Updated: 9/27/2020

Ovarian Cysts

Review Topic
  • Functional ovarian cysts simple follicular ovarian cyst
    • ovarian follicular cysts
    • corpus luteal cysts
    • theca lutein cysts
  • Other cysts
    • dermoid cyst/teratoma
    • endometriomas/chocolate cysts
  • Evaluation
    • ultrasound, CT or MRI
  • Complications
    • rupture or hemorrhage can cause peritonitis
    • ovarian torsion
      • often presents with nausea/vomiting and sharp, sudden lower abdominal pain
      • caused by twisting of the infundibulopelvic ligament 
Follicular Cyst
  • Most common ovarian mass in women of reproductive age
  • Non-neoplastic expansion of an unruptured graafian follicle
  • Associated with hyperestrogenism and endometrial hyperplasia
  • Evaluation with ultrasound
    • thin walled
    • unilocular
  • Treatment
    • large (>5cm) or symptomatic may undergo surgical resection
    • small asytompatic cysts managed conservatively
Corpus Luteal Cyst
  • Failure of corpus luteum to regress after ovum release
  • Most common pelvic mass within 1st trimester of pregnancy
  • Can result in complicating hemorrhage or rupture
  • Evaluation with ultrasound
    • diffuse thick wall
    • peripheral vascularity/ "ring of fire"
Theca-Lutein Cyst
  • Excessive circulating gonadotropins (beta-hcG) causes hyperplasia of theca interna cells
  • Often bilateral and multicystic
  • Associations with gonadotropin stimulation
    • multifetal pregnancy
    • PCOS
    • clomiphene intake
    • ovulation induction
    • gestational trophoblastic disease
Dermoid cyst/ Teratoma
  • Also known as mature cystic ovarian teratoma
  • Most common ovarian neoplasm
  • Contain elements from multiple germ layers (e.g. hair, skin or teeth)
  • Slow growing and rarely cancerous
  • Variant
    • struma ovarii tumor: contains thyroid elements
Endometrioma/ "Chocolate Cyst"
  • Endometriosis  of the ovaries 
  • Histopathology required for definitive diagnosis
  • Hormonal changes during menstrual cycle varies size
  • Treatment
    • NSAID
    • hormonal contraception
    • progestational agents or GnRH agonists
    • surgery



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