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Gynecology > Ovarian Cyst > Flashcards

Ovarian Cyst Flashcards

1
Q

What is an ovarian cyst?

A

It is a sac filled with a liquid or semi liquid material that arises from the ovary.

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2
Q

What are the risk factors for ovarian cyst ?

A
  1. Tamoxifen use
  2. Infertility treatments
  3. Pregnancy
  4. Hypothyroidism ( tsh exhibits hcg effects , ovarian cysts need hcg to proliferate. As they proliferate cysts develop)
  5. Cigarette smoking ( car oxyhemoglobin leads to cell death, dead cells have cavities which form cysts)
  6. Tubal ligation
  7. Maternal gonadotropins
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3
Q

What are the types of ovarian cysts?

A
  1. Functional cysts : their occurrence follow the HPO axis.

2. Non - functional / pathological cysts; their occurrence does not follow the HPO axis

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4
Q

What are the types of functional cysts?

A
  1. Follicular cysts
  2. Corpus literal cysts
  3. Theca- lutein cysts
  4. Luteoma of pregnancy
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5
Q

What are the types of non -functional cysts?

A
  1. PCOS
  2. Chocolate cysts / endometrioma
  3. Neoplastic cysts
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6
Q

What is a follicular cyst?

A
  • Usually greater than 2.5cm in diameter
  • occurs as a result of the failure of the physiological release of an ovum due to excessive FSH stimulation or failure of LH surge in the mid cycle prior to ovulation. The follicle starts accumulating fluids.
  • they are the most common .
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7
Q

What is a corpus luteal cyst?

A
  • results from the failure of dissolution of the corpus luteum by the 14th day in the absence of pregnancy or by the 14th week in the presence of pregnancy.
  • they usually grow up to 3cm in diameter
  • on USG:
  • presence of circumferential colors called ring of fire ( this is due to the bleeding in an irregular fashion such that the corpus luteal cysts attain a fish net or spider Web pattern)
  • They are prone to torsion
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8
Q

What is a theca-lutein cyst?

A
  • they arise due to the luteinization and hypertrophy of the theca interna cell layer in response to excessive hcg stimulation
  • they are usually bilateral
  • they are prone to torsion, rupture and hemorrhage.
  • they are usually associated with molar pregnancy, multiple pregnancy due to excessive HCG levels.
  • they can grow to excessive increase in ovarian size in what is called hyperactive luteinalis
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9
Q

What is a luteoma of pregnancy?

A

It occurs when the ovarian parenchyma is replaced by proliferation of luteinized stromal cells such that they become hormonally active with androgen production

  • It may predispose to maternal virilization and virilization of the female fetus
  • it is characterized by the presence of complex heterogenic hypoechoic mass on USG
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10
Q

What is a chocolate cyst?

A
  • they are associated with endometriosis and characterized by dysmenorrhea, dysparenia and menorrhagia.
  • they are also called endometrioma
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11
Q

What is a neoplastic cyst?

A

They arise from abnormal growth of cells in the ovary. Could be benign or malignant

Benign: serous cystadenoma , mucinous cystadenoma

Malignant: granuloma cells tumors , germ cell tumors (they arise from the primordial germ cell. Example is a teratoma), mucinous and serous cystadenomas

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12
Q

What is a dermoid cyst?

A

It is a matured cystic teratoma that contains hairs , teeth and bone . They are very heavy and have highest risk of torsion.

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13
Q

What are the clinical presentations ovarian cysts?

A
  1. Dull- aching abdominal pain or discomfort. (They are usually bilateral but can be bilateral in theca- lutein cysts?
  2. Abdominal bloating ( mass effect on the intestine that prevents the passage of intestinal contents )
  3. Nausea and vomiting ( no passage of intestinal contents, fluid builds up)
  4. Lower urinary tract symptoms if close to the bladder . Starts being irritative then moves to obstructive.
  5. Tenesmus: sensation of passing stool
  6. Dysmenorrhea and menorrhagia
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14
Q

What are the investigations for ovarian cysts?

A
  1. TSH: to rule out hypothyroidism
  2. Serum hcg or UPT: to rule out pregnancy
  3. Serum FSH/ serum LH
  4. Serum progesterone levels : corpus luteal cyst
  5. serum estrogen levels
  6. Serum androgen levels
  7. USG scan : GOLD STANDARD: route is transvaginal.
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15
Q

What’s are differential diagnosis for ovarian cysts ?

A
  1. Ovarian torsion
  2. Ovarian cancer
  3. PID
  4. Uterine fibroids: pedunculated
  5. Appendicitis
  6. Ectopic pregnancy
  7. PCOS
  8. Pelvic kidney
  9. Hydonephrosis
  10. Hydrosalpinx
  11. Tubo ovarian abscess
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16
Q

What are the complications of ovarian cysts?

A
  1. Torsion of the cyst: onset of sudden unilateral sharp pelvic cyst
  2. rupture of the cyst
  3. Hemorrhage or bleeding into the cyst
  4. Infection of the cyst
  5. Malignant transformation of the cyst
17
Q

How do you treat ovarian cysts?

A
  1. Expectant management : for functional cysts less than 4cm in diameter.
  2. Pharmacotherapy: for simple cysts less than 4cm that do not disappear. Oral contraceptives are used
  3. Surgery :
    * conservative surgery: cystectomy to preserve reproductive function
    * radical surgery: removal of the ovary( oophorectomy)
18
Q

What are the indications for surgery in ovarian cysts?

A
  1. Persistent ovarian cysts (fails to disappear)
  2. Cysts that’s are increasing in size
  3. Cysts causing increasing abdominal pain
  4. Malignant transformation of the cysts
  5. Simple cysts greater than 10cm in diameter which is persistent and symptomatic

Gynecology (1 decks)

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