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ovarian cysts and other cysts in the adnexae

functional ovarian cysts

follicular cysts

  • account for 20-50% of ovarian masses in post-menarchal women during the reproductive years
  • ruptured cysts may present as acute severe pelvic pain worse on movement +/- rebound tenderness. The pain usually decreases over 1-2 days.
  • torsion of the cyst is more likely in larger cysts and will cause prolonged pain unless it spontaneously untwists. Torsion may also cause bleeding or infarction of the ovary.
  • those smaller than 6-8cm will usually disappear after 1-2 menstrual cycles, and if still a problem, may shrink or disappear with combined oral contraceptive pill (OCP) Rx.
  • those larger than 6-8cm should be referred to O&G as suspicion of neoplasm is increased.
  • may be found in prepubertal females.

corpus luteum cysts

  • occur after ovulation (and thus in early pregnancy) and can reach 6-8cm diameter.
  • usually disappear over 1-2 menstrual cycles or with combined oral contraceptive pill (OCP) Rx, or by the end of the 1st trimester of pregnancy.

germinal inclusion cysts

  • small surface cysts that are benign, usually simple cysts, and generally asymptomatic.

theca lutein cysts

  • sometimes present in normal pregnancy, but more often accompany trophoblastic disease (30% of these patients have enlarged ovaries)
  • multiple cysts ranging from 1-15cm causing ovaries to enlarge rapidly and may continue growing for a short time after delivery of the molar pregnancy then return to normal size within 3-4 months.

polycystic ovary syndrome

  • generally smooth, enlarged ovaries on palpation
  • USS shows numerous 2-3cm subcapsular cysts
  • FSH/LH ratio usually LH elevated several times the normal ratio of 1:1 or 2:1


  • chocolate cysts associated with endometriosis
  • typically immobile as they form extensive scarring
  • gradually enlarge over many months
  • pain classically starts 1-2 days prior to menses but may be asymptomatic
  • if larger than 2cm, usually require surgical Rx

parovarian cysts

  • remnants of wolffian ducts
  • account for 10% of adnexal masses in reproductive years.
  • benign cysts are most commonly found in 30-40yr olds but may occur in any age.
  • tend to expand within the mesosalpinx, displacing the uterus both out of the pelvis and away from the involved side.
  • have no pedicle and thus not at risk of torsion.

hydatid of Morgagni

  • is a pedunculated cyst of mullerian origin, usually 1-2cm and usually of no concern, however, may reach 10-15cm and cause torsion of the adnexa.
ovarian_cysts.txt · Last modified: 2009/10/30 09:43 (external edit)