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Corpus Luteum Cyst

Corpus Luteum Cysts

A corpus luteum cyst develops from a corpus luteum that does not dissolve after ovulation.


Presentation

This clinical presentation of CL cyst is variable. While some patients with ruptured cysts exhibit mild unilateral discomfort, others will experience acute unilateral pelvic pain that is sharp in nature. Furthermore, the pain may occur with sexual intercourse, trauma, or physical activity [4] [5].

A ruptured cyst can result in peritonitis, which is characterized by severe abdominal pain, fever, nausea, and emesis.

Physical exam

Remarkable findings may include peritoneal signs, abdominal distention, and pelvic tenderness.

Renal Artery Stenosis
  • Renal artery stenosis: analysis of Doppler waveform parameters and tardus-parvus pattern. Radiology 1993; 189:779-787. ‎ Seite 379 - Roubidoux MA, Hertzberg BS, Carroll BA, Hedgepeth CA.[books.google.com]
Adnexal Mass
  • A young woman presented with an asymptomatic unilateral adnexal mass at six weeks postpartum. Her abdomen and pelvis had been considered unremarkable upon examination at parturition, at which time no adnexal masses were palpated.[ncbi.nlm.nih.gov]
  • All ectopic pregnancies were diagnosed on the basis of the presence of an extra-ovarian adnexal mass on sonography and were confirmed surgically.[ncbi.nlm.nih.gov]
  • A computed tomography (CT) scan depicts the CL cyst as a well-circumscribed, unilocular adnexal mass. The lesion is usually less than 3 cm and features a thick wall and peripheral vascularization.[symptoma.com]
  • Reliability of adnexal mass mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts .[medical-dictionary.thefreedictionary.com]
  • "ACOG Practice Bulletin No. 83: Management of Adnexal Masses". Obstetrics & Gynecology . 110 (1): 201–214. doi : 10.1097/01.AOG.0000263913.92942.40 . PMID 17601923 . Timmerman, D.; Valentin, L.; Bourne, T. H.; Collins, W.[en.wikipedia.org]

Workup

The workup consists of the patient's presentation, history, physical exam, and the relevant studies. The clinical assessment should rule out differential diagnoses such as ectopic pregnancy, acute appendicitis, etc.

Laboratory test

A serum beta-human chorionic gonadotropin (βhCG) - level must be obtained to determine the pregnancy status and the potential for an ectopic pregnancy [6] [7]. A complete blood count (CBC) is another important test.

Imaging

Pelvic/abdominal ultrasonography is the initial imaging study of choice. This modality demonstrates the presence of free hypoechoic fluid [3] [6]. Color doppler is used to reflect the vascularity of the cyst, which may display the "ring of fire" sign.

A computed tomography (CT) scan depicts the CL cyst as a well-circumscribed, unilocular adnexal mass. The lesion is usually less than 3 cm and features a thick wall and peripheral vascularization [8].

Treatment

Hemodynamically stable patients can be managed conservatively through monitoring of the vital signs and hemoglobin levels, repeat imaging, and pain management [9].

Unstable patients with hypotension, hemoperitoneum, and/or peritoneal signs warrant immediate surgical intervention.

Special consideration

The management of cysts found incidentally on ultrasonography depends on the size and characteristics of the mass. Larger cysts may require follow-up to ensure resolution [8].

Oral contraceptive pills (OCPs) are not used for the treatment of functional ovarian cysts since they have not proven to be effective [10].

Prognosis

While rupture of a CL cyst is rare, it is much more common in women of childbearing age as opposed to young adolescents [1] [2]. Hemoperitoneum is a severe consequence of hemorrhage [3].

Etiology

The CL cyst arises from the failure of the corpus luteum to regress after fertilization [1]. It may also be caused by clomiphene, which is a fertility drug that induces ovulation.

Epidemiology

Ovarian cysts are extremely common as almost all women of reproductive age will exhibit these on transvaginal ultrasound.

Sex distribution
Age distribution

Pathophysiology

Once an ovum is released from the mature follicle during ovulation, the remnants of the latter, known as corpus luteum, will secrete progesterone in anticipation and preparation of a pregnancy. If conception does not occur, the CL should spontaneously involute a few days after ovulation. Failure to dissolve will cause the CL to collect fluid and blood and form into a cyst. The latter has the potential to rupture.

Prevention

OCPs can prevent the formation of functional ovarian cysts.

Summary

A corpus luteum (CL) cyst is one of two types of functional ovarian cysts. The clinical presentation of women with this cyst ranges from no symptoms to severe abdominal and pelvic pain. Complications include cyst rupture, which may have serious consequences. Diagnosis is achieved through evaluation of the clinical manifestations, the physical exam, and the appropriate studies. Management depends on the hemodynamic stability and overall picture. Prompt surgery is warranted in cases with hemoperitoneum.

Patient Information

A corpus luteal (CL) cyst is a type of ovarian cyst. The clinical presentation ranges from no symptoms to severe abdominal and pelvic pain. Diagnosis is achieved through evaluation of the signs and symptoms, physical exam, and studies such as a pregnancy test, ultrasound, etc. The treatment depends on the hemodynamic stability and overall picture. Prompt surgery is warranted in cases with serious hemorrhage.

References

Article

  1. Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, Gratz B. Blood in the belly: CT findings of hemoperitoneum. Radiographics. 2007; 27(1):109-25.
  2. Takeda A, Sakai K, Mitsui T, Nakamura H. Management of ruptured corpus luteum cyst of pregnancy occurring in a 15-year-old girl by laparoscopic surgery with intraoperative autologous blood transfusion. J Pediatr Adolesc Gynecol. 2007;20(2):97-100.
  3. Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008; 28(6):1645-59.
  4. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009, 23(5):711-24.
  5. Lambert MJ, Villa M. Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. 2004; 22(3):683-96.
  6. Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging. 2012; 3(3):265-75.
  7. Kaakaji Y, Nghiem HV, Nodell C, Winter TC. Sonography of obstetric and gynecologic emergencies: Part II, Gynecologic emergencies. A J Roentgen. 2000;174(3):651-6.
  8. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2010;256(3): 943-54.
  9. Kim JH, Lee SM, Lee JH, et al. Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women. PLoS One. 2014; 9(3):e91171.
  10. ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010; 15(1):206-18.

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Last updated: 2018-06-22 05:20