Updated: 11/30/2021

Ovarian Cysts

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  • Snapshot
    • A 6-year-old girl is brought to the pediatrician by her father for vaginal bleeding. The father reports that he was changing her and noticed blood on her pants. The patient is obese but otherwise healthy. She just started kindergarten and gets allow well with her classmates. On physical examination, the patient has Tanner stage 3 breasts. There is no axillary or pubic hair. A pelvic ultrasound reveals a right ovarian cyst with smooth, thin lining and no solid areas. Hormonal analysis reveals an elevated estradiol level. (Follicular cyst)
  • Introduction
    • Introduction
      • clinical definition
        • fluid-filled sac(s) within an ovary
    • Studies
      • diagnostic approach
        • imaging
          • pelvic/vaginal ultrasound
        • studies
          • tumor markers (i.e., CA-125, alpha-fetoprotein, beta-HCG, or inhibin B)
            • if concerned for malignancy
    • Differential
      • dermoid cyst/teratoma
      • endometrioma
      • ovarian tumor
    • Treatment
      • observation
        • if small and asymptomatic
      • surgical resection
        • if large (> 5 cm) or symptomatic
    • Complications
      • ruptured ovarian cyst
        • presentation
          • unilateral lower abdominal pain/pelvic pain
            • sudden onset
            • usually after physical activity
            • signs of acute abdomen/shock
              • risk factors
                • endometrioma
                • dermoid cyst
                • bleeding diathesis
                • anticoagulation
        • imaging
          • pelvic ultrasound
            • free fluid
              • usually in the rectouterine pouch
        • treatment
          • conservative symptom management
            • if hemodynamically stable
          • laparoscopy for hemorrhage control
            • if hemodynamically unstable
      • ovarian torsion
        • presentation
          • unilateral lower abdominal/pelvic pain
            • sudden onset
            • nausea
            • vomiting
        • imaging
          • pelvic ultrasound with Doppler
            • enlarged ovary with decreased blood flow
        • treatment
          • detorsion
            • if viable ovary
  • Follicular Cyst
    • Follicular cyst
      • demographics
        • most common form
      • pathogenesis
        • non-neoplastic expansion of unruptured graafian follicle
        • cyst lined with follicular epithelium
    • Presentation
      • most often asymptomatic
      • associated with
        • hyperestrogenism (i.e., abnormal vaginal bleeding or enlarged breasts)
        • endometrial hyperplasia
    • Imaging
      • pelvic ultrasound
        • thin-walled
        • unilocular
  • Corpus Luteal Cyst
    • Corpus luteal cyst
      • demographics
        • most common pelvic mass within 1st trimester of pregnancy
        • can also develop physiologically during menstrual cycle
      • pathogenesis
        • failure of corpus luteum to regress after ovum release
    • Presentation
      • most often asymptomatic
      • may have delayed menses
        • due to production of progesterone
    • Imaging
      • pelvic ultrasound
        • diffusely thick wall
        • peripheral vascularity
          • “ring of fire”
  • Theca-Lutein Cyst
    • Theca-lutein cyst
      • risk factors
        • associated with gonadotropin stimulation
          • multifetal pregnancy
          • polycystic ovary syndrome (PCOS)
          • clomiphene
          • ovulation induction
          • gestational trophoblastic disease
      • pathogenesis
        • excessive circulating gonadotropins (such as beta-HCG) causes hyperplasia of theca interna cells
    • Presentation
      • most often asymptomatic
      • can cause hyperandrogenism
        • hirsutism
        • alopecia
        • acne
    • Imaging
      • pelvic ultrasound
        • bilateral, enlarged, multicystic ovaries
    • Treatment
      • management of underlying causes
        • usually regress when beta-HCG levels decrease

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