Ovarian_Cysts_Types_Flashcards
What are benign ovarian cysts?
Benign ovarian cysts are extremely common and may be divided into physiological cysts, benign germ cell tumours, benign epithelial tumours, and benign sex cord stromal tumours.
What should be done with complex (i.e. multi-loculated) ovarian cysts?
Complex ovarian cysts should be biopsied to exclude malignancy.
What are the types of physiological (functional) cysts?
Follicular cysts and corpus luteum cysts.
What is a follicular cyst?
The commonest type of ovarian cyst, due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle. Commonly regress after several menstrual cycles.
What is a corpus luteum cyst?
Occurs when the corpus luteum fills with blood or fluid and forms a cyst. More likely to present with intraperitoneal bleeding than follicular cysts.
What are benign germ cell tumours?
Dermoid cysts, also called mature cystic teratomas. Usually lined with epithelial tissue and may contain skin appendages, hair, and teeth.
What is a dermoid cyst?
The most common benign ovarian tumour in women under 30. Median age of diagnosis is 30 years old, bilateral in 10-20%, usually asymptomatic but torsion is more likely than with other ovarian tumours.
What are benign epithelial tumours?
Tumours that arise from the ovarian surface epithelium, including serous cystadenoma and mucinous cystadenoma.
What is a serous cystadenoma?
The most common benign epithelial tumour, resembling serous carcinoma, the most common type of ovarian cancer. Bilateral in around 20%.
What is a mucinous cystadenoma?
The second most common benign epithelial tumour. Typically large and may become massive. If ruptured, may cause pseudomyxoma peritonei.
summarise ovarian cysts
Ovarian cysts: types
Benign ovarian cysts are extremely common. They may be divided into physiological cysts, benign germ cell tumours, benign epithelial tumours and benign sex cord stromal tumours.
Complex (i.e. multi-loculated) ovarian cysts should be biopsied to exclude malignancy.
Physiological cysts (functional cysts)
Follicular cysts
commonest type of ovarian cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles
Corpus luteum cyst
during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts
Benign germ cell tumours
Dermoid cyst
also called mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
most common benign ovarian tumour in woman under the age of 30 years
median age of diagnosis is 30 years old
bilateral in 10-20%
usually asymptomatic. Torsion is more likely than with other ovarian tumours
Benign epithelial tumours
Arise from the ovarian surface epithelium
Serous cystadenoma
the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%
Mucinous cystadenoma
second most common benign epithelial tumour
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei
A 30-year-old lady presents to the gynaecological outpatient department after she presented to her GP complaining of inability to conceive despite attempting for 2 years.
A trans-vaginal ultrasound scan is performed, and the report is given below:
TV USS A single 5 cm by 7 cm septated cyst is seen on the superior aspect of the right ovary. The left ovary is normal in size and morphology.
What further management would you suggest for this patient?
Book for a bilateral salpingo-oophorectomy
Commence metformin
Perform a serum CA-125, αFP and βHCG, and book for elective cystectomy
Perform an ultrasound-guided fine needle aspiration of the cyst for cytology
Reassurance and review with repeat ultrasound in 8 weeks / 3 menstrual cycles’ time
Perform a serum CA-125, αFP and βHCG, and book for elective cystectomy
Complex (i.e. multi-loculated) ovarian cysts should be biopsied with high suspicion of ovarian malignancy
Complex cysts - defined as cysts containing a solid mass, or those which are multi-loculated - should be treated as malignant until proven otherwise. The Royal College of Obstetricians and Gynaecologists Green-top Guidelines (No. 62) recommend that a serum CA-125, αFP and βHCG are performed for all pre-menopausal women with complex ovarian cysts. Aspiration of cysts is associated with higher rate of recurrence and increased spillage into the peritoneal cavity, which may disseminate possible malignant cells, hence the guideline prefers cystectomy over aspiration.
Option 1 - This would be unwise, as although malignancy should be suspected, performing such a drastic operation in a patient who is still trying for children could be devastating. In reality, this option would be extensively discussed with the patient, who may ultimately agree to the operation. However, it is not the best option here as further investigation is warranted first.
Option 2 - This may be useful for polycystic ovarian syndrome (PCOS) leading to subfertility. However, the classic description of PCOS is not described here clinically, or on ultrasound examination. Even then, metformin is not licensed to treat PCOS-related subfertility.
Option 4 - Although this appears to be a good option, a better option would be to perform serum cancer markers and an elective cystectomy, as per RCOG guidance (see above).
Option 5 - This could be the case if the cyst were simple (thin walled, non-loculated, <5cm in size).
