Ovarian Cyst

How are ovarian cysts <5 cm treated?

< 5 cm observation is the mainstay (function, endometriomas, serous and mucinous adenomas).

How are ovarian cysts >5 cm treated?

> 5 cm cyst is removed by laparoscopy.

What is another term for a dermoid cyst?

A dermoid cyst is an ovarian cyst that is described as a mature teratoma.

What are follicular cysts?

A follicular cyst (the most common type) of ovarian cyst. In menstruating women, a follicle containing the ovum (unfertilized egg) will rupture during ovulation. If this does not occur, a follicular cyst of more than 2.5 cm diameter may result. Most resolve within 6-8 weeks (2 menstrual cycles). If the pt makes a lot of follicular cysts you may consider placing them on OCPs. If > 6 cm there is a risk of torsion and generally don't self-resolve. Could consider surgical removal.

What ovarian cyst is due to blood vessel rupture in the cyst wall and grows with increased blood retention?

A hemorrhagic cyst is an ovarian cyst that is due to blood vessel rupture in the cyst wall and one that grows with increased blood retention.

What do you call an ovarian cyst that forms due to endometriosis?

An endometrioid cyst is an ovarian cyst that forms due to endometriosis.

What is an ovarian cyst?

An ovarian cyst is a sac filled with liquid or semi-liquid material arising in an ovary. The number of diagnoses of ovarian cysts has increased with the widespread implementation of regular physical examinations and ultrasound technology. The vast majority of ovarian cysts are benign. -About 95% of ovarian cysts are benign

Which of the following types of cysts most commonly ruptures? A. Endometriomas B. Corpus luteum cysts C. Dermoid cysts D. Cystadenoma

B. Corpus luteum cysts Corpus luteum cysts tend to be larger and more symptomatic than follicular cysts and are more prone to hemorrhage and rupture. Follicular cysts are usually smaller, with internal hemorrhage being relatively uncommon.

Which of the following is not associated with symptoms of ovarian cyst rupture? A. Abdominal distention B. Unilateral pelvic pain C. Amenorrhea D. Peritoneal signs

C. Amenorrhea Cyst rupture is characterized by sudden, unilateral, sharp pelvic pain. This can be associated with trauma, exercise, or coitus. In addition, cyst rupture can lead to peritoneal signs, abdominal distention, and bleeding that is usually self-limited.

Cancer is always a concern with ovarian cysts, and cancer antigen 125 (CA-125) testing is often used to investigate for ovarian cancer. Which of the following is a contraindication to CA-125 testing? A. Age 20-30 years B. Anemia C. Pregnancy D. Postmenopause

C. Pregnancy CA-125 testing should not be done in pregnant patients with ovarian cysts because levels are significantly higher, especially during the first trimester. CA-125 testing should also not be done in the acute setting of ovarian cyst accidents, as this marker is raised in peritonitis, hemorrhage, cyst rupture, and infection, as well as in menstruation, fibroids, and endometriosis.

Which of the following is the preferred imaging modality for assessing ovarian cysts with or without rupture? A. CT B. MRI C. Ultrasonography D. Radiography

C. Ultrasonography Ultrasonography is the preferred imaging modality for assessing gynecologic structures, given its low cost, availability, and sensitivity in recognizing adnexal cysts and hemoperitoneum. Despite this, ultrasound findings are nonspecific in some instances, particularly after rupture and decompression of a cyst in the setting of apparent physiologic levels of fluid in the pelvis. If ultrasound yields ambiguous results in a patient with significant pain, CT of the pelvis with contrast should be performed.

How do you manage complex (dermoid) ovarian cysts?

Concern for malignant development (ovarian cancer).

What are corpus luteum cysts?

Corpus luteum cysts appear after ovulation. The corpus luteum is the remnant of the follicle after the ovum has moved to the fallopian tubes. This normally degrades within 5-9 days. A corpus luteum that is more than 3 cm is defined as cystic. -Average size 4cm Can have bleeding within the cyst and can rupture (hemorrhagic cysts). Pain immediately after sex is a common presentation. Often occur on the right side due to increased luminal pressure from the Inferior Vena Cava. Rupture usually occurs day 20-16 of the menstrual cycle. Menses may be delayed days to weeks with subsequent menorrhagia.

When should ovarian cysts raise suspicion?

Cysts that persist beyond two or three menstrual cycles, or occur in postmenopausal women, should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy.

Although most patients with unruptured ovarian cysts do not require treatment, which of the following is an indication that treatment is necessary? A. Premenopausal women with cysts < 7 cm and a CA-125 level ≤ 20 U/mL B. Premenopausal women with cysts < 8 cm and a CA-125 level of 25-30 U/mL C. Postmenopausal women with cysts 3-5 cm and a CA-125 level of 30 U/mL D. Postmenopausal women with cysts < 5 cm and a CA-125 level ≥ 35 U/mL

D. Postmenopausal women with cysts < 5 cm and a CA-125 level ≥ 35 U/mL In a postmenopausal patient, a persistent simple cyst < 5 cm in the presence of a normal CA-125 value (< 35 U/mL) may be monitored with serial ultrasound. Some evidence suggests that cysts ≤ 10 cm can be safely followed in this way. Premenopausal women with asymptomatic simple cysts < 8 cm on sonograms in whom the CA-125 value is within the reference range may be monitored with a repeat ultrasound in 8-12 weeks.

Dyspareunia is associated with ovarian cysts often due to what condition?

Dyspareunia is associated with ovarian cysts due to endometriosis.

What is the tumor marker for ovarian cancer?

Elevated CA-125, a tumor marker, is often found in increased levels in ovarian cancer.

What is the risk of ovarian cancer with ovarian cysts?

Estimating the risk of malignant ovarian cancer based on initial workup using risk of malignancy index (RMI). It is recommended that women with an RMI score over 200 should be referred to a center with experience in ovarian cancer surgery.

When is follow-up imaging of ovarian cysts indicated?

Follow-up imaging in women of reproductive age for incidentally discovered simple cysts on ultrasound is not needed until 5 cm, as these are usually normal ovarian follicles.

How frequently should cysts 5-7 cm be followed?

For simple cysts greater than 5 cm but less than 7 cm in premenopausal females, cysts should be followed yearly.

How should cysts >7 cm be followed?

For simple cysts greater than 7 cm, further imaging with MRI or surgical assessment is mandated as these cysts cannot be reliably assessed by ultrasound alone.

Which ovarian cysts are likely to resolve spontaneously?

Functional cysts and hemorrhagic ovarian cysts usually resolve spontaneously. However the bigger an ovarian cyst is, the less likely it is to disappear on its own.

What are the types of functional ovarian cysts?

Functional cysts form as a normal part of the menstrual cycle. There are several types of cysts: -Follicular cyst -Corpus luteum cyst -Theca lutein cyst

How do ovarian cysts commonly present?

Most commonly presents with lower abdominal pain with radiation to the back area.

What is the epidemiology of ovarian cysts?

Most women of reproductive age develop small cysts each month. Large cysts that cause problems occur in about 8% of women before menopause. Ovarian cysts are present in about 16% of women after menopause and if present are more likely to be cancer.

What are non-functional cysts?

Non-functional cysts may include the following: -An ovary with many cysts, which may be found in normal women, or within the setting of polycystic ovary syndrome -Cysts caused by endometriosis, known as chocolate cysts -Hemorrhagic ovarian cyst -Dermoid cyst (teratomas) -Ovarian serous cystadenoma -Ovarian mucinous cystadenoma -Paraovarian cyst -Cystic adenofibroma -Borderline tumoral cysts

How do you manage hemorrhagic ovarian cysts?

Not much, unless they bleed profusely, in which case they must be removed surgically.

How do you manage simple ovarian cysts?

Not much; pain control, if necessary, but the body will likely reabsorb it.

How are ovarian cysts diagnosed?

Ovarian cysts are usually diagnosed by either ultrasound, CT scan or MRI, and correlated with clinical presentation and additional endocrinologic tests as appropriate.

What is the recommended follow up of ovarian cysts measuring less than five centimeters?

Ovarian cysts measuring less than five centimeters do not usually require long-term follow up.

How do patients with ovarian cysts typically present?

Patient will present as → a 22-year-old nulligravida presents with pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her β-hCG urine test is negative. She has never been on oral contraceptives. On pelvic examination, unilateral tenderness on the left side and a palpable cystic mass approximately 4 to 5 cm in size are present.

What are the types of ovarian cyst?

Simple Hemorrhagic Complex (AKA Dermoid)

When is surgical intervention indicated for ovarian cysts?

Surgery indicated if benign but symptomatic tumors, malignant tumors, cysts that are hemorrhaging severely, and ovarian torsion.

How is the RMI calculated?

The RMI is calculated as follows: RMI = ultrasound score x menopausal score x CA-125 level in U/ml.

What is the best initial test for the diagnosis of ovarian cysts?

The best initial test for the diagnosis of ovarian cysts is abdominal ultrasonography.

What is the gold standard for the diagnosis of ovarian cysts?

The gold standard for the diagnosis of ovarian cysts is laparoscopy.

What is the mainstay of the management of the majority of ovarian cysts?

The mainstay of the management of the majority of ovarian cysts is observation.

What is the management of symptomatic ovarian cysts larger than five centimeters?

The management of symptomatic ovarian cysts larger than five centimeters is laparoscopic surgical removal.

What are theca lutein cysts?

Theca lutein cysts occur within the thecal layer of cells surrounding developing oocytes. Under the influence of excessive hCG, thecal cells may proliferate and become cystic. This is usually on both ovaries.

Which type of ovarian cysts often occurs as multiple ovarian cysts due to gonadotropin stimulation and is associated with choriocarcinoma and moles?

Theca-lutein cysts often occur as multiple ovarian cysts due to gonadotropin stimulation and are associated with choriocarcinoma and moles.

How can ovarian cysts be classified?

There are two types of cysts: Functional and Nonfunctional.

How are ovarian cysts treated?

Treatment is based on type and size.

How are uncomplicated ovarian cyst ruptures treated?

Uncomplicated cyst rupture (hemodynamically stable): expectant management and NSAIDs.

Uncomplicated ovarian cysts usually present with what type of abdominal pain?

Uncomplicated ovarian cysts usually present with dull aching lower abdominal pain.