Ovarian Cysts

Intro & Functional Cysts - Ovary's Bubble Trouble

• Ovarian Cysts: Fluid-filled sacs in/on ovary. Often asymptomatic.
  • Types: Functional (commonest) vs. Neoplastic.
• Functional Cysts: Hormone-related, usually benign, resolve spontaneously.
  • Follicular: Unruptured follicle. Most common. Usually <3 cm. Resolve in 1-2 cycles.
  • Corpus Luteum: Failed CL involution. Progesterone → delayed menses. Often hemorrhagic. Usually 3-5 cm. Resolve in 1-3 months.
  • Theca Lutein: Bilateral, multiple. Due to ↑hCG (molar pregnancy, ovulation induction). Resolve with ↓hCG.
  • Symptoms (if any): Dull ache, dyspareunia, menstrual irregularities.
  • Complications (rare): Torsion, rupture, hemorrhage.

⭐ Most functional ovarian cysts resolve spontaneously within 1-3 cycles; observation is key in asymptomatic premenopausal women.

Benign Neoplastic Cysts - Not-So-Nasty Neoplasms

• Epithelial Tumors: Most common benign ovarian neoplasms.
  • Serous Cystadenoma:
    • Most common benign epithelial tumor (overall).
    • Often bilateral (15-25%).
    • Lined by fallopian tube-like epithelium; psammoma bodies may be seen.
  • Mucinous Cystadenoma:
    • Can grow very large.
    • Multiloculated, filled with gelatinous material.
    • Risk of pseudomyxoma peritonei if ruptured (esp. borderline types).
• Germ Cell Tumors:
  • Mature Cystic Teratoma (Dermoid Cyst):
    • Most common ovarian neoplasm in women < 20 years.
    • Contains elements from ≥ 2 germ layers (e.g., hair, teeth, sebum).
    • High risk of torsion (10-15%).
    • Struma ovarii: teratoma with >50% thyroid tissue; may cause hyperthyroidism.
• Sex Cord-Stromal Tumors:
  • Fibroma/Thecoma/Fibrothecoma:
    • Solid, firm tumors.
    • Fibromas can be associated with Meigs syndrome.

⭐ Meigs Syndrome: Triad of ovarian fibroma (or other benign solid pelvic tumor), ascites, and pleural effusion. Symptoms resolve post-tumor removal. Crucial to differentiate from malignancy causing effusions.

Symptoms & Diagnosis - Cyst Detective Work

• Symptoms:
  • Often asymptomatic.
  • Pain: dull ache; acute (torsion, rupture, hemorrhage); dyspareunia.
  • Menstrual dysfunction (hormonal cysts).
  • Pressure (large cysts): urinary frequency, bloating. Abdominal distension.
  • Hormonal: virilization, precocious puberty/postmenopausal bleeding (PMB).
• Diagnosis:
  • Pelvic Exam: Adnexal mass/tenderness.
  • Transvaginal Ultrasound (TVS): Key investigation.
    • Simple: unilocular, anechoic, smooth walls, posterior enhancement.
    • Complex: septations, solid areas, papillary projections, ↑Doppler flow. (IOTA criteria).
  • Tumor Markers (if suspicious, esp. postmenopausal/complex):
    • CA-125, AFP, β-hCG, LDH, Inhibin.
  • MRI: for complex masses. Laparoscopy: diagnostic & therapeutic.

⭐ CA-125 >35 U/mL is suspicious in postmenopausal women with a pelvic mass; less specific in premenopausal.

Management & Complications - Handling Cyst Chaos

• Strategy: Based on symptoms, cyst type, age, RMI.
• Conservative:
  • Asymptomatic simple cysts:
    • Premenopausal: <5cm observe; 5-7cm yearly USG.
    • Postmenopausal: <1cm & normal CA-125.
  • Medical: OCPs (functional), analgesics.
• Surgical (Laparoscopy preferred):
  • Indications: Symptomatic, large (>7cm premeno), complex (↑RMI), complications.
  • Types: Cystectomy, oophorectomy.
• Complications & Acute Care:
  • Ovarian Torsion: Acute severe pain, N/V. USG Doppler (↓ flow). 📌 Surgical emergency!

    ⭐ Ovarian torsion requires prompt surgical detorsion to preserve ovarian function. Delay risks necrosis.

  • Rupture/Hemorrhage: Acute pain, shock. Supportive; surgery if unstable.

High‑Yield Points - ⚡ Biggest Takeaways

• Functional cysts (follicular, corpus luteum) are most common.
• Serous cystadenoma: most common benign epithelial tumor. Serous cystadenocarcinoma: most common malignant.
• CA-125: key tumor marker for epithelial ovarian cancer.
• Dermoid cysts (mature cystic teratomas): most common germ cell tumor; may show calcification (e.g., teeth).
• Meigs syndrome triad: ovarian fibroma, ascites, and pleural effusion.
• Simple cysts <5 cm in premenopausal women: usually observed. Postmenopausal cysts: investigate further.
• Ovarian torsion: presents with acute severe pain, a common surgical emergency related to cysts.