Ovarian cysts Flashcards
Functional ovarian cysts
Related to the fluctuating hormones of the menstrual cycle
Common in premenopausal women
Follicular cysts or Corpus luteum cysts
Cysts in postmenopausal women
More concerning for malignancy and need further investigation
Symptoms of ovarian cysts
Mostly asymptomatic
Can have:
- Pelvic pain
- Bloating
- A palpable pelvic mass
Acute pelvic pain with ovarian cysts
Associated with ovarian torsion, haemorrhage or rupture
Follicular cysts
Represents the developing follicle.
Failure of rupture causes the cyst to persist
Corpus luteum cysts pathophysiology
Occur when the corpus luteum fails to break down and fills with fluid
Presentation of corpus luteum cysts
May cause pelvic discomfort, pain or delayed menstruation
Often seen in early pregnancy
Serous Cystadenoma
Benign tumours of the epithelial cells
Mucinous Cystadenoma
Benign tumour of the epithelial cell
Can become huge
Endometrioma
Lumps of endometrial tissue within the ovary
Occur in patients with endometriosis
Can cause pain and disrupt ovulation
Dermoid Cysts / Germ Cell Tumours
Benign ovarian tumours
Teratomas - come from the germ cells and may contain various tissue types
What are dermoid cysts associated with
Ovarian torsion
Sex Cord-Stromal Tumours
Rare tumours, that can be benign or malignant
Arise from the stroma or sex cords (embryonic structures associated with the follicles).
Types of sex cord stromal tumours
Sertoli–Leydig cell tumours
Granulosa cell tumours
Ovarian cyst history
Exclude malignancy:
- Abdominal bloating
- Reduce appetite
- Early satiety
- Weight loss
- Urinary symptoms
- Pain
- Ascites
- Lymphadenopathy
Risk factors for ovarian maligancy
Age
Postmenopause
Increased number of ovulations
Obesity
HRT
Smoking
FHX and BRCA1 and BRCA2 genes
Factors that decrease ovarian malignancy risk
Later onset of periods (menarche)
Early menopause
Any pregnancies
Use of COCP
Investigations for ovarian cysts
Premenopausal women with a simple ovarian cyst < 5cm on USS do not need further investigations
CA125
Who requires bloods for tumour markers in patients with an ovarian mass
Women < 40 years with a complex ovarian mass
Tumour markers for germ cell tumours
Lactate dehydrogenase (LDH)
Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)
Causes of Raised CA125
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
Risk of Malignancy Index
Estimates the risk of an ovarian mass being malignant by:
- Menopausal status
- USS findings
- CA125 level
Management of ovarian cysts
Possible ovarian cancer - 2ww referral
Dermoid cysts - referral to gynae for possible surgery
Simple ovarian cysts in premenopausal women can be managed based on their size
Possible ovarian cancer
Complex cysts or raised CA125
Management of simple ovarian cysts in premenopausal women < 5cm
Almost always resolve within three cycles
Do not require a follow-up scan.
Management of simple ovarian cysts in premenopausal women 5 - 7cm
Require routine referral to gynaecology and yearly ultrasound monitoring.
Management of simple ovarian cysts in premenopausal women > 7cm
Consider an MRI scan or surgical evaluation
Cysts in postmenopausal women
Require correlation with the CA125 result and referral to a gynaecologist W
Simple cysts under 5cm with a normal CA125 in postmenopausal women
Monitored with an ultrasound every 4 – 6 months
Persistent or enlarging cysts
May require surgical intervention
Complications of ovarian cysts
Torsion
Haemorrhage into the cyst
Rupture, with bleeding into the peritoneum
Meig’s Syndrome
Triad of:
- Ovarian fibroma
- Pleural effusion
- Ascites
