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Ovarian cysts
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Ovarian cysts

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Contributors: Mary N.W. Towner MD, Mitchell Linder MD
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Synopsis

An ovarian cyst is a collection of fluid on the ovarian surface or within the ovarian stroma. The term "ovarian cysts" encompasses a broad collection of diagnoses, ranging from benign physiologic processes to ovarian malignancy. Ovarian cysts can occur in females of any age (fetus to postmenopausal), although they are more likely in women of childbearing age.

Ovarian cysts are most commonly asymptomatic and diagnosed incidentally on physical exam or imaging. Sometimes the patient with an ovarian cyst may present with acute or chronic abdominal pain.

Depending on the underlying etiology, an ovarian cyst might develop slowly or rapidly. Rapidly forming cysts may be more likely to cause pain. Ovarian cysts, especially functional or physiologic cysts, often resolve spontaneously.

Contraceptive agents that inhibit ovulation decrease the risk of formation of physiologic cysts.

Related topic: Teratoma of ovary

Codes

ICD10CM:
N83.209 – Unspecified ovarian cyst, unspecified side

SNOMEDCT:
79883001 – Cyst of ovary

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Physiologic (functional) cysts – Usually resolve spontaneously within several weeks.
  • Follicular cyst – More likely in the first half of the menstrual cycle.
  • Corpus luteal cyst – More likely in the second half of the menstrual cycle. Normally present for first several weeks of pregnancy.
  • Hemorrhagic cyst – When a functional cyst develops internal and/or external bleeding; usually painful, especially if external bleeding leads to peritoneal irritation; hemoglobin or hematocrit may be noted to decrease on serial labs.
  • Benign ovarian cysts (eg, serous cystadenoma, mucinous cystadenoma) – Can range from small to very large (>15 cm). If persistent and/or symptomatic, surgical excision is warranted. 
  • Endometrioma – Generally appears homogeneous and mildly echogenic internally. Typical "lace-like" internal echoes may be seen with old clots. Depending on severity of pelvic adhesive disease, may be fixed in place on bimanual exam.
  • Mature teratoma (dermoid cyst) – Most common benign neoplasm in young women (aged 10-30). Complex on imaging, often with calcifications.
  • Tubo-ovarian abscess – Associated with fever, leukocytosis. Usually complex on imaging. Ruptured tubo-ovarian abscess can be life-threatening and is an indication for urgent surgery.
  • Ovarian cancer (eg, epithelial adenocarcinomas, germ cell tumors, sex cord-stromal tumors) – May have elevated tumor markers (CA-125, HE4, AFP, lactate dehydrogenase, Inhibin).

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 11/27/2017
Last Updated: 12/04/2017
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Ovarian cysts
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Ovarian cysts : Constipation, Pelvic pain, Urinary frequency, Pelvic mass, Dysmenorrhea, Menorrhagia
Imaging Studies image of Ovarian cysts
Image from a transvaginal ultrasound demonstrating a highly echogenic mass in the right ovary, consistent with a dermoid cyst.
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