Ovarian cysts

Question 1

Functional ovarian cysts

Answer 1

3 types: follicular, corpus luteal, theca luteal
Common is girls, adolescents and women of reproductive age
Treat according to symptoms. Conservative vs analgesia vs surgical excision and wash out

Question 2

Clinical features

Answer 2

Asymptomatic
Dull ache in lower abdomen/low back pain
Fyspareunia
Swollen abdomen, palpable mass arising from pelvis, dull to percussion and doesn’t disappear if bladder emptied
Pressure effects (urinary frequency, varicose veins, leg oedema)
Torsion, infarction, haemorrhage => severe pain
Rupture: sudden, severe pain, peritonitis, shock

Question 3

Inflammatory ovarian cysts

Answer 3

Usually associated with PID
Most common in young women
May involve the tube, ovary and bowel
Can occasionally develop from other infective causes eg appendicitis
Diagnosis based on PID
Antibiotics, surgical drainage, excision

Question 4

Germ cell tumours

Answer 4

Most common ovarian tumours in young women
Dermoid cyst (cystic teratoma) most common type
Can be bilateral
MRI
Often present with torsion
Surgical excision (cystectomy), torsion may require complete oophorectomy
Small chance of malignant change

Question 5

Epithelial tumours

Answer 5

Most common in peri-menopausal women
Serous cystadenoma most common type - typically unilocular
Mucinous cystadenomas large multiloculated, bilateral in 10%
Brenner tumours small, oestrogen secreting

Question 6

Sex cord stromal tumours

Answer 6

Ovarian fibromas most common - older women often with torsion. Patients may present with Meig syndrome (pleural effusion, ascites and ovarian fibroma)
Thecomas - oestrogen producing, present post menopause with manifestations of excess oestrogen production