Ovarian cyst: ultrasound characterisation and management

What it is

Ovarian cysts split first into non-neoplastic and neoplastic. The non-neoplastic ones are the benign functional cysts: follicular cyst, luteal cyst of the corpus luteum, and theca lutein cyst, the pregnancy luteoma. The neoplastic ones are endometriomas, benign tumours and malignant tumours.

The functional cysts each have a setting. A follicular cyst is seen in PCOS. A luteal cyst is a corpus luteum that fails to regress after 14 days; it is more painful, and can turn hemorrhagic if ovarian vessels invade the cyst. A theca lutein cyst is seen in molar pregnancy, is usually bilateral, and regresses after delivery.

Among neoplasms, the benign are epithelial (serous cystadenoma, mucinous cystadenoma), germ cell (teratoma, the dermoid cyst) and sex cord stromal (fibromas, theca cell tumour, Sertoli Leydig cell tumour). The malignant are epithelial (serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometroid carcinoma, clear cell tumour), germ cell (immature teratoma, dysgerminoma, yolk sac tumour, non gestational choriocarcinoma) and sex cord stromal (granulosa cell tumour).

Causes and risk

General risk is age and asbestos; genetic risk is BARCA I and II and HNPCC; hormonal risk is infertility, low parity, early menarche, late menopause and endometriosis. Protective are the surgical (hysterectomy, bilateral salpingo-oophorectomy) and the hormonal (oral contraception, breastfeeding).