Benign Ovarian Cysts

Question 1

another name for follicular cysts?

Answer 1

functional cysts

Question 2

what is most common benign ovarian cyst

Answer 2

follicular/ functional cyst

Question 3

pathophysiology of follicular/ functional cyst?

Answer 3

Physiological in nature and related to ovulation (but can still form when ovulation doesn’t occur)
-Follicle doesn’t rupture but grows until it becomes a cyst

Question 4

what disease is associated with follicular/ functional cysts?

Answer 4

PCOS

Question 5

symptoms- follicular/ functional cyst?

Answer 5

Often asymptomatic
May cause menstrual disturbances

-my rupture or bleed causing acute abdomen

Question 6

how big do follicular/ functional cysts grow?

Answer 6

-up to several cms

rarely >5cm

Question 7

histology of follicular/ functional cysts?

Answer 7

Think walled, lined by granulosa cells

Question 8

treatment follicular/ functional cysts?

Answer 8

resolve spontaneously usually after a few months

Question 9

What is the most common endocrine disorder and most common cause of hirsutsim in women?

Answer 9

PCOS

Question 10

what is PCOS?

Answer 10

-when there are multiple small cysts in the ovary and excess androgen production from ovaries

Question 11

criteria used for PCOS?

Answer 11

Rotterdam diagnostic criteria
2 of:
1. Oligo/Amenorrhoea
2. Polycystic ovaries on USS
* 12/more 2-9mm follicles
* Increased ovarian volume >10ml
* Unilateral / bilateral
3. Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism, weight gain)

Question 12

symptoms/ signs PCOS?

Answer 12

Symptoms:
* Oligomenorrhoea/ amenorrhoea
* Infertility
* Obesity (70%)
* Hirsutism
* Acne
* Hair loss (in a male pattern)

Signs:
* Insulin resistance + diabetes
* Acanthosis nigricans (thickening of skin occurs with insulin resistance)
* CVD
* Hypercholesterolaemia
* Depression + anxiety
* Sexual problems
* Endometrial hyperplasia + cancer
*Obstructive sleep apnoea

Question 13

Gold standard investigation and what is found- PCOS

Answer 13

Transvaginal USS= gold standard
-‘string of pearls appearance’
Diagnosis on US:
* 12 or more developing follicles in one ovary
*Ovarian volume more than 10ml

Question 14

PCOS bloods findings?

Answer 14

Bloods:
* Testosterone (increased)
* LH (increased)
* LH : FSH (increased)
* Insulin (increased)
* Sex binding hormone globulin (usually decreased)
* Oestrogen (normal or raised)
* Prolactin (may be mildly elevated)

Question 15

Treatment for fertility- PCOS?

Answer 15

1st line- Clomiphene
* Metformin may be used if clomiphene doesn’t work
-Ovarian drilling
-IVF
-Gonadotrophins

Question 16

treatment for menstrual disturbacnes- PCOS?

Answer 16

-Cyclical oestrogen + progesterone
-Metformin

Question 17

Treatment for Hirsutism- PCOS?

Answer 17

Oral Contraceptives
* Supress ovarian androgen production and reduce free androgens by increasing SHBG levels

Question 18

what type of cancer are you more at risk of- PCOS?

Answer 18

endometrial cancer