranial part of the mesonephric duct during the embryonic stage, including the longitudinal tube and the 10-15 short transverse tubules connected to it. Traditionally, it is believed that the remnants of the mesonephric duct are the main source of ovarian crown cysts. In recent years, some scholars believe that ovarian crown cysts can also originate from mesothelium, paramesonephric duct, and remnants of the mesonephric duct.

　　From the perspective of embryology, the urogenital system includes the mesonephric system, the paramesonephric system, the renal structure, and the gonads. Before the differentiation of the gonads during embryonic development, both males and females have two pairs of longitudinal tubes located on the lateral side of the genital ridge, namely the mesonephric duct and the paramesonephric duct; after the differentiation of the gonads, the male embryo, under the influence of androgens produced by the testes, continues to develop into male reproductive organs, while the paramesonephric duct stops developing and regresses under the influence of the paramesonephric duct inhibitory substance produced by the fetal testes. The female fetus is different, as there are no testes and no endogenous androgens to support, the mesonephric duct gradually regresses, and the paramesonephric duct develops into the female internal reproductive organs without inhibition. In fact, the mesonephric system does not completely regress and disappear, as the ureters, bladder trigone, and adjacent urethra are derived from the mesonephric duct, and the small tubes at the head of the mesonephric duct become remnants and are preserved in the broad ligament within the adult female, at the side of the cervix, and at the side of the vagina. Most of the remnants can remain stable for a long time without change, but a few remnants of the mesonephric duct can develop into cysts, known as mesonephric duct cysts.

　　Ovarian coronary cysts are prone to complications such as infertility and acute pedicle torsion, leading to acute abdominal symptoms. Cysts are one of the causes of infertility, and this has no direct relationship with the size of the cyst. Therefore, once symptoms are found, timely treatment must be sought.

　　Ovarian coronary cysts usually have no symptoms when they are small. Some believe that ovarian coronary cysts may already exist in young people and until after puberty, due to the onset of endocrine function activity and the enhancement of secretory activity of intracystic epithelial cells, the cyst cavity expands and symptoms appear, but the diameter usually does not exceed 10cm. Some scholars reported 50 cases of ovarian coronary cysts, of which 44% of the patients were found to have pelvic masses during gynecological examinations for infertility or early pregnancy, 28% came for consultation due to the discovery of masses, and 28% were admitted to the hospital due to acute abdominal pain. According to literature reports, the cysts originating from the mesonephric structure are the smallest, the cysts originating from the paramesonephric structure are larger, and the cysts formed by mesothelial cells are the largest. Cysts with a diameter less than 5cm rarely have symptoms, and those with a diameter greater than 5cm usually have a feeling of distension and pain. As for the location, they can occur from the broad ligament along the side of the uterus, cervix, and up to the side of the vagina. They are generally unilateral, and bilateral cases are rare. The cyst wall is thin and smooth, and a few may have papillary hyperplasia, becoming benign serous papillary cystadenoma. Some cases may have malignant transformation, even forming a solid cancerous tumor.
　　Generally, ovarian coronary cysts are located within the broad ligament, with little mobility, so they will not twist. However, a few cysts located on the pedicle of the ostium can also twist acutely and produce acute abdominal pain symptoms. In addition, large cysts can compress adjacent organs, such as the bladder, colon, and ureter, causing corresponding symptoms.

　　The etiology of ovarian coronary cysts is not clear, and there are currently no effective preventive measures. The focus of prevention is currently on regular physical examinations for high-risk populations, doing a good job of gynecological examinations, and early detection, timely treatment, and follow-up of diseases.

　　Ovarian coronary cysts with a diameter less than 3cm generally have no clinical symptoms and are not easily palpated during gynecological examination, so they are often missed. Larger ovarian coronary cysts, due to their proximity to the ovary, are often misdiagnosed as ovarian cysts or inflammatory masses of the adnexa. Therefore, preoperative diagnosis is not common in clinical practice. If auxiliary examinations such as B-ultrasound, laparoscopic examination, and pneumoperitoneal angiography can be used preoperatively, the diagnostic rate can be improved.
　　During gynecological examination, a cystic mass in the shape of a circle or oval can be felt above or above the left or right side of the uterus, and it is mobile.
　　Other auxiliary examinations:
　　1. Laparoscopic Examination After abdominal inflation, the intestinal loops move upwards, and the pelvic organs can be clearly exposed. If a cyst within the broad ligament is seen, along with the ovary and fallopian tube, the diagnosis can be made clear.
　　2. Pneumoperitoneal Angiography After abdominal inflation, X-ray photography is performed. If normal shadows of the uterus and ovaries are seen in the film, the shadows of the other masses may be ovarian coronary cysts. This method has the same disadvantages as B-ultrasound examination, as it cannot directly see the nature of the mass and cannot exclude cysts originating from the fallopian tubes.
　　3. Histopathology If the cyst is large and has papillary projections into the lumen, a frozen section histological examination must be performed.
　　4. B-ultrasound examination If the image of the uterus and ovaries is seen in the ultrasound, the mass next to it is most likely an ovarian crown cyst, and this method is inferred indirectly.

　　Recommend several food therapy recipes suitable for patients with ovarian crown cysts.
　　1. Hawthorn, black fungus, and brown sugar decoction
　　Ingredients: 100 grams of hawthorn, 50 grams of black fungus, 30 grams of brown sugar;
　　Preparation: Boil hawthorn for about 500 milliliters, remove the dregs, add soaked black fungus, simmer over low heat until soft, and then add brown sugar. It can be taken 2-3 times a day, finish it within 5 days, and continue for 2-3 weeks;
　　Properties: Activating blood and dissipating blood stasis, invigorating the spleen and nourishing the blood.
　　Indications: Ovarian cysts with menstrual disorders; dysmenorrhea, worse before menstruation, accompanied by sharp pain in the lower abdomen, pain increases when pressed, and blood clots are present, belong to Qi stagnation and blood stasis.
　　2. Yam and walnut kernel stewed hen soup
　　Ingredients: One hen, 40 grams of yam, 30 grams of walnut kernel, 25 grams of dried mushrooms, 25 grams of bamboo slices, 25 grams of ham, one hen, an appropriate amount of yellow wine and table salt;
　　Preparation: Peel the yam and cut it into thin slices, wash the walnut kernel; blanch the clean hen in boiling water to remove blood impurities, place it in a soup bowl, add 50 milliliters of yellow wine, an appropriate amount of table salt, and 1000 milliliters of fresh soup; place the yam, walnut kernel, mushrooms, bamboo slices, and ham slices on top of the hen, steam for about 2 hours, and remove it when the hen is tender.
　　Properties: Tonifying Qi and strengthening the spleen, activating blood and removing blood stasis.
　　Indications: Ovarian cysts with symptoms such as fatigue, weakness, shortness of breath, and lack of speech, fatigue, more severe after movement; hidden pain in the lower abdomen, preferring to press, menstrual periods late with less amount, pale and dark tongue, teeth marks on the edges, thin and涩脉, belong to Qi deficiency and blood stasis.
　　3. Water chestnut, coix seed, and fish maw porridge
　　Ingredients: 500 grams of water chestnuts, 100 grams of raw coix seed, 150 grams of fish maw (fish belly), half a piece of dried tangerine peel, an appropriate amount of sticky rice, a little salt.
　　Preparation: Wash each material with clean water and set aside; remove the shell of the water chestnut and take out the meat, soak the fish maw in clean water first and then cut it into pieces; add a sufficient amount of water to a pot, bring it to a boil over high heat, then add the materials when the water boils again, and continue to simmer over medium heat until the sticky rice blooms into a thin porridge, season with salt to taste and it is ready to eat.
　　Properties: Invigorating the spleen and removing dampness, detoxifying and dissipating nodules, nourishing the liver and kidney;
　　Indications: Ovarian cysts with obesity, excessive leucorrhea, sticky, yellowish with an unpleasant smell, vaginal itching; pale red tongue with white coating, slippery pulse, symptoms of spleen deficiency and dampness. This porridge is not dry and hot, suitable for daily consumption by the whole family, can invigorate the spleen and nourish the liver and kidney, but those with frequent nocturnal urination or enuresis are not suitable.
　　4. Walnut kernel, trigonum, and curcuma honey drink
　　Preparation: Separate the kernel of walnuts, trigonum, curcuma, angelica sinensis, salvia miltiorrhiza, and aurantium, remove impurities, wash, dry or dry in the oven, cut into slices or chop, and place them in a bowl for later use. Clean the turtle shell, dry it, crush it, put it in a pot, add water, soak for a moment, boil over high heat, then switch to medium heat to simmer for 30 minutes. Pour the other six herbs into the pot, mix well, add an appropriate amount of warm water as needed, and simmer for another 30 minutes. Filter with clean gauze, collect the filtrate into a container, and when it is warm, add 30 milliliters of honey, mix well and it is ready to serve. Take in the morning and afternoon.
　　5. Deer antler fish maw soup
　　Ingredients: Deer antler gelatin, fish maw (pre-soaked), goji berries, shrimp.
　　Preparation: First, dissolve and melt the deer antler gelatin in water and a little yellow wine, then cut the fish maw into strips and fry with shrimp in the oil pan. Add fresh soup, goji berries, and dissolved deer antler gelatin juice, and boil for about 5-10 minutes. Add scallions, salt, and monosodium glutamate before serving. It can be eaten as a dish, once a day, for 5-7 days.
　　

　　Some ovarian coronary cysts can remain stable for a long time without developing, so small ovarian coronary cysts may not necessarily require surgery and can be followed up regularly. If they increase in size or symptoms appear, surgery can still be performed later.
　　Since it often occurs in women of childbearing age, those who want to have children can undergo cystectomy, and those who do not want to have children can have one fallopian tube removed. There are also reports of interventional ultrasound puncture treatment for ovarian coronary cysts, trying to preserve normal ovarian tissue.
　　If surgical treatment is necessary, young patients can retain their fallopian tubes and ovaries, incise the broad ligament or mesosalpinx, and separate it from the loose connective tissue around the cyst. After the cyst is delivered, if the wall is thin and breaks during the separation process, the wall should be removed. The fluid inside the cavity is non-irritating and does not require special treatment. Older patients can have the fallopian tubes and ovaries removed together, but special attention should be paid to whether the ureter is closely attached to the cyst wall during surgery. The separation should be delicate to avoid injury to the ureter. When separating cysts located near the ovarian hilum or the cervix, care should be taken to avoid injury to blood vessels. If there is bleeding at the ovarian hilum, it is necessary to suture and stop the bleeding, which may affect the blood supply to the ovary and lead to its functional decline. The blood vessel plexus near the cervix can cause massive bleeding if injured during surgery, so special attention is needed. Sometimes the cyst cavity is deep into the vaginal parietal space, and the gap left after the cyst is removed is prone to bleeding, which needs to be stopped carefully. If necessary, a cigarette drain can be placed to prevent postoperative hematoma. If malignancy is confirmed, radical surgery should be performed.