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Ovarian Cyst

Cysts Ovarian

Ovarian cysts are basically fluid filled sacs that develop on or inside the ovary.


Presentation

Ovarian cysts seldom present with any signs and symptoms as these get corrected on their own. However, when cysts fail to resolve and enlarge in size interfering with the blood supply to the organ then it presents with the following signs and symptoms:

In addition to the above mentioned symptoms, ovarian cysts may also give rise to the following symptoms indicating medical emergency [7]:

Abdominal Pain
  • A 69-year-old Japanese woman presented to her practitioner complaining of dull lower abdominal pain. She was referred to us for presumed uterine tumor.[ncbi.nlm.nih.gov]
  • We report a case of a patient with acute abdominal pain. The patient showed a voluminous mass situated in the abdomen and noncontiguous to the uterus by ultrasound scan.[ncbi.nlm.nih.gov]
  • Spontaneous splenic rupture is always neglected when consulting acute abdominal pains in gynecological emergencies. It constitutes about 1% of all splenic ruptures and can be managed by abstention, surgery or embolization.[ncbi.nlm.nih.gov]
  • Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage.[ncbi.nlm.nih.gov]
  • This report describes a case of a presacral mass found on CT of a 37-year-old woman who initially presented with worsening abdominal pain and a history of ovarian cyst rupture.[ncbi.nlm.nih.gov]
Lower Abdominal Pain
  • Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage.[ncbi.nlm.nih.gov]
  • A woman of 46-year-old was admitted with the history of lower abdominal pain, bleeding per vaginum and irregular menstrual cycles for last 6 months. An irregular non-tender mass of 16 x 10cm in size was palpable in suprapubic region.[ncbi.nlm.nih.gov]
  • Majority of the ovarian cysts are asymptomatic or present with vague lower abdominal pain, whereas the presentation of a large ovarian cyst as an inguinolabial swelling as in our patient is extremely rare.[ncbi.nlm.nih.gov]
  • A 69-year-old Japanese woman presented to her practitioner complaining of dull lower abdominal pain. She was referred to us for presumed uterine tumor.[ncbi.nlm.nih.gov]
  • However, if a larger cyst ruptures, twists, or if there is bleeding into the middle of the cyst, then one-sided lower abdominal pain is common. If the cyst is large then it may cause pressure on the bladder or bowel.[netdoctor.co.uk]
Abdominal Fullness
  • A 32-year old G3P1102 at 29.2 weeks gestation presented with left lower quadrant pressure, right abdominal fullness, and left uterine displacement.[ncbi.nlm.nih.gov]
  • Ovarian cysts and masses should be suspected in the cases of: Precocious Puberty Dull, aching pelvic pain or "heaviness" Abdominal fullness or bloating Adenexal Mass Unexplained constipation Differential Diagnosis Torsion Pregnancy Ectopic Pregnancy!![pedclerk.bsd.uchicago.edu]
  • Ovarian Cyst Symptoms and Signs Cysts can arise through a variety of processes in the body, including: Pain during intercourse Nausea Vomiting Unusual bleeding Abdominal fullness Breast pain Aching in the pelvic region What are the signs and symptoms[medicinenet.com]
  • Alert your doctor to symptoms that may indicate a problem, such as: changes in your menstrual cycle ongoing pelvic pain loss of appetite unexplained weight loss abdominal fullness The outlook for premenopausal women with ovarian cysts is good.[healthline.com]
  • When symptoms do occur, they may include the following: Pain during intercourse or menstruation Abdominal fullness Nausea Vomiting Unusual bleeding Weight gain Inability to empty the bladder completely Breast pain Aching in the pelvic region, lower back[onhealth.com]
Pelvic Mass
  • Patients may present with sudden-onset pelvic pain, pelvic mass, or they may be asymptomatic and the HOC is an incidental finding 4 .[radiopaedia.org]
  • Roswell Park’s team of board-certified gynecologic oncologists who specialize in cancers of the female reproductive system are committed to evaluating and treating women with pelvic masses that may be at risk for ovarian cancer.[roswellpark.org]
  • Pelvic masses diagnosed in menopause can indicate more dangerous pathology, as cancerous (malignant) cystic ovarian masses are more common in the menopausal years.[trmbaby.com]
  • […] menstruation Abdominal swelling or unusual increased abdominal girth Abdominal pain in patient's taking blood thinners such as warfarin (Coumadin) Increased facial hair Excessive thirst or urination Unexplained weight loss A noticeable abdominal or pelvic[emedicinehealth.com]
Abdominal Mass
  • We present the case of a term female infant born to a mother of 28 years of age and found to have a cystic abdominal mass through prenatal sonographic evaluation in the third trimester.[ncbi.nlm.nih.gov]
  • A large abdominal mass was visible and palpable in the periumbilical and epigastric regions. Results of physical examination revealed that the general health status was satisfactory.[ncbi.nlm.nih.gov]
  • Ovarian and genital tract abnormalities constitute approximately 20% of all abdominal masses in the neonate. These cysts vary in size; they can be simple or complex, and are commonly unilateral.[nature.com]
  • It is estimated that 5% of all abdominal masses in the first month of life are ovarian cysts.[clevelandclinicmeded.com]
Foot Drop
  • A review of the literature shows that this is a rare case where a histologically confirmed benign ovarian cystadenoma (of indeterminate type) is shown to cause foot drop and radiculopathy.[ncbi.nlm.nih.gov]
Radiculopathy
  • We describe the unique case of a 58-year-old woman who presented with right leg radiculopathy caused by an ovarian cyst mimicking lumbar pathology.[ncbi.nlm.nih.gov]
Pelvic Pain
  • Acute pelvic pain in women is a common diagnostic dilemma encountered by the gynecologist. We describe a case of acute pelvic pain with an unusual etiology. A 40-year-old multipara presented within hours of the onset of acute pelvic pain.[ncbi.nlm.nih.gov]
  • At 14 years of age, she received salpingo-oophorectomy because of ovarian cyst torsion presenting as acute pelvic pain.[ncbi.nlm.nih.gov]
  • A ruptured cyst will have noticeable symptoms including: An irregular menstrual cycle Pelvic pain that may feel like an ache Pelvic pain before your period begins or before your period ends Pelvic pain during sexual intercourse Pain during bowel movements[longstreetclinic.com]
  • The symptoms of ovarian cysts may include: Irregular menstrual cycles Pelvic pain, which can be constant or come and go, that may radiate to your lower back and thighs Pelvic pain shortly before your period begins or just before it ends Pelvic pain during[floridawomenscenteraltamonte.com]
Adnexal Mass
  • Careful evaluation and consultation must be the mainstay of surgery for adnexal masses. A patient initially diagnosed as having an adnexal mass was discovered to have an anterior meningocele at surgery.[ncbi.nlm.nih.gov]
  • A 47-year-old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen.[ncbi.nlm.nih.gov]
  • Here we report a case of nongravid uterus torsion with a large adnexal mass. A 73-year-old woman presented at the emergency room with acute abdominal pain. A preoperative diagnosis of torsion of an ovarian cyst was made and laparotomy was performed.[ncbi.nlm.nih.gov]
  • Persistent adnexal masses increase the risk of pregnancy complications including cyst rupture, ovarian torsion, and labor obstruction. Treatment options include observation, surgical excision, and early first or second trimester drainage.[ncbi.nlm.nih.gov]
  • Definition Ovarian cysts, also known as ovarian masses or adnexal masses, are frequently found incidentally in asymptomatic women.[clevelandclinicmeded.com]
Dyspareunia
  • Problems associated with endometriosis include dysmenorrhoea, dyspareunia and infertility.[ncbi.nlm.nih.gov]
  • […] movements Pelvic pain before or during menstrual cycle – may be persistent or intermittent- may range from a dull, heavy sensation to a sudden, severe and sharp pain; may start and stop; may occur after any strenuous activity Painful intercourse /sex – dyspareunia[beatsofhealth.com]
  • […] ovarian cysts might experience any of the following symptoms: Menstrual irregularities or abnormal bleeding Dull ache in your lower back or thighs Pelvic pain shortly before or after the beginning of your menstrual cycle Pelvic pain with intercourse (dyspareunia[innovativegyn.com]
  • […] pelvis, sometimes radiating to the low back, is the most common symptom Feeling of bloating or indigestion Increased abdominal girth Feeling an urge to have a bowel movement or having difficult, painful bowel movements Pain during sexual intercourse (dyspareunia[medicinenet.com]
  • Endometriomas are associated with endometriosis, which can cause dysmenorrhea and dyspareunia. Polycystic ovarian syndrome In polycystic ovarian syndrome, the ovary often contains multiple cystic follicles 2-5 mm in diameter as viewed on sonograms.[emedicine.medscape.com]
Dysmenorrhea
  • Menstrual irregularities including absence of menstrual bleeding (amenorrhea), heavy bleeding (menorrhagia), and painful periods (dysmenorrhea).[hopkinsmedicine.org]
  • Morbidity also includes menorrhagia, an increased intermenstrual interval, dysmenorrhea , pelvic discomfort, and abdominal distention. Benign cysts rarely cause death.[emedicine.medscape.com]
Ovarian Pain
  • Wild Yam is also an excellent remedy for reducing ovarian pain. Yarrow aerial parts (Achillea millefolium) : Yarrow relieves pelvic congestion through improved circulation to the reproductive organs.[natural-fertility-info.com]
  • However, patients with suspected cancers, with family or personal history of breast or ovarian cancer, or with prior histories of ovarian pain or scarring may need complete removal of the ovary at the time of surgery.[innovativegyn.com]

Workup

Usually a routine pelvic examination is sometimes enough to detect an ovarian cyst. If the examination does not reveal normal findings then further confirmatory tests may be advised. These include the following:

  • Ultrasound tests that shows presence of cysts in the ovaries. This test also helps in determining the size, location and nature of the cysts.
  • Pregnancy test if turns out to be positive suggests that the cysts is of corpus luteum type [8].
  • Blood test to determine the levels of antigen 125 is carried out. If the level of this particular antigen is found to be elevated then it indicates that cyst can be cancerous in nature. In such cases, further tests to confirm the condition need to be carried out.
Pericardial Effusion
  • However detailed fetal echocardiography revealed functional abnormalities such as: monophasic inflow pattern of tricuspid valve, holosystolic tricuspid regurgitation and pericardial effusion.[ncbi.nlm.nih.gov]

Treatment

In many cases, the cysts get corrected by themselves requiring no treatment. In conditions, when the cysts enlarge in size and cause discomfort to the patients the following treatment regime is suggested:

  • Medications such as birth control pills are suggested to stop the ovulation in order to prevent the recurrence of the cysts [9].
  • Laparoscopy is a surgical procedure to remove the cysts from the ovaries. Such a kind of method is employed when the cyst is smaller in size.
  • Laparatomy is the treatment of choice when the cyst is larger in size. 

Prognosis

Women who develop ovarian cysts while they are still having periods usually require little or no treatment. However, post menopausal women who develop cysts are more likely to develop ovarian cancer. When the cysts are of simple type then the chances of developing cancer is low [5].

Ovarian cysts normally resolve on their own seldom requiring any treatment. However, in cases, when the cysts are diagnosed as been cancerous in nature, it could lead to the following complications:

  • Ovarian torsion: It is a rare complication of ovarian cysts, wherein a large cyst that develops on the ovary causes it to twist and shift from its original position. In the condition of ovarian torsion, the blood supply to the ovaries is interrupted causing death of the ovarian tissue. It has been estimated that about 3% of women with ovarian cysts develop ovarian torsion [6].
  • Ruptured cysts: This is also a rare accompaniment of ovarian cysts, but can turn life threatening if the condition is not treated on time. Cysts can rupture causing intense pain and internal bleeding.

Etiology

The most common type of cysts known as functional cysts develop as a result of regular menstrual cycle. Functional cysts are further divided into 2 types: Follicular and luteum cysts. Follicular cysts occur during menstrual cycle when the follicles fail to break open and release an egg. Such a phenomenon causes the fluid to get accumulated inside the follicle giving rise to development of follicular cysts [2]. 

Luteum cysts develop after the follicle has released the egg during the monthly ovulation cycle. Such type of cysts contains some amount of blood along with fluid.

In some cases, taking fertility drugs can also lead to development of large cysts on the ovaries. However, such a condition may get corrected after the menstrual cycle or after pregnancy.

Epidemiology

Ovarian cysts are a common occurrence in almost all premenopausal women. It has also been estimated that about 18% of women in their postmenopausal stage develop ovarian cysts. The exact incidence of ovarian cysts however is unknown due to its high resolution rate and lack of appropriate recording of cases [3]. Research has postulated the fact that ovarian cysts are the most common cause of fetal and infant tumor, with a prevalence rate of about 30%.

Sex distribution
Age distribution

Pathophysiology

Under normal conditions, during each menstrual cycle every month, an egg is released by the follicles. In conditions when the follicle fails to break open and release an egg, the fluid continues to stay in the follicle and is not released giving rise to development of cysts. Such a type of cyst that develops within a follicle is known as follicular cysts [4]. The second type of cyst known as the corpus luteum cysts develop after the egg is released from the follicle. A cyst of this type may also contain blood in it.

Prevention

It is practically impossible to prevent the development of ovarian cysts. However, regular follow up examination with gynecologist can help in detection of cysts in its early stages.

Summary

Ovarian cysts are a common problem experienced by almost all women across the globe at least once in their lifetime. In majority of the cases, ovarian cysts that develop, present with no signs and symptoms, are harmless and cause no discomfort to the affected woman. Such type of cysts usually resolve by themselves requiring no treatment [1]. However, those cysts that rupture are a significant cause of discomfort and produce serious debilitating symptoms.

Patient Information

Definition

Ovarian cysts are the ones which develop either on the surface or inside the ovary. These cysts develop in women in the child bearing age. In majority of the cases, the cysts resolve without any treatment.

Cause

There are 2 types of ovarian cysts: Follicular and corpus luteum cysts. The follicular cysts develop when the follicle fails to break and release egg during monthly menstrual cycle. In corpus luteum cysts, mass develops after the follicles have released the egg.

Symptoms

Symptoms of ovarian cysts include, pain in the pelvic region during menstruation, abdominal bloating, breast tenderness, nausea, vomiting, pain during intercourse and painful bowel movements.

Diagnosis

A pelvic examination to observe for tenderness and inflammation of the pelvic region is carried out. In addition, blood tests, pregnancy test, ultrasound of the pelvic are also necessary to confirm the condition.

Treatment

When the cysts enlarge in size and cause discomfort, treatment would include administration of birth control pills to stop the process of ovulation. In addition, surgical procedures may also be required for removal of the cysts [10].

References

Article

  1. Bailey CL, Ueland FR, Land GL, DePriest PD, Gallion HH, Kryscio RJ, et al. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol. Apr 1998;69(1):3-7.
  2. Castillo G, Alcázar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol 2004; 92:965.
  3. ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. Jan 2010;115(1):206-18.
  4. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117:742.
  5. Holt VL, Cushing-Haugen KL, Daling JR. Risk of functional ovarian cyst: effects of smoking and marijuana use according to body mass index. Am J Epidemiol. Mar 15 2005;161(6):520-5.
  6. Modesitt SC, Pavlik EJ, Ueland FR, et al. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol 2003; 102:594.
  7. Chan L, Lin WM, Uerpairojkit B, Hartman D, Reece EA, Helm W. Evaluation of adnexal masses using three-dimensional ultrasonographic technology: preliminary report. J Ultrasound Med. May 1997;16(5):349-54.
  8. Perrotin F, Potin J, Haddad G, et al. Fetal ovarian cysts: a report of three cases managed by intrauterine aspiration. Ultrasound Obstet Gynecol 2000; 16:655.
  9. Osmers R. Sonographic evaluation of ovarian masses and its therapeutical implications [editorial].Ultrasound Obstet Gynecol. Oct 1996;8(4):217-22. 
  10. Arisaka O, Shimura N, Nakayama Y, et al. Ovarian cysts in precocious puberty. Clin Pediatr (Phila) 1989; 28:44.

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Last updated: 2018-06-22 12:34