Ovarian Abnormalities and Cyst Classifications

Abnormalities of the Ovaries

Cysts and tumors

ovarian torsion

PCOS

ovarian hyperstimulation syndrome

Sonographic classification of ovarian masses

Simple, complex, or solid

Functional ovarian masses

Related to menstrual cycle and usually resolve on their own

Non-functional ovarian masses

Do not resolve spontaneously and often require removal

Simple ovarian cyst (definition)

Smooth-walled cyst filled with clear fluid

Simple ovarian cyst (ultrasound features)

No internal echoes and good through transmission

Simple ovarian cyst (size criteria)

Called a cyst when larger than 2.5 cm

Complex ovarian mass (definition)

Ovarian mass containing both fluid and internal echogenic material

Complex ovarian mass (contents)

May contain blood, pus, clot, mucin, septations, or papillary projections

Solid ovarian mass (definition)

Mass composed of solid tissue with no cystic components

Solid ovarian mass (ultrasound features)

Echogenic, homogeneous texture with poor through transmission

Solid ovarian mass (additional finding)

May produce acoustic shadowing

Involuting cyst

Resolving cyst that appears irregular and collapsing, may contain hemorrhage

An involuting cyst is commonly seen with resolving __________ ____________.

Corpus Luteums

What are the 5 simple ovarian cysts?

Corpus Luteum

Follicular Cysts

Simple Postmenopausal Cysts

Theca-Lutein Cysts

Serous Cystadenoma

Corpus luteum is it functional or non-functional?

Functional ovarian structure

Corpus luteum when/how does it form?

Forms when the Graafian follicle fails or is delayed in reabsorption after ovulation

Corpus luteum (hemorrhagic change)

May bleed internally and become a hemorrhagic corpus luteum

Corpus luteum (role in pregnancy)

Persists to support early pregnancy if fertilization occurs

Corpus luteum (ultrasound appearance)

Typically has a thicker wall or rim

Corpus luteum (evolution)

Often starts as a simple cyst and becomes more complex as it resolves

Corpus luteum (Doppler finding)

Peripheral "ring of fire" blood flow

Follicular cyst functional or non-functional?

Functional ovarian cyst

Follicular cyst (cause)

Failure of a dominant Graafian follicle to ovulate or rupture

Follicular cyst Is a _________ ___________ that fails to involute after ovulation and persists.

Dominant follicle fails to involute after ovulation and persists

Follicular cyst (size)

Typically 2-20 cm

Follicular cyst unilateral or bilateral?

Usually unilateral

Follicular cyst (symptoms)

Usually asymptomatic

Follicular cyst when does is resolve?

Typically resolves spontaneously within 1-2 menstrual cycles

Why are postmenopausal ovaries smaller?

Postmenopausal ovaries are small due to lack of hormonal stimulation

Do Postmenopausal ovaries have follicles?

Postmenopausal ovary should have no follicles or only a few very tiny follicles

Why might a women have Simple postmenopausal cyst if in menopause?

May persist from a cyst that formed during the menopausal hormonal transition

Simple postmenopausal cyst (follow-up threshold)

If >1.5 cm, requires periodic ultrasound follow-up

Simple postmenopausal cyst (follow-up interval)

Typically monitored every 6 months to 1 year

Simple postmenopausal cyst (malignancy risk)

Unlikely malignant if simple and <5 cm

Theca-lutein cyst (classification), are they functional or non-functional?

Functional ovarian cyst

Theca-lutein cyst (size)

Largest type of functional ovarian cyst

Theca-lutein cyst (appearance)

Large, bilateral, multicystic ovaries

Theca-lutein cyst (hormonal association)

Associated with extremely high levels of beta-hCG

Theca-lutein cyst associated with _____________ ___________ & ____________ __________

Molar pregnancy and multiple gestations

Theca-lutein cyst is often confused with what?

Can be confused with ovarian hyperstimulation syndrome

Serous cystadenoma (classification) functional or non-functional?

Non-functional ovarian tumor

Serous cystadenoma what type of tumor and where does it arise from?

Epithelial tumor arising from the surface layer of the ovary

Serous cystadenoma. does it resolve itself?

Does not resolve on its own and requires surgical removal

Serous cystadenoma (frequency), how common is it?

Second most common benign ovarian tumor after dermoid

Serous cystadenoma accounts for ~____________% of all benign ovarian tumors

Accounts for ~20-25% of all benign ovarian tumors

Serous cystadenoma (laterality)

Usually unilateral (affects only ONE ovary)

Serous cystadenoma (size)

Typically large

Serous cystadenoma (ultrasound appearance)

Variable—may be completely cystic or have thin septations (can appear simple or complex)

Serous cystadenoma (contents)

Filled with pale, yellow fluid

Serous cystadenoma (patient population)

Most commonly seen in women in their 40s-50s

how do we know its Serous cystadenoma?

Confirmed by pathology after removal