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ovarian cyst; adnexal cyst; includes ovarian incidentalomas

Epidemiology: - 15% of postmenopausal women at autopsy have cysts > 4 mm in diameter (> 95% benign) [2] - ovarian cancer is rare in premenopausal women [4] Pathology: - most ovarian masses in pregnancy resolve spontaneously, especially if 1st trimester, < 5-6 cm, simple (smooth, thin walls, no septations) Special laboratory: - pelvic ultrasound - repeat in 3 months to evaluate growth of cyst [4] - do NOT aspirate cyst - cyst fluid reaccumulates in ~25% of patients within 1 year - aspiration of a malignant cyst can cause seeding of the abdomen & spread of malignancy [4] Complications: - ovarian hemorrhage - ovarian torsion, rupture - obstruction of labor Management: 1) observation - an asymptomatic unilateral ovarian cyst <10 cm with no concerning features on ultrasound may be observed 2) oral contraceptives 3) referral to gynecologist 4) surgical evaluation when cyst is symptomatic or when it has septations, thickened walls, or a mix of solid & cystic components [4] - an otherwise benign-appearing cyst with a single septation in an asymptomatic woman does not require surgical evaluation [8]

Related

pelvic pain Stein-Leventhal (polycystic ovary) syndrome

Specific

corpus luteum cyst

General

cyst ovarian neoplasm incidentaloma

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 397
  2. Journal Watch 25(6):51, 2005 Dorum A, Blom GP, Ekerhovd E, Granberg S. Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study. Am J Obstet Gynecol. 2005 Jan;192(1):48-54. PMID: 15672002
  3. Valesky AW, Jr Ovarian Cysts in Emergency Medicine http://emedicine.medscape.com/article/795877-overview
  4. NEJM Knowledge+. Question of the Week. June 21, 2016 http://knowledgeplus.nejm.org/question-of-week
  5. Alcazar JL, Castillo G, Jurado M, Garcia GL. Is expectant management of sonographically benign adnexal cysts an option in selected asymptomatic premenopausal women? Hum Reprod. 2005 Nov;20(11):3231-4. Epub 2005 Jul 15. PMID: 16024535 Free Article
  6. Bonilla-Musoles F, Ballester MJ, Simon C, Serra V, Raga F. Is avoidance of surgery possible in patients with perimenopausal ovarian tumors using transvaginal ultrasound and duplex color Doppler sonography? J Ultrasound Med. 1993 Jan;12(1):33-9. PMID: 8455219 Free Article
  7. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007 Jul;110(1):201-14. PMID: 17601923
  8. NEJM Knowledge+ Question of the Week. Oct 4, 2016 http://knowledgeplus.nejm.org/question-of-week/4464/
  9. NEJM Knowledge+ Question of the Week. June 16, 2020 https://knowledgeplus.nejm.org/question-of-week/4799/
  10. Solnik MJ, Alexander C. Ovarian incidentaloma. Best Pract Res Clin Endocrinol Metab. 2012 Feb;26(1):105-16 PMID: 22305456 https://www.sciencedirect.com/science/article/abs/pii/S1521690X11000789
  11. Mansour S, Hamed S, Kamal R. Spectrum of Ovarian Incidentalomas: Diagnosis and Management. Br J Radiol. 2023 Feb;96(1142):20211325. PMID: 35142537 Review