Ovarian cysts

Question 1

How are ovarian masses normally detected?

Answer 1

They are often silent.
Detected when they are very large and cause abdominal distension or on US scan
Acute presentation is with ‘accidents’

Question 2

Name some ovarian ‘accidents’

Answer 2

1. Rupture of an ovarian cyst into the peritoneal cavity
2. Haemorrhage into a cyst
3. Torsion of the pedicle

Question 3

Sx of a ruptured cyst?

Answer 3

Intense pain, particularly with an endometrioma or dermoid cyst

Question 4

Where can a cyst haemorrhage into?

Answer 4

Into the cyst itself, or into the peritoneal cavity

Question 5

Sx of a cyst haemorrhage?

Answer 5

Pain

Question 6

What can severe haemorrhage into the peritoneal cavity cause?

Answer 6

Hypovolaemic shock

Question 7

What does pedicle torsion cause?

Answer 7

Infarction of the ovary and/or fallopian tube

This is v painful

Question 8

What is the Mx/Tx of torsion?

Answer 8

Urgent surgery and detorsion to save the ovary

Question 9

What can a cyst be?

Answer 9

Anything from the malignant to the physiological

Question 10

Common ovarian cysts in premenopausal women?

Answer 10

1. Follicular / luteal cysts
2. Dermoid cysts
3. Endometriomas
4. Benign epithelial tumours

Question 11

Common ovarian cysts in postmenopausal women?

Answer 11

1. Benign epithelial tumour

2. Malignancy

Question 12

What is a follicular or luteal cyst?

Answer 12

Enlarged follicles or corpora lutea respectively.

Question 13

What can prevent folliuclar or luteal cysts?

Answer 13

The combined pill

Question 14

Do follicular or luteal cysts cause more Sx?

Answer 14

Luteal

Question 15

How are cysts managed if no Sx present?

Answer 15

Tx not required and the cyst is observed using serial US scans and CA125

Question 16

What is done if a cyst appears >5cm for more than 2 months?

Answer 16

There is a remote possibility of malignancy, so the serum cancer antigen 125 (CA 125) level is measured and a laparoscopy considered to remove or drain the cyst

Question 17

Chronic Sx from ovarian cysts?

Answer 17

1. Chronic pain (dull ache)
2. Pressure on other organs (urinary frequency or bowel disturbance)
3. Dyspareunia (endometrioma)
4. Cyclical pain (endometrioma)
5. Abnormal uterine bleeding
6. Hormonal effects

Question 18

What is a dermoid cyst?

Answer 18

A common benign tumour usually arising in young premenopausal women. May contain fully differentiated tissue of all cell lines, commonly hair and teeth. Commonly bilateral, seldom painful and often ASx. However, rupture is painful.
Malignant form, solid teratoma, do exist but rare

Question 19

What is an endometrioma?

Answer 19

Endometriosis commonly causes altered blood to accumulate in ‘chocolate cysts’. In the ovary, they are called endometriomas. Rupture is very painful but uncommon

Question 20

What haematological tests should be done?

Answer 20

1. FBC

2. Tumour markers (CA125 and in younger women (<40) with a solid mass; AFP, hCG, LDH, inhibin and oestradiol)

Question 21

What imaging should be done?

Answer 21

Abdominal and pelvic USS; presence and appearance of pelvic mass and ascites