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Updated: Oct 9 2022

Ovarian Cysts

Images cyst.jpg
  • Introduction
    • Functional ovarian cysts
      • 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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