Ovarian Cysts

Question 1

Functional cysts:

• What are they made of?
• What age are they common in?
• What do they release?
• Why may they cause pain?

Answer 1

Follicular or corpus luteum cysts

Women of reproductive age

Hormones

By rupture, failing to rupture at ovulation or bleeding

Question 2

Endometriomas:

What are they filled with?

What is another name for them?

Answer 2

Cysts filled with old blood

Chocolate cysts - due to colour on laparoscopy

Question 3

Serous cystadenomas:

• The common age range of onset
• % that are bilateral
• % that are malignant
• What may fill the cysts?
• Average size?

Mucinous cystadenomas:

• Average size?

Answer 3

30-40 yrs

30% - bilateral

30% - malignant

Clear watery fluid - serous

10 cm but can be up to 30 cm

Question 4

Fibromas:

What are they?

Answer 4

Small, solid, benign, fibrous tissue tumours

Question 5

Teratomas:

What is a mature teratoma called?

What may it contain?

Answer 5

A dermoid cyst

Well-differentiated tissue - teeth, hair etc.

Question 6

What percentage of cysts are not malignant?

Answer 6

95%

Question 7

S+S - similar to ovarian cancer:

Abdo - 4

Where may there be tenderness?

What may they have doing?

Examination:

• Abdo
• Vaginal

Answer 7

Swollen
Pain
Bloating
Nausea

Adnexa

Dyspareunia 
----
Palpable pelvic mass 
Tenderness 
Peritonism 
Ascites

Vaginal discharge
Bleeding
Cervical excitation
Adnexal mass/tenderness

Question 8

S+S:

Local mass effects:

• Bladder - 1
• Ureters - 3
• Bowel - 2

Answer 8

Bladder - urinary frequency
Ureters - hydronephrosis, recurrent UTI, haematuria
Bowel - constipation, obstruction

Question 9

S+S:

How might a rupture present? - 2

What would torsion cause?

Meigs syndrome:
- It is a triad of fibroma plus 2 other symptoms. What are they?

What may functional tumours cause?

Answer 9

Shock and peritonism

Ascites
Pleural effusion

Virilisation
Altered menstruation
PMB

Question 10

Investigations:

Imaging - 1

What is measured in all PM women and contributes to the RMI score?

Other basic examinations:

• What needs to be ruled out?
• Why is FBC measured? - 2

Answer 10

TVUS

Pregnancy - Beta-hCG

Low Hb = bleed
Raised WBC = infection or torsion

Question 11

Investigations:

When is a fine needle aspiration and cytology and/or diagnostic laparoscopy used?

Why should these 2 things not be done if cancer is suspected?

Answer 11

If the cyst is thought to be benign

You risk spreading the disease

Question 12

Management:

Conservative:

• Size of a cyst, classed as small and can be left alone?
• What may be measured in PM women and seen as normal?
• How long do these cysts take to resolve?

Answer 12

<5cm

CA-125

3 months

Question 13

Management:

Conservative:

• What follow up can be done for cysts between 5-7 cm in size

Answer 13

Annual USS to follow up

Question 14

Management:

Surgical:
- Why is it done?

Indications

Procedures for those:

• Wishing to retain fertility
• Those done having children

Answer 14

To prevent malignancy and/or relieve symptoms

A large cyst (>5cm) and post-menopausal
Persistent large cyst and pre-menopausal
Expanding cyst
Persistent symptomatic cyst

Cystectomy

Bilateral oophorectomy