Pocket ObGyn -Ovarian Cysts
See Abbreviations
Definitions (Obstet Gynecol 2011;117:1413; Am Fam Physician 2009;80:815)
- Functional ovarian cysts: Follicular cysts form when an unruptured ovarian follicle fills w/ serous fluid ® capsule distention/pain. Corpus luteum cysts, normally present in early Preg; can bleed ® distention or active
- Benign & neoplastic ovarian cysts (see also 21): Dermoid, stromal & germ cell tumors, fibroma, epithelial neoplasm, cystadenoma, endometrioma.
Epidemiology and Etiology
- Incid of ovarian cysts = 5–15%. Lifetime risk 5–10% for adnexal mass Surg
- Diff dx: Leiomyomata,TOA, hydrosalpinx, ectopic Preg, paratubal cysts, diverticular abscess, appendiceal abscess, nerve sheath tumors, ureteral diverticulum, pelvic kidney, bladder diverticulum, peritoneal inclusion cysts,
Clinical Manifestations
- Most are asymptomatic, but may p/w pain, pressure sensation, dyspareunia
- Intermittent pain may indicate ovarian Acute, sev pain may represent ovarian torsion or cyst rupture. Increased abdominal girth, bloating, wt loss, & early satiety raise concern for malig. Hormonal disruption w/ estrogen/androgen secretion.
Physical Exam and Diagnostic Workup
- Pelvic exam: 45% sens & 90% ¯ detection w/ BMI >30
- Labs: hCG, CBC, coags/other labs depending on presentation & Hx
- Abdominal & pelvic US: TVUS sens 82–91% & spec 68–81% for distinguishing benign from malignant Classic US appearance of a simple cyst is anechoic, well circumscribed, echolucent w/ post acoustic enhancement.
- See 21 for w/u for malig, tumor markers, & referral to gyn oncology
Treatment and Medications
- Observation: Most simple ovarian cysts spontaneously regress in 6 adnexal/ ovarian torsion at 6–10 cm mass. 0–1% risk of malig if cyst is unilocular, thin walled, sonolucent, <10 cm in diameter, & has smooth, regular borders.
Premenopausal women w/ cyst <3 cm do not require f/u
Premenopausal women w/ cyst 4–10 cm who desire expectant mgmt ® rpt US for resolution in 12 w (4–12 w depending on concern)
Postmenopausal women w/ cysts 4–10 cm & CA-125 <35 U/mL who desire expectant mgmt ® serial USs every 4–6 w
- Surg: Provides definitive pathologic Indicated for hemodynamic instability, cyst
>6–10 cm, concern for malig, concern for torsion, or persistent sx
Laparoscopy: ¯ operative morbidity, postoperative pain, analgesics, recovery time, & costs
Laparotomy: Usually for malig (w/ appropriate staging), hemodynamic instability, or failed laparoscopy
Cystectomy vs. oophorectomy: Consider the pt’s age, reproductive desires, menopausal status, & preoperative dx. (If a corpus luteum cyst is removed dur- ing Preg at <12 WGA ® progesterone supplementation.)