Although benign and often self-limited can cause significant pelvic pain and menstrual dysfunction and result in 200,000 hospitalizations annually in the U.S.
Follicle cysts most common cystic structure found in the ovary.
Arise from physiologic processes.
Physiologic cysts are common in adolescence and are classified as either follicular for corpus luteal.
Corpus luteal cysts are more complex than follicular cysts.
Physiologic cysts are almost less than 10 cm in size and resolve over 6-8 weeks.
Unilocular cysts are invariably benign and 50 to 70% of the time they resolve spontaneously.
Large benign cyst that do not resolve can be surgically removed.
The presence of thin septations does not increase the risk of cancer.
Normal functioning organ produces a follicular cyst 6-7 times each year, and in most cases these functional cystic masses are self-limiting and resolve within the duration of the normal menstrual cycle.
Forms as a result from the non rupture of the mature follicle or failure of an immature follicle to undergo atresia.
Many ovarian cysts lose ability to produce estrogen and in others the granulosa cell continues to produce secretion of estrogen.
Solid follicle cysts occur commonly throughout life from fetal stage to post menopause.
Size ranges from several millimeters to 8 cm.
Usually thin walled and unilocular
Follicle cysts lined with an inner layer of granulosa cells and an outer layer of theca interna cells.
Little or no effect on incidence by the use of low dose oral contraceptives.
Laparoscopic drainage of an ovarian cyst that may be malignant should not be performed because of extremely high recurrence rate and the risk of tumor dissemination.
Corpus luteum cysts result mainly from intracystic hemorrhage.
Corpusus luteum cysts are less frequent than follicular cysts.
Corpus luteum cysts are hormonally inactive.
Corpus luteum cysts may rupture into the peritoneum and this may occur with bleeding diatheses.
Many corpus luteum cysts resolve within 6-12 weeks and require no treatment.
Rarely may have torsion and surgical intervention may be needed.
Epithelial cysts account for approximately 60% of ovarian neoplasms.
Approximately 15% of ovarian cystic lesions are neoplastic.
Ultrasound is the primary imaging study for assessment of ovarian cysts.
A benign cyst appears unilocular, with a thin smooth wall and no solid elements.
Sometimes benign lesions may have a complex cystic feature such is a thick wall, septations, and solid components, these features, however, are more typical of malignant masses.
Imaging with CT scans or MRI may be required to provide further information with complex cysts.
Laboratory evaluation for simple cyst is unnecessary.
If a malignancy is suspected in an ovarian cyst, markers should be done to include CA 125, alpha-fetoprotein, hCG-Alpha and Beta, CEA, inhibin, LDH, estradiol, HE4, and testosterone.
Stable cyst without solid components can be followed at a one-year interval and those with solid components that are stable at a two year follow up.