Ovarian cyst Flashcards
What is an ovarian cyst?
Fluid-filled sac in ovarian tissue
8% of premenopausal women have large cysts
90% of all ovarian tumours are benign (but this varies with age)
What are the RFs for an ovarian cyst?
PCOS
Endometriosis
Pregnancy
What are the types of cyst?
Physiological
Benign Germ cell
Benign Epithelial
What is a functional cyst?
§ Follicular -> failed rupture (of dominant Graafian follicle or nondominant follicles to degenerate)
· Lined by Granulosa cells
· May occasionally continue to produce oestrogen and lead to EH
§ Luteal -> following rupture, follicle reseals, distends with fluid -> NORMAL in early pregnancy *
· Lined by Luteal cells
§ Haemorrhagic -> bleeding into a functional cyst
What is a benign germ cell cyst?
Dermoid cyst / mature cystic teratoma -> most common benign tumour in those <30yo
· Lined by epithelial cells
· Often asymptomatic but most likely to tort
· Rokitansky protuberances = multiple or single white shiny masses that protrude out
What is a benign epithelial cyst?
Serous or mucinous cystadenoma
Rupture: pseudomyxoma peritonei (mucin in abdomen)
What are the signs and symptoms of ovarian cysts?
o Lower abdominal pain
o Swelling with pressure symptoms (i.e. urinary symptoms)
o Deep dyspareunia
o Acute abdomen (torsion/haemorrhagic) – severe right or left iliac fossa pain (± vomiting in torsion)
What investigations do you do for ovarian cysts?
RMI = USS score, menopause status, CA-125 score
o Pregnancy test
o TVUSS -> outcome dependant on menopause status:
§ Pre-menopausal; simple -> manage depending on size; complex (<40yo) -> LDH, aFP, b-hCG levels
§ Post-menopausal; simple or complex -> CA-125 level -> RMI calculation
What is the pre menopausal management of ovarian cysts?
o Simple/unilocular cyst:
§ <5cm -> no follow-up required
§ 5-7cm -> repeat USS yearly
§ >7cm à MRI ± surgery
o Indications for watchful waiting:
§ Unilateral Unilocular (no solid parts)
§ Pre-MP (3-10cm) Post-MP (2-6cm)
§ Normal CA125 No free fluid
o If recurrent or unresolved -> medical (COCP -> preventing ovulation will prevent recurrent cysts)
o If recurrent, sustained >5cm, suspicious/multiloculated -> surgical (laparoscopic cystectomy; usually curative)
What is the post menopausal management of ovarian cysts?
(postmenopausal) – n.b. an RMI will already be calculated and management is based on this:
o RMI <200:
§ All of… asymptomatic, simple cyst, <5cm, unilocular, unilateral -> repeat USS, Ca-125 in 4-6m ->
· (1) Resolved
· (2) Unchanged -> repeat USS, Ca-125 in 4-6m
· (3) Changed -> laparoscopic cystectomy
§ Any of… symptomatic, non-simple features, >5cm, multilocular, bilateral -> BSO
o RMI >200 -> CT-AP -> MDT management:
§ TAH, BSO ± omentectomy
What are the complications of ovarian cysts?
o Ovarian cyst rupture
§ Most common with functional cysts
§ Conservative (pain relief) + watchful waiting
§ Laparoscopy ± cautery (if evidence of active bleeding)
o Ovarian torsion (if >5cm; most common in dermoid)
o Subfertility
o Malignant change
o Oophorectom
