Ovarian cysts/Pelvic prolapse Flashcards
Ovary
Adnexal structure
Produce numerous follicles every month, with one dominant follicle maturing → ovulation
Suspended laterally to the uterus by the utero-ovarian ligament
Covered by the mesovarium (component of the broad ligament)
Connected to the pelvic wall by the suspensory ligament
Blood supply: ovarian artery, a direct branch of the aorta, and the uterine artery
Ovarian Cyst
general and RF
Defined as a collection of fluid or semiliquid material, often walled off by a membrane, located in the ovary
Etiology:
Can occur at any age, but more common in reproductive years (endogenous hormone production)
Most are benign
Post-menopausal women with any type of ovarian cyst should undergo evaluation to rule out malignancy
Risk Factors:
Infertility treatment → ovarian hyperstimulation
Tamoxifen → causeexcessive growth of ovarian follicles
Pregnancy – formation in the second trimester due to peak levels of hCG
Cigarette smoking
Tubal ligation
ovarian cysts
categorized as
Categorized as:
Functional
Occur as a result of normal physiologic processes
Uncommon after menopause
Neoplastic
Abnormal growth of ovarian cells within the ovary
Subcategorized as
Benign: Women of reproductive age
Malignant: Risk of malignancy increases in the postmenopausal period
ovarian cysts
simple
Common
Thin-walled with no evidence of wall thickening or internal walls (septation)
Fluid-filled
Most often benign
Typically disappear without treatment
ovarian cysts
complex
Generally large
Irregular borders
Internal septations creating a multilocular appearance
Fluid inside tends to be heterogeneous (solid material and fluid)
Could be part of an ovarian tumor → HIGHER SUSPICION for malignancy
Functional cyst
follicular cysts
Most common ovarian mass in women of reproductive age
Follicles that fail to rupture during ovulation and continues to grow because of hormonal stimulation
Characteristics
Simple collections of fluid
Thin-walled
Single or multiple
Variablesize
A few millimeters to 15 cm
Lined with granulosa andtheca cells
functional cyst
Corpus Luteal cyst
Corpus luteum that does not dissolve
Followingovulation, the follicle becomes the corpus luteum → secretes progesterone
Pregnancy negative: life span of the corpus luteum is 14 days
Pregnancy positive: corpus luteum continues to secrete progesterone until dissolution at ~14 weeks
Present during pregnancy
Characteristics
Unilateral
Simple or complex
~2‒3 cm size; can be up to 8 cm
Uniloculated cysts, which can contain internal debris
Can hemorrhage into the cyst cavity (hemorrhagic cyst) or rupture into the peritoneum
functional cyst
Clin man
Often asymptomatic
Symptoms if present may include:
Pain or pressure:
Unilateral in the lower abdomen
Intermittent or constant
Sharp or dull
Peritoneal irritation
Delayedmenses
Vaginal bleeding
functional cysts
Dx
History and exam
Consistent clinical symptoms
Palpable adnexalmasson bimanual examination
Location, shape, size, mobility, and level of tenderness
Imaging – required for definitive diagnosis
Transvaginal ultrasonography
Cancerantigen125 (CA-125) blood test
Only for postmenopausal women
Complex cysts and highCA-125level = ↑ risk of malignancy
functional cysts
managament
surgical indications
Typically, no treatment is required unless complications occur
Follicular cysts usually resolve spontaneously within 1–2 menstrual cycles
Resolution occurs after cyst fluid resorption or spontaneous rupture
Cysts that do not resolve require further investigation
Serial transvaginal ultrasounds may be required to monitor cyst changes
Surgical removal indications
Suspectedovarian torsion
Persistent adnexalmass
Suspected malignancy
Neoplastic cysts
general
Classified according to the cell of origin:
Epithelial cells
Germ cells
Sexcord-stromal cells
Each has multiple histologic subtypes
Each subtype can be either benign or malignant
Neoplastic Cyst
Epithelial cell tumors
Most common type of malignant ovarian tumor
Multiple histological subtypes
Histology (not radiographic appearance) determines if the tumor is benign, borderline, or malignant
Typicallyaffectmiddle-aged and elderly women
Neoplastic Cyst
Germ cell tumor (teratomas)
Arise from all 3 germ cell layers
Common in children and adolescents
Usually asymptomatic and discovered incidentally on pelvic exam
Also called “dermoid cysts” because they often contain ectodermal components (teethand hair)
Most often benign
High risk ofovarian torsion
Neoplastic Cyst
Sexcord-stromal tumors
Multiple histologic subtypes
Arise from the stroma of the ovary
Common in middle-aged women
Associated with ascites and pleural effusions
neoplastic cysts
Clin man
Lower abdominal/pelvicpain
Acute-onset pain associated with ovarian rupture, torsion, or bleeding
Abdominal distention
Abdominal fullness, bloating
Early satiety
Painful intercourse
Irregular periods
Abnormal vaginal bleeding
Urinary frequency
Constipation
Weight loss