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Ovariancyst
FromWikipedia,thefreeencyclopedia

Anovariancystisafluidfilledsacwithintheovary.Oftenthey
causenosymptoms.Occasionallytheymayproducebloating,
lowerabdominalpain,orlowerbackpain.Ifthecysteither
breaksopenorcausestwistingoftheovaryseverepainmay
occur.Thismayresultinvomitingorfeelingfaint.Themajority
ofcystsare,however,harmless.[1]
Mostovariancystsarerelatedtoovulationbeingeitherfollicular
cystsorcorpusluteumcysts.Othertypesincludecystsdueto
endometriosis,dermoidcysts,andcystadenomas.Manysmall
cystsoccurinbothovariesinpolycysticovariansyndrome.
Pelvicinflammatorydiseasemayalsoresultincysts.Rarely
cystsmaybeaformofovariancancer.Diagnosisisundertaken
bypelvicexaminationwithanultrasoundorothertestingusedto
gatherfurtherdetails.[1]
Oftencystsaresimplyobservedovertime.Iftheycausepain,
medicationssuchasparacetamol(acetaminophen)oribuprofen
maybeused.Hormonalbirthcontrolmaybeusedtoprevent
furthercystsinthosewhoarefrequentlyaffected.[1]However,
evidencedoesnotsupportbirthcontrolasatreatmentofcurrent
cysts.[2]Iftheydonotgoawayafterseveralmonths,getlarger,
lookunusual,orcausepaintheymayberemovedbysurgery.[1]
Mostwomenofreproductiveagedevelopsmallcystseach
month.Largecyststhatcauseproblemsoccurinabout8%of
womenbeforemenopause.[1]Ovariancystsarepresentinabout
16%ofwomenaftermenopauseandifpresentaremorelikelyto
becancer.[1][3]

Contents
1 Signsandsymptoms
1.1 Cystrupture
1.2 Ovariantorsion
2 Diagnosis
2.1 Ultrasound
2.2 Scoringsystems
2.3 Functional
2.4 Nonfunctional
2.5 Associatedmedicalconditions
2.6 Riskofcancer
3 Treatment
3.1 Pain
3.2 Surgery
4 Frequency
https://en.wikipedia.org/wiki/Ovarian_cyst

Ovariancyst

Asimpleovariancystofmostlikelyfollicular
origin
Classificationandexternalresources
Specialty

Gynecology

ICD10

N83.0(http://apps.who.int/classificati
ons/icd10/browse/2016/en#/N83.0)
N83.2(http://apps.who.int/classificati
ons/icd10/browse/2016/en#/N83.2)

ICD9CM

620.0(http://www.icd9data.com/getI
CD9Code.ashx?icd9=620.0)620.2(h
ttp://www.icd9data.com/getICD9Cod
e.ashx?icd9=620.2)

DiseasesDB 9433(http://www.diseasesdatabase.co
m/ddb9433.htm)
MedlinePlus 001504(http://www.nlm.nih.gov/me
dlineplus/ency/article/001504.htm)
eMedicine

med/1699(http://www.emedicine.co
m/med/topic1699.htm)emerg/352(ht
tp://www.emedicine.com/emerg/topic
352.htm#)

MeSH

D010048(https://www.nlm.nih.gov/c
gi/mesh/2016/MB_cgi?field=uid&ter
m=D010048)

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4 Frequency
5 References
6 Externallinks

Signsandsymptoms
Someorallofthefollowingsymptomsmaybepresent,thoughitispossiblenottoexperienceanysymptoms:[4]
Abdominalpain.Dullachingpainwithintheabdomenorpelvis,especiallyduringintercourse.
Uterinebleeding.Painduringorshortlyafterbeginningorendofmenstrualperiodirregularperiods,or
abnormaluterinebleedingorspotting.
Fullness,heaviness,pressure,swelling,orbloatingintheabdomen.
Whenacystrupturesfromtheovary,theremaybesuddenandsharppaininthelowerabdomenononeside.
Changeinfrequencyoreaseofurination(suchasinabilitytofullyemptythebladder),ordifficultywith
bowelmovementsduetopressureonadjacentpelvicanatomy.
Constitutionalsymptomssuchasfatigue,headaches
Nauseaorvomiting
Weightgain
Othersymptomsmaydependonthecauseofthecysts:[4]
Symptomsthatmayoccurifthecauseofthecystsispolycysticovariansyndrome(PCOS)mayinclude
increasedfacialhairorbodyhair,acne,obesityandinfertility.
Ifthecauseisendometriosis,thenperiodsmaybeheavy,andintercoursepainful.
TheeffectofcystsnotrelatedtoPCOSonfertilityisunclear.[5]

Cystrupture
Arupturedovariancystisusuallyselflimiting,andonlyrequireskeepinganeyeonthesituationandpain
medications.Themainsymptomisabdominalpain,buttheycanalsobeasymptomatic.Thepainmaylastfroma
fewdaystoseveralweeks.[6]Ruptureoflargeovariancystscancausebleedinginsidetheabdominalcavityandin
somecasesshock.

Ovariantorsion
Ovariancystsincreasetheriskforovariantorsion,cystslargerthan4cmareassociatedwithapproximately17%
risk.Thetorsioncancauseobstructionofbloodflowandleadtoinfarction.[7]

Diagnosis
Ovariancystsareusuallydiagnosedbyeitherultrasound,CTscanorMRI,andcorrelatedwithclinical
presentationandendocrinologictestsasappropriate.

Ultrasound
Followupimaginginwomenofreproductiveageforincidentallydiscoveredsimplecystsonultrasoundisnot
neededuntil5cm,astheseareusuallynormalovarianfollicles.Forsimplecystsgreaterthan5cmbutlessthan
7cminpremenopausalfemales,cystsshouldbefollowedyearly.Forsimplecystsgreaterthan7cm,further
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imagingwithMRIorsurgicalassessmentismandatedas,becauseoftheir
largesize,thesecystscannotbereliablyassessedbyultrasoundalone.The
primaryconcernforlargercystsisthepotentialfornonvisualizationofsoft
tissuenodularityorthickenedseptationattheirposteriorwallduetolimited
penetranceoftheultrasoundbeam.Forthecorpusluteum,adominant
ovulatingfolliclethattypicallyappearsasacystwithcircumferentially
thickenedwallsandcrenulatedinnermargins,followupisnotneededifthe
cystislessthan3cmindiameter.Inpostmenopausalpatients,anysimple
cystgreaterthan1cmbutlessthan7cmneedsyearlyfollowup,while
thosegreaterthan7cmneedMRIorsurgicalevaluation,similarto
reproductiveagefemales.[8]

A2cmleftovariancystasseenon
ultrasound

Forincidentallydiscovereddermoids,diagnosedonultrasoundbytheir
pathognomonicechogenicfat,eithersurgicalremovaloryearlyfollowupis
indicated,regardlessofpatientage.Forperitonealinclusioncysts,which
haveacrumpledtissuepaperappearanceandtendtofollowthecontourof
adjacentorgans,followupisbasedonclinicalhistory.Hydrosalpinx,or
fallopiantubedilation,canbemistakenforanovariancystduetoits
anechoicappearance.Followupforthisisalsobasedonclinical
presentation.[8]
Formultiloculatecystswiththinseptationlessthan3mm,surgical
evaluationisrecommended.Thepresenceofmultiloculationsuggestsa
neoplasm,althoughthethinseptationimpliesthattheneoplasmisbenign.
Foranythickenedseptation,nodularity,orvascularflowoncolordoppler
assessment,surgicalremovalshouldbeconsideredduetoconcernfor
malignancy.[8]

AnAxialCTdemonstratingalarge
hemorrhagicovariancyst.Thecystis
delineatedbytheyellowbarswith
bloodseenanteriorly.

Scoringsystems
Thereareseveralsystemstoassessriskofanovariancystofbeinganovariancancer,includingtheRMI(riskof
malignancyindex),LR2andSR(simplerules).Sensitivitiesandspecificitiesofthesesystemsaregivenintables
below:[9]
Scoringsystems

Premenopausal

Postmenopausal

Sensitivity Specificity Sensitivity Specificity

RMII

44%

95%

79%

90%

LR2

85%

91%

94%

70%

SR

93%

83%

93%

76%

Ovariancystsmaybeclassifiedaccordingtowhethertheyareavariantofthenormalmenstrualcycle,referredto
asafunctionalorfollicularcyst.[4]
Ovariancystsareconsideredlargewhentheyareover5cmandgiantwhentheyareover15cm.Inchildren
ovariancystsreachingabovetheleveloftheumbilicusareconsideredgiant.

Functional
Functionalcystsformasanormalpartofthemenstrualcycle.Thereareseveraltypesofcysts:
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Follicularcyst,themostcommontypeofovariancyst.Inmenstruatingwomen,afolliclecontainingthe
ovum(unfertilizedegg)willruptureduringovulation.Ifthisdoesnotoccur,afollicularcystofmorethan
2.5cmdiametermayresult.[4]
Corpusluteumcystsappearafterovulation.Thecorpusluteumistheremnantofthefollicleaftertheovum
hasmovedtothefallopiantubes.Thisnormallydegradeswithin59days.Acorpusluteumthatismorethan
3cmisdefinedascystic.[4]
Thecaluteincystsoccurwithinthethecallayerofcellssurroundingdevelopingoocytes.Undertheinfluence
ofexcessivehCG,thecalcellsmayproliferateandbecomecystic.Thisisusuallyonbothovaries.[4]

Nonfunctional
Nonfunctionalcystsmayincludethefollowing:
Anovarywithmanycysts,whichmaybefoundinnormalwomen,or
withinthesettingofpolycysticovarysyndrome.
Cystscausedbyendometriosis,knownaschocolatecysts.
Hemorrhagicovariancyst
Dermoidcyst
Ovarianserouscystadenoma
Ovarianmucinouscystadenoma
Paraovariancyst
Cysticadenofibroma
Borderlinetumoralcysts

Associatedmedicalconditions
Injuvenilehypothyroidismmulticysticovariesarepresentinabout75%of
cases,whilelargeovariancystsandelevatedovariantumormarksareone
ofthesymptomsoftheVanWykandGrumbachsyndrome.[10]

Transvaginalultrasonographyofa
hemorrhagicovariancyst,probably
originatingfromacorpusluteum
cyst.Thecoagulatingbloodgivesthe
contentacobweblikeappearance.

TheCA125markerinchildrenandadolescentscanbefrequentlyelevated
eveninabsenceofmalignancyandconservativemanagementshouldbe
considered.
Polycysticovariansyndromeinvolvesthedevelopmentofmultiplesmall
cystsinbothovariesduetoanelevatedratioofleutenizinghormoneto
folliclestimulatinghormone,typicallymorethan25cystsineachovary,or
anovarianvolumeofgreaterthan10mL.[11]

Transvaginalultrasonography
showinga67x40mm
endometrioma,withasomewhat
grainycontent.

Largerbilateralcystscandevelopasaresultoffertilitytreatmentdueto
elevatedlevelsofHCG,ascanbeseenwiththeuseofclomifenefor
follicularinduction,inextremecasesresultinginaconditionknownas
ovarianhyperstimulationsyndrome.[12]Certainmalignanciescanmimicthe
effectsofclomifeneontheovaries,alsoduetoincreasedHCG,inparticulargestationaltrophoblasticdisease.
Ovarianhyperstimulationoccursmoreoftenwithinvasivemolesandchoriocarcinomathancompletemolar
pregnancies.[13]

Riskofcancer

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Awidelyrecognisedmethodofestimatingtheriskofmalignantovariancancerbasedoninitialworkupistherisk
ofmalignancyindex(RMI).[14]ItisrecommendedthatwomenwithanRMIscoreover200shouldbereferredtoa
centrewithexperienceinovariancancersurgery.[15]
TheRMIiscalculatedasfollows:[15]
RMI=ultrasoundscorexmenopausalscorexCA125levelinU/ml.
Therearetwomethodstodeterminetheultrasoundscoreandmenopausalscore,withtheresultantRMIbeing
calledRMI1andRMI2,respectively,dependingonwhatmethodisused:[15]
Feature

RMI1

RMI2

Ultrasoundabnormalities:
multilocularcyst
solidareas
bilaterallesions
ascites
intraabdominalmetastases
Menopausalscore
CA125

0=noabnormality
1=oneabnormality
3=twoormoreabnormalities

0=none
1=oneabnormality
4=twoormore
abnormalities

1=premenopausal
3=postmenopausal

1=premenopausal
4=postmenopausal

QuantityinU/ml

QuantityinU/ml

AnRMI2ofover200hasbeenestimatedtohaveasensitivityof74to80%,aspecificityof89to92%anda
positivepredictivevalueofaround80%ofovariancancer.[15]RMI2isregardedasmoresensitivethanRMI1.[15]

Treatment
Cystsassociatedwithhypothyroidismorotherendocrineproblemsaremanagedbytreatingtheunderlying
condition.
About95%ofovariancystsarebenign,notcancerous.[16]
Functionalcystsandhemorrhagicovariancystsusuallyresolvespontaneously.[17]Howeverthebiggeranovarian
cystis,thelesslikelyitistodisappearonitsown.[18]Treatmentmayberequiredifcystspersistoverseveral
months,groworcauseincreasingpain.[19]
Cyststhatpersistbeyondtwoorthreemenstrualcycles,oroccurinpostmenopausalwomen,mayindicatemore
seriousdiseaseandshouldbeinvestigatedthroughultrasonographyandlaparoscopy,especiallyincaseswhere
familymembershavehadovariancancer.Suchcystsmayrequiresurgicalbiopsy.Additionally,abloodtestmay
betakenbeforesurgerytocheckforelevatedCA125,atumourmarker,whichisoftenfoundinincreasedlevelsin
ovariancancer,althoughitcanalsobeelevatedbyotherconditionsresultinginalargenumberoffalse
positives.[20]

Pain
Painassociatedwithovariancystsmaybetreatedinseveralways:
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Painrelieverssuchasacetaminophen,nonsteroidalantiinflammatorydrugs,[1]oropioids.
Whilehormonalbirthcontrolpreventsthedevelopmentofnewcystsinthosewhofrequentlygetthem,[1]it
isnotusefulforthetreatmentofcurrentcysts.[2]

Surgery
Althoughmostcasesofovariancystsinvolvemonitoring,somecasesrequiresurgery.[21]Thismayinvolve
removingthecyst,oroneorbothovaries.[22]Techniqueistypicallylaparoscopic,unlessthecystisparticularly
large,orifpreoperativeimagingsuggestsmalignancyorcomplexanatomy.[23]Incertainsituations,thecystis
entirelyremoved,whilewithcystswithlowrecurrencerisk,youngerpatients,orwhichareinanatomically
eloquentareasofthepelvis,theycanbedrained.[24][25]Featuresthatmayindicatetheneedforsurgeryinclude:[26]
Persistentcomplexovariancysts
Persistentcyststhatarecausingsymptoms
Complexovariancystslargerthan5cm
Simpleovariancystslarger10centimetersorlargerthan5cminpostmenopausalpatients
Womenwhoaremenopausalorperimenopausal

Frequency
Mostwomenofreproductiveagedevelopsmallcystseachmonth.Largecyststhatcauseproblemsoccurinabout
8%ofwomenbeforemenopause.[1]Ovariancystsarepresentinabout16%ofwomenaftermenopauseandif
presentaremorelikelytobecancer.[1][3]
Benignovariancystsarecommoninasymptomaticpremenarchalgirlsandfoundinapproximately68%ofovaries
ofgirls212yearsoldandin84%ofovariesofgirls02yearsold.Mostofthemaresmallerthan9mmwhile
about1020%arelargermacrocysts.Whilethesmallercystsmostlydisappearwithin6monthsthelargerones
appeartobemorepersistent.[27][28]

References
1."Ovariancysts".OfficeonWomen'sHealth.November19,2014.Retrieved27June2015.
2.Grimes,DAJones,LBLopez,LMSchulz,KF(29April2014)."Oralcontraceptivesforfunctionalovariancysts.".
TheCochranedatabaseofsystematicreviews.4:CD006134.doi:10.1002/14651858.CD006134.pub5.PMID24782304.
3.Mimoun,CFritel,XFauconnier,ADeffieux,XDumont,AHuchon,C(December2013)."[Epidemiologyof
presumedbenignovariantumors].".Journaldegynecologie,obstetriqueetbiologiedelareproduction.42(8):7229.
doi:10.1016/j.jgyn.2013.09.027.PMID24210235.
4.Helm,William."OvarianCysts".Retrieved30August2013.
5.Legendre,GCatala,LMorinire,CLacoeuille,CBoussion,FSentilhes,LDescamps,P(March2014).
"Relationshipbetweenovariancystsandinfertility:whatsurgeryandwhen?".FertilityandSterility.101(3):60814.
doi:10.1016/j.fertnstert.2014.01.021.PMID24559614.
6.OvarianCystRupture(http://emedicine.medscape.com/article/253620overview#showall)atMedscape.Authors:Nathan
WebbandDavidChelmow.Updated:Nov30,2012
7."OvarianCystsCauses,Symptoms,Diagnosis,andTreatment".eMedicineHealth.com.
8.Levine,DBrown,DLAndreotti,RFBenacerraf,BBenson,CBBrewster,WRColeman,BDepriest,PDoubilet,
PMGoldstein,SRHamper,UMHecht,JLHorrow,MHur,HCMarnach,MPatel,MDPlatt,LDPuscheck,E
SmithBindman,R(September2010)."ManagementofasymptomaticovarianandotheradnexalcystsimagedatUS:
SocietyofRadiologistsinUltrasoundConsensusConferenceStatement.".Radiology.256(3):94354.
doi:10.1148/radiol.10100213.PMID20505067.

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9.KaijserJ,SayasnehA,VanHoordeK,GhaemMaghamiS,BourneT,TimmermanD,VanCalsterB(2013)."Presurgical
diagnosisofadnexaltumoursusingmathematicalmodelsandscoringsystems:asystematicreviewandmetaanalysis".
HumanReproductionUpdate.20(3):449462.doi:10.1093/humupd/dmt059.ISSN13554786.PMID24327552.
10.DurbinKL,DiazMontesT,LovelessMB(2011)."Vanwykandgrumbachsyndrome:Anunusualcaseandreviewofthe
literature".Journalofpediatricandadolescentgynecology.24(4):e936.doi:10.1016/j.jpag.2010.08.003.
PMID21600802.
11.Dewailly,DLujan,MECarmina,ECedars,MILaven,JNorman,RJEscobarMorreale,HF(May2014).
"Definitionandsignificanceofpolycysticovarianmorphology:ataskforcereportfromtheAndrogenExcessand
PolycysticOvarySyndromeSociety.".HumanReproductionUpdate.20(3):33452.doi:10.1093/humupd/dmt061.
PMID24345633.
12.Altinkaya,SOTalas,BBGungor,TGulerman,C(October2009)."Treatmentofclomiphenecitraterelatedovarian
cystsinaprospectiverandomizedstudy.Asinglecenterexperience.".Thejournalofobstetricsandgynaecology
research.35(5):9405.doi:10.1111/j.14470756.2009.01041.x.PMID20149045.
13.Suzuki,HMatsubara,SUchida,SOhkuchi,A(October2014)."Ovaryhyperstimulationsyndromeaccompanying
molarpregnancy:casereportandreviewoftheliterature.".Archivesofgynecologyandobstetrics.290(4):8036.
doi:10.1007/s0040401433190.PMID24966119.
14.NICEclinicalguidelinesIssued:April2011.GuidelineCG122.Ovariancancer:Therecognitionandinitialmanagement
ofovariancancer(http://publications.nice.org.uk/ovariancancercg122/appendixdriskofmalignancyindexrmii),
AppendixD:Riskofmalignancyindex(RMII).
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ml)fromTheScottishIntercollegiateGuidelinesNetwork.GuidelineNo75.October2003.ISBN1899893938
16.http://www.nhs.uk/Conditions/Ovariancyst/Pages/Symptoms.aspx
17.V.T.(14May2014).UnderstandingOvarianCyst.V.T.pp.25.GGKEY:JTX84XQARW9.
18.EdwardI.Bluth(2000).Ultrasound:APracticalApproachtoClinicalProblems.Thieme.p.190.ISBN978086577
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LippincottWilliams&Wilkins.p.161.ISBN9780781742542.
20.MedlinePlusEncyclopediaCA125(http://www.nlm.nih.gov/medlineplus/ency/article/007217.htm)
21.Tamparo,CarolLewis,Marcia(2011).DiseasesoftheHumanBody.Philadelphia,PA:LibraryofCongress.p.475.
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22."HealthHints:GynecologicHealth(January/February,2003)".TexasAgriLifeExtensionService:HealthHints.
23.Surgit,OInegolGumus,I(2014)."SingleportLaparoscopicTotalHysterectomyandBilateralSalpingooopherectomy
CombinedwithBurchColposuspension.".ActachirurgicaBelgica.114(4):0.PMID26021429.
24.Cho,MJKim,DYKim,SC(October2015)."OvarianCystAspirationintheNeonate:MinimallyInvasiveSurgery.".
Journalofpediatricandadolescentgynecology.28(5):34853.doi:10.1016/j.jpag.2014.10.003.PMID26148782.
25.Nohuz,E(11December2015)."[HowIdo...theaspirationofanadnexalcystwithoutiterativeneedlepuncturesneither
irrigationaspirationdeviceduringalaparoscopy].".Gynecologie,obstetrique&fertilite.44:636.
doi:10.1016/j.gyobfe.2015.11.001.PMID26701109.
26.Ovariancysts(http://www.nlm.nih.gov/medlineplus/ency/article/001504.htm)fromMedlinePlus.UpdateDate:2/26/2012.
Updatedby:LindaJ.VorvickandSusanStorck.AlsoreviewedbyDavidZieve
27.CohenHL,EisenbergP,MandelF,HallerJO(1992)."Ovariancystsarecommoninpremenarchalgirls:Asonographic
studyof101children212yearsold".AJR.Americanjournalofroentgenology.159(1):8991.
doi:10.2214/ajr.159.1.1609728.PMID1609728.
28.QublanHS,AbdelhadiJ(2000)."Simpleovariancysts:Frequencyandoutcomeingirlsaged29years".Clinicaland
experimentalobstetrics&gynecology.27(1):513.PMID10758801.

Externallinks
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Ovarian_cyst&oldid=734237073"
Categories: Noninflammatorydisordersoffemalegenitaltract Cysts
Thispagewaslastmodifiedon12August2016,at23:40.
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