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OVARIAN

CYSTS
Fahad
zakwan

Introduction
Ovarian enlargements can be
cystic or solid but in most
cases ovarian enlargement are
cystic.
Non-neoplastic
Neoplastic (Ovarian Tumors)

Non-neoplastic cysts of the ovary


An ovarian cyst is a sac filled with liquid or
semi-liquid material arising in an ovary.
The number of diagnoses of ovarian cysts has
increased with the widespread
implementation of regular physical
examinations and ultrasound technology.
The finding of an ovarian cyst causes
considerable anxiety for women because of
the fear of malignancy, but the vast majority
of ovarian cysts are benign.

TYPES OF OVARIAN CYSTS.


1. POLYSTIC OVARIAN SYNDROME
(PCOS)
2. ENDOMETRIOMATOUS CYSTS
3. FUNCTIONAL CYSTS (commonest)
Follicular cysts
Theca lutein cysts
Corpus luteum cysts.

FUNCTIONAL CYSTS
Ovarian cysts arising in the normal
process of ovulation
They may be follicular ,theca-lutein or
corpus luteum cysts.
These cysts can be stimulated by
gonadotropins, including folliclestimulating hormone (FSH) and human
chorionic gonadotropin (hCG).

Multiple functional cysts can occur as a


result of excessive gonadotropin
stimulation or sensitivity
This stimulation may occurs in cases of
GTDs (hydatiform mole and choriocarcinoma)
multiple pregnancy.
In patients being treated for infertility, ovulation
induction with gonadotropins (FSH and luteinizing
hormone [LH]), and clomiphene citrate, may lead to
ovarian hyperstimulation syndrome, especially
if accompanied by hCG administration

ENDOMETRIOMATOUS CYSTS OF THE


OVARY

Cysts filled with blood arising from


the ectopic endometrium.
They usually enlarge pre and during
menses and slightly shrink there
after.
The ovary is the commonest site of
pelvic endometriosis.

POLYCYSTIC OVARIAN SYNDROME (PCOS)

Risk factors of ovarian cysts


1.
2.
3.
4.
5.
6.
7.

Hypothyroidism
Infertility or women who are on treatment for infertility
Those taking tamoxifen, a drug to combat breast cancer
Irregular periods
Early periods (before 11 years)
Previous history of ovarian cysts.
A drug called clomiphene may lead to formation of
corpus luteum cyst.

Rotterdam criteria for diagnosis of PCOS


1. Menstrual irregularities. Most patients
with PCOS have menstrual irregularities
that begin during adolescence.
Oligomenorrhea: less than nine menses per
year
Amenorrhea: no menses for 6 months or
three or more skipped cycles
Difficulty in conceiving is present in many
women with PCOS

2. Hyperandrogenism. Patients may


either show signs of clinical
hyperandrogenism or have biochemical
hyperandrogenism:
Clinical hyperandrogenism: e.g
hirsutism, acne, or male pattern hair loss.
Biochemical hyperandrogenism: Up to
90% of women with PCOS have elevated
serum androgen concentration. However,
the androgen levels may be normal.

3. Polycystic ovaries. A diagnosis of


polycystic-appearing ovaries can be
made using pelvic ultrasound.
PCOS by ultrasound criteria is defined as
12 or more antral follicles between 2 and
9 mm in size and peripheral in location in
at least one ovary
Transvaginal ultrasound is more sensitive,
but may not be appropriate to perform in
a young female.

History: Clinical presentation


of ovarian cysts
The majority of ovarian cysts are asymptomatic.
Pain or discomfort may occur in the lower abdomen.
Torsion (twisting) or rupture may lead to more
severe pain.
Patients may experience discomfort with
intercourse, particularly deep penetration.
Having bowel movements may be difficult, or
pressure may develop, leading to a desire to
defecate.

Micturition may occur frequently and is due


to pressure on the bladder.
Patients may experience abdominal fullness
and bloating.
Endometriomas are associated with
endometriosis, which causes a classic triad of
painful and heavy periods and dyspareunia.
Patients with polycystic ovary syndrome
presents hirsutism, infertility,
oligomenorrhea, obesity, and acne.
Note that infertility is not a rule.

Physical findings
A large cyst may be palpable during the
abdominal examination
Sometimes, discerning the cystic nature
of an ovarian cyst may be possible, and
it may be tender to palpation.
If a cyst is huge ,The cervix and uterus
may be pushed to one side.

Laboratory Studies:
No laboratory tests are diagnostic for
ovarian cysts except for PCOS for which
hormone assays are done:
FSH
LH
Testosterone
Oestradiol

Imaging Studies:
Ultrasonography
Doppler flow studies
MRI
CT scan

Medical Care:
Many patients with
simple ovarian cysts
based on
ultrasonography findings
do not require treatment.

Surgical Care:
Persistent simple ovarian
cysts larger than 5-10 cm and
complex ovarian cysts should
be removed surgically.
Laparotomy
Laparascopically

The following diagnostic tests may also be


ordered:
Ultrasound scan - this will be carried out to help
the doctor make a diagnosis. A wand-like scanner
probe (transducer) is placed on the abdomen, over
where the ovaries are.
Sometimes the probe may be placed inside the
vagina. In both cases, the doctor is observing the
ovaries on a video screen. This test can help the
doctor determine whether there is a cyst, and
whether it is solid, filled with fluid (or both).

Blood test - if there is a tumor present blood


levels of CA125 (a protein) will be elevated.
High CA125 levels could also mean the patient
has ovarian cancer. If a woman develops an
ovarian cyst that is partially solid she may have
ovarian cancer.
High CA125 levels may also be present in other
conditions, including endometriosis, uterine
fibroids or pelvic inflammatory disease.

Laparoscopy - a thin, lighted


instrument (laparoscope) is
inserted into the patient's
abdomen through a small incision
(skin cut). If the doctor spots an
ovarian cyst he/she may also
remove it there and then.

Pregnancy test - a
positive result may
suggest the patient
has a corpus luteum
cyst

Complications of ovarian cysts

Torsion
Rupture
Hemorrhage
?Malignant change :remains
unproven

Prognosis:
The prognosis
for benign cysts
is excellent