Ovarian cysts

Ovarian cysts are usually fluid-filled sacs developed on the ovaries, and one of the most common findings in women of reproductive (15-45 years) and postmenopausal age groups. The vast majority of ovarian cysts range in size from 2.5 to 10-12 cm in diameter. Rarely may they reach extremely large size, even occupying the whole pelvis and/or abdomen.

Symptoms:
Ovarian cysts are often discovered accidentally on routine ultrasound or abdominal ultrasound imaging performed for other reasons. The usual symptom is pelvic pain (pain in the pelvis) which may be sharp with relatively fast onset, but it may also be mild and localized in the right or left lower abdomen.

Before the specialist proceeds to monitoring or performing surgical treatment of a cyst, the following factors should be taken into account: the age of the patient; the size and “characteristics” of the cyst on the vaginal ultrasound (or MRI); the presence or absence of symptoms such as a significant pain; and the coexistence of risk factors from the patient’s personal or family history. For instance, if a cyst is found in a young woman of reproductive age, then it is more likely to be functional or endometriotic than neoplastic. Neoplastic cysts in female patients are the rarest; if found, the probability of being malignant is 13-15% (compared to 45-50% in postmenopausal women).

TYPES OF OVARIAN CYSTS AND TREATMENT:
There are three types of ovarian cysts in general: 1) functional cysts (almost never cancerous); 2) endometriotic cysts (or endometriomas), in the context of endometriosis - extremely rarely malignant; and 3) neoplastic cysts or tumors (benign or malignant). Occasionally, an acute infection of the fallopian tubes and ovaries may seem as a large and “suspicious” cyst (when in fact it is a tubal-ovarian abscess or hydro/pyosalpinx).

FUNCTIONAL CYSTS:

• The most common type of cysts in women of reproductive age;
• They are of three types: Follicular cysts (also known as simple or serous – both are synonyms); Corpus luteum cysts (often bloody); and Theca Luteal cysts usually found during the first trimester of pregnancy;
• 80% of the cysts are spontaneously absorbed without any treatment (contraceptives are just a myth, not used as treatment since 1998), 10% are persistent and 10% keep growing (surgical treatment is necessary to prevent ovarian (adnexal) torsion);
• Created due to and cause = Hormonal abnormality;
• Rarely exceeding 10 cm in diameter;
• In case of rupture, they may cause severe and sudden pain or internal bleeding, needing immediate surgical treatment (this is rare nowadays).

ENDOMETRIOTIC CYSTS(endometrioma or endometriomas)

• Found in 60% of female patients with endometriosis;
• Only 1% of female patients with endometriosis have the condition localized on the ovary only;
• Cause pain and/or infertility;
• Rarely exceeding 10 cm in diameter;
• The most appropriate medical treatment is surgical removal of the endometriosis cyst by LAPAROSCOPIC TECHNIQUE (and not by open incision surgery. There is no need to analyze the reasons, it is the 21st century after all).

NEOPLASTIC CYSTS:

• Presumably the most dangerous for health;
• Ultrasound imaging and/or MRI occasionally may help diagnose these cysts;
• They often cause symptoms, but more often today they are discovered accidentally;
• The older the woman, the greater the chances to develop malignant neoplastic cysts; but, in general the chance remains quite low (about 1.5% in a woman’s lifetime);
• They may sometimes reach up to 20-40 cm in diameter;
• The discovery of a “suspicious” cyst on ultrasound imaging, CT or MRI should trigger the gynecologist to refer the case to or consult other gynecology specialists, such as Gynecologic Oncology specialists. The vast majority of neoplastic cysts require surgical removal (laparoscopy or open incision surgery depending on the surgeon’s specialty).