Ovarian Cyst Flashcards
Definition
Fluid-filled sac.
Epidemiology
- Premenopausal women (Benign)
- Cysts in postmenopausal women (more likely malignant)
Risk factors
- Early menarche
- Increased number of ovulations (nulliparity)
- Obesity
- Hormone replacement therapy
- Smoking
- Breastfeeding (protective)
- Family history and BRCA1 and BRCA2 genes
Classic appearance of multiple ovarian cysts
“String of pearls” appearance
Presentation
Majority asymptomatic
Vague symptoms:
- Pelvic pain
- Bloating
- Fullness in the abdomen
- Dyspareunia
- A palpable pelvic mass (particularly with very large cysts such as mucinous cystadenomas)
Ruptured cyst symptoms
Sudden severe sharp pain
Shoulder tip pain
Shock
When may ovarian cysts present with acute pelvic pain
Ovarian torsion
Haemorrhage
Rupture of cyst
Types of cysts
- Functional/Physiological: related to the fluctuating hormones of the menstrual cycle
= Follicular cysts (MC)
= Corpus Luteum Cyst - Pathological
= Benign germ cell tumours: sertoli-leydig, fibroma
= Benign sex cord stromal: Dermoid cysts/ Teratomas
= Benign epithelial tumours: serous cystadenoma, mucinous cystadenoma
= Endometriomas
Follicular cysts (MC)
(MC) = represent the developing follicle
- When these fail to rupture and release the egg, the cyst can persist.
- Harmless and tend to disappear after a few menstrual cycles.
- Typically they have thin walls and no internal structures.
Corpus luteum cysts
Occurs when the corpus luteum fails to break down and instead with fluid. They may cause pelvic discomfort, pain or delayed menstruation.
Seen often in early pregnancy.
Serous cystadenoma
These are benign tumours of the epithelial cells
Mucinous cystadenoma
Benign tumour of the epithelial cells. They can become huge, taking up lots of space in the pelvis and abdomen
Endometrioma
These are lumps of endometrial tissue within the ovary, occurring in patients with endometriosis. They can cause pain and disrupt ovulation.
Dermoid cysts/ Germ cell tumours
- Benign ovarian tumours.
They are teratomas (come from the germ cells) and may contain various tissue types, such as skin, teeth, hair and bone. - MC benign ovarian tumour in women <30
They are particularly associated with ovarian torsion.
Sex Cord-Stromal Tumours
- Rare tumours, can be benign or malignant.
- They arise from the stroma (connective tissue) or sex cords (embryonic structures associated with the follicles).
- There are several types, including Sertoli–Leydig cell tumours and fibroma’s
More ovulation periods = high risk of ovarian cancer. Which factors reduce the number of ovulations?
- Later onset of periods (menarche)
-Early menopause - Any pregnancies
- Use of the combined contraceptive pill
Diagnosis
- Premenopausal women with a simple ovarian cyst less than 5cm on USS do not need further investigations.
- CA125
- Women < 40 years + complex ovarian mass require tumour markers for a possible germ cell tumour:
= Lactate dehydrogenase (LDH)
= Alpha-fetoprotein (α-FP)
= Human chorionic gonadotropin (HCG)
Causes of raised CA125
- Endometriosis
- Fibroids
- Adenomyosis
- Pelvic infection
- Liver disease
- Pregnancy
Treatment
Managed based on their size:
- <5cm cyst = will always resolve within three cycles
- 5 - 7cm = require routine referral to gynaecology and yearly USS monitoring
- >7cm = Consider MRI scan or surgical evaluation as they can be difficult to characterise with USS
- Persistent or enlarging cysts may require surgical intervention.
= removing the cyst (ovarian cystectomy), = possibly along with the affected ovary (oophorectomy).
Meig’s syndrome
Typically occurs in older women.
Triad of:
- Ovarian fibroma (a type of benign ovarian tumour)
- Pleural effusion
- Ascites
Removal of the tumour results in complete resolution of the effusion and ascites.
* IN EXAM LOOK OUT FOR OLDER WOMEN WITH PLEURAL EFFUSION AND OVARIAN MASS *
