Ovarian Cysts: Presented by Neha Barari Assistant Professor SNSR

OVARIAN CYSTS
PRESENTED BY
NEHA BARARI
ASSISTANT PROFESSOR
SNSR
LEARNING OBJECTIVES
GENERAL OBJECTIVES:- BY THE END OF THE CLASS STUDENTS
WILL BE ABLE TO UNDERSTAND THE COMPLETE ABOUT OVARIAN
CYST.
SPECIFIC OBJECTIVES: BY THE END OF THE CLASS STUDENT WILL
BE ABLE TO:-
•TO INTRODUCE THE TOPIC
•TO DEFINE THE OVARIAN CYST
•TO EXPLAIN THE TYPES OF OVARIAN CYST.
•TO DESCRIBE THE MANAGEMENT OF OVARIAN CYST.
INTRODUCTION
Ovarian cysts are fluid-filled sacs or pockets in an
ovary or on its surface. Women have two ovaries —
each about the size and shape of an almond — on each
side of the uterus. Eggs (ova), which develop and
mature in the ovaries, are released in monthly cycles
during the childbearing years.
DEFINITION
• Ovarian enlargements can be cystic or solid but in most
cases ovarian enlargement are cystic.
 Non-neoplastic
 Neoplastic (Ovarian Tumours)

NON-NEOPLASTIC CYSTS OF THE OVARY
• An ovarian cyst is a sac filled with liquid or semi

liquid material arising in an ovary.
• The finding of an ovarian cyst causes considerable anxiety
for women because of the fear of malignancy, but the vast
majority of ovarian cysts are benign.
TYPES OF OVARIAN CYSTS
1. PATHOLOGICALCYST
a.. Polycystic ovarian syndrome (pcos)
b. Enometriomatous cysts
c. Dermoid Cyst
d. Cystadenomas
2. FUNCTIONAL CYSTS (commonest)
a. Follicular cysts
b. Theca lutein cysts
c. Corpus luteum cysts.
It is a condition that affects a woman’s
hormone levels. Women with PCOS
produce higher-than-normal amounts of
male hormones. This hormone
imbalance causes them to skip
menstrual periods and makes it harder
for them to get pregnant.
ENDOMETRIOMATOUS CYSTS OF THE
OVARY
• Cysts filled with blood arising from the ectopic
endometrium.
• They usually enlarge pre and during menses and
slightly shrink there after.
• The ovary is the commonest site of pelvic
endometriosis.
• Endometriomas :
• cysts that form as a result of endometriosis
(a condition in which tissue similar to that is
normally found in the uterus is found outside
of the uterus, usually in the ovaries,
fallopian tubes etc.
• This tissue responds to monthly changes in
hormones. Eventually, a cyst may form as the
endometrial tissue continues to bleed with each
menstrual cycle.
• These cysts are sometimes called “chocolate
cysts” because they are filled with dark, reddish-
brown blood.
a. DERMOID CYST
• Dermoid cysts may be present from birth but grow during a

woman’s reproductive years.
• These cysts may be found on one or both ovaries.
• Dermoid cysts form from a type of cell capable of
developing into different kinds of tissue.
b. CYSTADENOMAS
• Cystadenomas are cysts that develop from cells on the outer
surface the ovary.
• Sometimes they are filled with a liquid or a thick gel.
• They usually are benign, but they can grow very large
• There are different types:
• Mucinous cyst adenoma
• Serous cyst adenoma
2. FUNCTIONAL CYSTS
Ovarian cysts arising in the normal process of ovulation
• They may be follicular ,theca-lutein or corpus luteum
cysts.
• These cysts can be stimulated by gonadotropins,
including follicle-stimulating hormone (FSH) and
human chorionic gonadotropin (hCG).
• Multiple functional cysts can occur as a result of excessive gonado-
tropin stimulation or sensitivity
• This stimulation may occurs in cases of
 GTDs (hydatiform mole and chorio-carcinoma)
 multiple pregnancy.
 In patients being treated for infertility, ovulation induction with

gonadotropins (FSH and luteinizing hormone [LH]), and clomiphene
citrate, may lead to ovarian hyper-stimulation syndrome, especially if
accompanied by hCG administration.
a. FOLLICLE CYST
During a woman’s menstrual cycle, an egg grows in a sac
called a follicle. This sac is located inside the ovaries. In
most cases, this follicle or sac breaks open and releases an
egg. But if the follicle doesn’t break open, the fluid inside
the follicle can form a cyst on the ovary.
b. THECA LUTEIN CYSTS
Theca-lutein cyst ( Hyperreactio luteinalis) is a rare benign

physiological ovarian enlargement with multiple theca
lutein cysts caused by increased human chorionic
gonadotropin (hCG) serum levels. It occurs during the luteal
phase of the menstrual cycle or during early pregnancy
c. CORPUS LUTEUM CYSTS
RISK FACTORS OF OVARIAN CYSTS
1. Hypothyroidism
2. Infertility or women who are on treatment for infertility
3. Those taking tamoxifen, a drug to combat breast cancer
4. Irregular periods
5. Early periods (before 11 years)
6. Previous history of ovarian cysts.

7. A drug called clomiphene (infertility) may lead to formation of corpus
luteum cyst.
PCOD
ROTTERDAM CRITERIA FOR DIAGNOSIS OF
PCOS
1.MENSTRUAL IRREGULARITIES. Most patients with PCOS
have menstrual irregularities that begin during adolescence.
– OLIGOMENORRHEA: less than nine menses per year
– AMENORRHEA: no menses for 6 months or three or more

skipped cycles
Difficulty in conceiving is present in many women with PCOS
2. HYPERANDROGENISM(FEMALE):- Patients may either show
signs of clinical hyper-andro-genism or have biochemical hyper-andro-
genism:
Clinical hyper-androgenism: e.g hirsutism (growth of hair), acne, or
male pattern hair loss.
Biochemical hyper-androgenism: Up to 90% of women with PCOS
have elevated serum androgen concentration. However, the androgen
levels may be normal.
• Cigarette smoking - The risk of functional ovarian
cysts is increased with cigarette smoking; risk from
smoking is possibly increased further with a
decreased body mass index .
• Tubal ligation - Functional cysts have been
associated with tubal ligation sterilizations
POLYCYSTIC OVARIES:- A diagnosis of polycystic- appearing
ovaries can be made using pelvic ultrasound.
PCOS by ultrasound criteria is defined as 12 or more antral follicles
between 2 and 9 mm in size and peripheral in location in at least one
ovary
–Trans-vaginal ultrasound is more sensitive, but may not be appropriate

to perform in a young female.
SYMPTOMS
• Benign cysts can cause pain and discomfort related to pressure on adjacent
structures, torsion, rupture, and hemorrhage (within and outside of the cyst).
Morbidity also includes menorrhagia, an increased inter menstrual interval ,
dysmenorrhea, pelvic discomfort, and abdominal distention. Benign cysts
rarely cause death.
• Ovarian cysts, and more specifically corpus luteal cysts, can rupture,
causing hemo peritoneum, hypotension, and peritonitis. This can be
exacerbated in women with bleeding dyscrasias, such as those with von
Willebrand disease and those receiving anticoagulation therapy.
• Ovarian torsion can complicate ovarian cysts and can result in
ovarian infarction, necrosis, infertility, premature ovarian
menopause, and preterm labour.
• Malignant ovarian cystic tumors can cause severe morbidity,

including the following:
• Pain Abdominal distension
• Bowel obstruction Nausea
• Wasting Cachexia (extreme weight loss) Heartburn
• Indigestion Abnormal uterine bleeding
• Dyspnea
• Deep venous thrombosis
PHYSICAL FINDINGS
• A large cyst may be palpable during the abdominal
examination
• Sometimes, discerning the cystic nature of an ovarian cyst may
be possible, and it may be tender to palpation.
• If a cyst is huge ,The cervix and uterus may be pushed to one
side.
LABORATORY STUDIES
• No laboratory tests are diagnostic for ovarian cysts
except for PCOS for which hormone assays are
done:
 FSH
 LH
 Testosterone
 Oestradiol (Estrogen steroid hormone)
IMAGING STUDIES
• Ultrasonography
• Doppler flow studies
• MRI
• CT scan
The following diagnostic tests may also be
ordered:
• Ultrasound scan - this will be carried out to help the doctor
make a diagnosis. A wand-like scanner probe (transducer) is
placed on the abdomen, over where the ovaries are.
• Sometimes the probe may be placed inside the vagina. In both

cases, the doctor is observing the ovaries on a video screen. This
test can help the doctor determine whether there is a cyst, and
whether it is solid, filled with fluid (or both).
• Blood test - if there is a tumour present blood levels of
CA125 (a protein) will be elevated.
• High CA125 levels could also mean the patient has ovarian
cancer. If a woman develops an ovarian cyst that is partially
solid she may have ovarian cancer.
• High CA125 levels may also be present in other conditions,

including endometriosis, uterine fibroids or pelvic inflammatory
disease.
MEDICAL CARE
• Many patients with simple ovarian cysts

based on ultrasonography findings do not
require treatment.
• Several factors are taken into account when deciding on
the type of treatment for ovarian cysts; and whether to
treat at all. The main factors are:
• The patient's age
• Whether the patient is pre- or postmenopausal
• The appearance of the cyst
• The size of the cyst
• Whether or not there are any symptoms

• Watchful waiting (observation) - sometimes watchful
waiting, also known as observation is recommended,
especially if the woman is pre-menopausal and she
has a small functional cyst (2cm to 5cm). An
ultrasound scan will be carried out about a month or
so later to check it, and to see whether it has gone.
BIRTH CONTROL PILLS
Oral contraceptives to stop ovulation and prevent the
development of new cysts. Oral contraceptives can also reduce
your risk of ovarian cancer. The risk of ovarian cancer is higher
in postmenopausal women.
SURGICAL CARE
• Persistent simple ovarian cysts larger than 5-10 cm and complex ovarian cysts
should be removed surgically
 LAPAROTOMY:-
If you have a large cyst, your doctor can surgically remove the cyst through
a large incision in your abdomen. They’ll conduct an immediate biopsy, and
if they determine that the cyst is cancerous, they may perform a
hysterectomy to remove your ovaries and uterus.
 LAPROSCOPICALLY:- If your cyst is small and results from an imaging

test to rule out cancer
Laparoscopy - a thin, lighted instrument (laparoscope)
is inserted into the patient's abdomen through a small
incision (skin cut). If the doctor spots an ovarian cyst he/she
may also remove it there and then.

• PREGNANCY TEST - a positive result
may suggest the patient has a corpus
luteum cyst.
COMPLICATIONS OF OVARIAN
CYSTS
• Torsion
• Rupture
• Hemorrhage
OVARIAN CYST PREVENTION
it’s important to visit your doctor and receive a correct diagnosis.

Alert your doctor to symptoms that may indicate a problem, such as:
•changes in your menstrual cycle
•ongoing pelvic pain
•loss of appetite
•unexplained weight loss
•abdominal fullness.
PREGNANCY
Ovarian cysts in pregnancy are usually benign. Benign cystic
teratomas (also called dermoid cysts) are the most common ovarian
tumor during pregnancy, accounting for one-third of all benign
ovarian tumors in pregnancy. The second most common benign
ovarian cyst is a cyst-adenoma. In caring for pregnant women with
ovarian cysts, a multidisciplinary approach and referral to a
perinatologist and gyneco-logic oncologist is advised.

REFRENCES
•https://www.mayoclinic.org/diseases-conditions/ovarian-
cysts/symptoms-causes/syc-20353405
•https://www.healthline.com/health/ovarian-cysts#types

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OVARIAN CYSTS

 Neoplastic (Ovarian Tumours)

• An ovarian cyst is a sac filled with liquid or semi

• Dermoid cysts may be present from birth but grow during a

 In patients being treated for infertility, ovulation induction with

Theca-lutein cyst ( Hyperreactio luteinalis) is a rare benign

2. Infertility or women who are on treatment for infertility

3. Those taking tamoxifen, a drug to combat breast cancer

5. Early periods (before 11 years)

6. Previous history of ovarian cysts.

– AMENORRHEA: no menses for 6 months or three or more

–Trans-vaginal ultrasound is more sensitive, but may not be appropriate

• Malignant ovarian cystic tumors can cause severe morbidity,

• Sometimes, discerning the cystic nature of an ovarian cyst may

be possible, and it may be tender to palpation.

• If a cyst is huge ,The cervix and uterus may be pushed to one

• Sometimes the probe may be placed inside the vagina. In both

• High CA125 levels may also be present in other conditions,

• Many patients with simple ovarian cysts

• Whether the patient is pre- or postmenopausal

• The appearance of the cyst

• The size of the cyst

• Whether or not there are any symptoms

development of new cysts. Oral contraceptives can also reduce

your risk of ovarian cancer. The risk of ovarian cancer is higher

 LAPROSCOPICALLY:- If your cyst is small and results from an imaging

is inserted into the patient's abdomen through a small

incision (skin cut). If the doctor spots an ovarian cyst he/she

may also remove it there and then.

it’s important to visit your doctor and receive a correct diagnosis.

tumor during pregnancy, accounting for one-third of all benign

ovarian tumors in pregnancy. The second most common benign

ovarian cyst is a cyst-adenoma. In caring for pregnant women with

ovarian cysts, a multidisciplinary approach and referral to a

perinatologist and gyneco-logic oncologist is advised.

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