Ovarian cyst

Question 1

What is an ovarian cyst (RF, types)

Answer 1

Fluid filled sac in ovarian tissue-
8% of premenopausal have cysts
90% are benigns

RF - PCOS, Endometriosis, pregnancy

Physiological/functional-
follicular (failed rupture of graffian)
Luteal- following rupture, follicule reseal, fills with fluid
heamorhagic - bleeding in functional

Benign germ cell-
dermoid cells/cystic teratoma-most common under 30
Lines with epithelial cells, likely to tort

Benign epithelial -
serous cystadenoma
mucinous cysadenoma- large

Question 2

Sx and Ix of ovarian cysts

Answer 2

Sx-
lower abdominal poain
swelling with pressure sx - urinary LUTS
deep dyspareunia
acute abdomen when torsion-severe right/lefft illiac fossa pain + vomit

Ix-
pregnancy test
TVUSS-
pre-menopausal- simple- mage on size, complex (LDH, aFP, bHCg)
post meno - simple or complex Ca-125 - RMI calculation

Question 3

Mx (premenopausal) of ovarian cysts

Answer 3

simple/unilocular cyst-
<5cm - no follow up
5-7cm- repeat USS yearly
>7cm - MRI+ surgery

Indication for watchful wait - unilateral, unilocular, no free fluid, normal Ca125, small

If reccurent/unresolve- medical COCP-> preventing ovulation prevent cysts
Reccurent, large, suspicious-> surgical (laproscopic)

Question 4

Mx (menopausal) of ovarian cysts

Answer 4

RMI is a calculation based on Ca125, menopausal status and ultrasound score

so start with Ca125 measurment

if RMI <200
if asympto, simple, small, low risk- repeat USS and Ca125 in 6m
if no change - in 6m again
if change - surgery
if symptomatic, non simple, large- BSO

RMI >200– CTAP, MDT
TAH, BSO + omentectomy

Question 5

Complication of ovarian cysts

Answer 5

Rupture - most common with functional -
either conservative or laproscopy-

ovarian torsion- if >5cm, dermoid -
subfertility
malignant changes