(27) Non Neopl. Cysts
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بسم ال الرحمن الرحيم
NON NEOPLASTIC CYSTS OF THE OVARY
NON NEOPLASTIC CYSTS OF THE OVARY
Enlargement of the ovary is one of the common gynaecological conditions encountered in clinical practice. Ovarian cysts could be either non neoplastic or neoplastic cysts. Non neoplastic cysts of the ovary are by far more common than neoplastic cysts
Non neoplastic cysts of the ovary include: 1. 2. 3. 4. 5. 6. 7.
Follicular cysts Corpus luteum cysts Theca lutein cysts Endometriotic cysts Inflammatory cysts Germinal inclusion cysts Polycystic ovary
I. FOLLICULAR CYSTS
the commonest non neoplastic cysts of the ovary. They may arise either from cystic over-distension of an atretic follicle, or a dominant Graafian follicle that failed to rupture.
Pathology: usually single unilateral small in size (<7 cm) unilocular, containing clear fluid. The cyst wall is thin, lined by granulosa cells.
Commonly encountered with: a) Metropathia Haemorrhagica (MH) b) Polycystic ovarian syndrome (PCOS) c) In association with fibroids and endometriosis.
Fate & Complications:
rupture spontaneously haemorrhage Spontaneous resolution
Clinical picture:
Asymptomatic Menstrual disturbance Pain (rarely acute abdomen Diagnosis:
Abdominal palpation Bimanual examination Ultrasonography: Pelvic TAS or TVS, it is the gold standard in diagnosis
Pathology: lined by leutinized granulosa cells usually unilateral, single, unilocular, small sized (3-7 cm), containing either bloody fluid or clear content.
D.D.: From simple serous cystadenoma
Treatment: • •
Conservative by follow up Surgery (ovarian cystectomy)
II. CORPUS LUTEUM CYSTS
They arise from excessive haemorrhage inside the corpus luteum during the stage of vascularization. They are less common than follicular cysts
Pathology:usually Unilateral Single Unilocular Small sized (3-7 cm) Containing either bloody fluid or clear content. Lined by leutinized granulosa cells
Fate & Complications: Spontaneous resolution Spontaneous rupture Haemorrhage
Clinical picture: Asymptomatic Menstrual disturbance Acute lower abdominal pain
Diagnosis: is settled by detection of the cyst by pelvic TAS, or TVS. Treatment: A) Conservative B) Surgery
III. THECA LUTEIN CYSTS
They commonly arise due to ovarian hyperstimulation by either: a. Excessive amounts of hCG in the circulation: or b. Excessive amounts of Pituitary gonadotropins:
Pathology: usually multiple commonly bilateral bluish in colour thin walled, containing clear fluid they may reach a large size > 20 cm lined by leutinized theca cells.
Fate & complications: The majority undergo spontaneous regression whenever hCG levels fall. Less commonly cysts may undergo torsion or haemorrhage Diagnosis: Pelvic Ultrasonography: Multilocular, bilateral, echolucent cysts in a patient with a history suggestive of abnormally elevated hCG levels, or ovarian stimulation by HMG or CC
Treatment:
Expectant treatment after removal of the source of gonadotropin stimulation
Laparotomy should always be avoided, unless cysts are complicated.
IV. ENDOMETRIOTIC CYSTS
Incidence & Origin: Not uncommon especially with infertility and pelvic endometriosis. Pathology:
haemorrhagic cysts of the ovary lined by endometrial tissue (glands & stroma). They have a relatively thick wall. Their size is rarely large, and spontaneous rupture is uncommon.
The contents are characteristic with thick chocolate appearance (chocolate cysts): Blood accumulates within the cyst By time, absorption of the serous element of the retained blood occurs leaving behind RBCs
Treatment:
Superficial ovarian lesions can be vaporized. Small endometriomas <3 cm can be aspirated, irrigated, and the interior wall vaporized. Large endometriomas >3 cm require removal of the cyst wall to prevent recurrence.
V. INFLAMMATORY CYSTS OF THE OVARY
Origin: These may be in the form of Tuboovarian cysts or Tubo-ovarian abscess. Infection may reach the ovary either by lymphatics or a nearby- infected organ.
Tubo-ovarian cyst
Tubo-ovarian abscess
Clinically: usually bilateral, the patient usually presents with a history of recent delivery or abortion, a recent surgical pelvic operation or IUD insertion.
VI. GERMINAL INCLUSION CYSTS
They are microscopic cysts that result from invagination of the germinal epithelium into the substance of the ovary near or after menopause. Previously they were considered of no clinical importance, but now they are regarded as forerunners for ovarian epithelial cancers.
Thank you
NON NEOPLASTIC CYSTS OF THE OVARY
NON NEOPLASTIC CYSTS OF THE OVARY
Enlargement of the ovary is one of the common gynaecological conditions encountered in clinical practice. Ovarian cysts could be either non neoplastic or neoplastic cysts. Non neoplastic cysts of the ovary are by far more common than neoplastic cysts
Non neoplastic cysts of the ovary include: 1. 2. 3. 4. 5. 6. 7.
Follicular cysts Corpus luteum cysts Theca lutein cysts Endometriotic cysts Inflammatory cysts Germinal inclusion cysts Polycystic ovary
I. FOLLICULAR CYSTS
the commonest non neoplastic cysts of the ovary. They may arise either from cystic over-distension of an atretic follicle, or a dominant Graafian follicle that failed to rupture.
Pathology: usually single unilateral small in size (<7 cm) unilocular, containing clear fluid. The cyst wall is thin, lined by granulosa cells.
Commonly encountered with: a) Metropathia Haemorrhagica (MH) b) Polycystic ovarian syndrome (PCOS) c) In association with fibroids and endometriosis.
Fate & Complications:
rupture spontaneously haemorrhage Spontaneous resolution
Clinical picture:
Asymptomatic Menstrual disturbance Pain (rarely acute abdomen Diagnosis:
Abdominal palpation Bimanual examination Ultrasonography: Pelvic TAS or TVS, it is the gold standard in diagnosis
Pathology: lined by leutinized granulosa cells usually unilateral, single, unilocular, small sized (3-7 cm), containing either bloody fluid or clear content.
D.D.: From simple serous cystadenoma
Treatment: • •
Conservative by follow up Surgery (ovarian cystectomy)
II. CORPUS LUTEUM CYSTS
They arise from excessive haemorrhage inside the corpus luteum during the stage of vascularization. They are less common than follicular cysts
Pathology:usually Unilateral Single Unilocular Small sized (3-7 cm) Containing either bloody fluid or clear content. Lined by leutinized granulosa cells
Fate & Complications: Spontaneous resolution Spontaneous rupture Haemorrhage
Clinical picture: Asymptomatic Menstrual disturbance Acute lower abdominal pain
Diagnosis: is settled by detection of the cyst by pelvic TAS, or TVS. Treatment: A) Conservative B) Surgery
III. THECA LUTEIN CYSTS
They commonly arise due to ovarian hyperstimulation by either: a. Excessive amounts of hCG in the circulation: or b. Excessive amounts of Pituitary gonadotropins:
Pathology: usually multiple commonly bilateral bluish in colour thin walled, containing clear fluid they may reach a large size > 20 cm lined by leutinized theca cells.
Fate & complications: The majority undergo spontaneous regression whenever hCG levels fall. Less commonly cysts may undergo torsion or haemorrhage Diagnosis: Pelvic Ultrasonography: Multilocular, bilateral, echolucent cysts in a patient with a history suggestive of abnormally elevated hCG levels, or ovarian stimulation by HMG or CC
Treatment:
Expectant treatment after removal of the source of gonadotropin stimulation
Laparotomy should always be avoided, unless cysts are complicated.
IV. ENDOMETRIOTIC CYSTS
Incidence & Origin: Not uncommon especially with infertility and pelvic endometriosis. Pathology:
haemorrhagic cysts of the ovary lined by endometrial tissue (glands & stroma). They have a relatively thick wall. Their size is rarely large, and spontaneous rupture is uncommon.
The contents are characteristic with thick chocolate appearance (chocolate cysts): Blood accumulates within the cyst By time, absorption of the serous element of the retained blood occurs leaving behind RBCs
Treatment:
Superficial ovarian lesions can be vaporized. Small endometriomas <3 cm can be aspirated, irrigated, and the interior wall vaporized. Large endometriomas >3 cm require removal of the cyst wall to prevent recurrence.
V. INFLAMMATORY CYSTS OF THE OVARY
Origin: These may be in the form of Tuboovarian cysts or Tubo-ovarian abscess. Infection may reach the ovary either by lymphatics or a nearby- infected organ.
Tubo-ovarian cyst
Tubo-ovarian abscess
Clinically: usually bilateral, the patient usually presents with a history of recent delivery or abortion, a recent surgical pelvic operation or IUD insertion.
VI. GERMINAL INCLUSION CYSTS
They are microscopic cysts that result from invagination of the germinal epithelium into the substance of the ovary near or after menopause. Previously they were considered of no clinical importance, but now they are regarded as forerunners for ovarian epithelial cancers.
Thank you
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