ovarian cysts

Question 1

cyst

Answer 1

fluid filled sac

Question 2

functional ovarian cysts

Answer 2

related to the fluctuating hormones of menstrual cycle

very common in premenopausal women

Question 3

cysts in premenopausal women

Answer 3

vast majority are benign

Question 4

cysts in postmenopausal women

Answer 4

more concerning for malignancy and need further Ix

Question 5

presentation

Answer 5

incidental finding on USS
pelvic pain 
bloating 
feeling fullness
palpable mass

Question 6

types of functional cysts

Answer 6

follicular

corpus luteum cysts

Question 7

follicular cysts

Answer 7

follicle fails to rupture and release egg, can persist asa cyst

most common type of cyst

harmless and tend to dissapear after a few cycles

Question 8

follicular cyst USS findings

Answer 8

thin walls

no internal structures

Question 9

corpus luteum cysts

Answer 9

corpus luteum fails to breakdown and fills with fluid

pelvic discomfort, pain, delayed menstruation

often seen in early pregnancy

Question 10

serous cystadenoma

Answer 10

benign tumours of epithelial cells

Question 11

mucinous cystadenoma

Answer 11

benign tumours of epithelial cells

can become huge and take up lots of space

Question 12

dermoid cysts/germ cell tumours

Answer 12

benign ovarian tumours

teratomas and may contain various tissue types

Question 13

sex cord stromal tumours

Answer 13

rare tumours, can be benign or malignant

arise from stroma or sex cords

Question 14

assess for risk factors for ovarian malignancy

Answer 14

age 
post menopause
inc number ovulations
obesity 
HRT
smoking 
FHx
BRCA1 BRCA2

Question 15

Ix - premenopausal women with simple cyst <5cm

Answer 15

no further Ix

Question 16

Ix - women under 40 with complex mass

Answer 16

LDH
alpha-fetoprotein
hCG

Question 17

causes of raised CA125

Answer 17

endometriosis 
fibroids
adenomyosis 
PID
liver disease
pregnancy

Question 18

risk of malignancy index

Answer 18

menopausal status
USS findings
CA125

Question 19

Mx - possible caner

Answer 19

(complex cyst or raised CA125)

2wk wait referral to gynae oncology

Question 20

Mx - possible dermoid cyst

Answer 20

gynae referral for further Ix and consideration of surgery

Question 21

Mx - simple cyst in premenopausal women

Answer 21

< 5cm - no follow up

5-7cm gynae referral, yrly USS

> 7cm - MRI

Question 22

Mx - cyst in postmenopausal women

Answer 22

if raised CA125 - 2wk referral

<5cm and normal CA125 = monitor 4-6mo USS

Question 23

main complications

Answer 23

torsion
haemorrhage into cyst
rupture

Question 24

Meig’s syndrome

Answer 24

ovarian fibroma
pleural effusion
ascites