Ovarian Cysts
Usually nonneoplastic, ovarian cysts are fluid or semisolid sacs on an ovary. Although they’re usually small and produce no symptoms, they require thorough investigation as possible sites of malignant
change. Common ovarian cysts include follicular cysts and lutein cysts (granulosa-lutein, corpus luteum, and theca-lutein cysts). Ovarian cysts can develop any time between puberty and menopause, including during pregnancy. Granulosa-lutein cysts occur infrequently, usually during early pregnancy. The prognosis for nonneoplastic cysts is excellent.
change. Common ovarian cysts include follicular cysts and lutein cysts (granulosa-lutein, corpus luteum, and theca-lutein cysts). Ovarian cysts can develop any time between puberty and menopause, including during pregnancy. Granulosa-lutein cysts occur infrequently, usually during early pregnancy. The prognosis for nonneoplastic cysts is excellent.
Causes
Follicular cysts are usually small and arise from follicles that overdistend instead of going through the atretic stage of the menstrual cycle. They appear semitransparent and are filled with a watery fluid visible through their thin walls. Follicular cysts that persist into menopause secrete excessive amounts of estrogen in response to the hypersecretion of follicle-stimulating hormone and luteinizing hormone that normally occurs during menopause.
Granulosa-lutein cysts, which occur within the corpus luteum, are functional, nonneoplastic enlargements of the ovaries caused by excessive accumulation of blood during menstruation. Theca-lutein cysts are commonly bilateral and filled with clear, straw-colored fluid; these cysts are commonly associated with hydatidiform moles, choriocarcinoma, or hormone therapy with human chorionic gonadotropin (HCG) or clomiphene citrate. These cysts may also be associated with multiple gestation, diabetes, and Rh sensitization.
Polycystic ovarian disease is part of Stein-Leventhal syndrome and stems from endocrine abnormalities.
Complications
Possible complications include amenorrhea, oligomenorrhea, secondary dysmenorrhea, and infertility. Torsion of the ovary and fallopian tube may result in rupture of the cyst, with resulting peritonitis or intraperitoneal hemorrhage, shock, and death.
Assessment
Small ovarian cysts (such as follicular cysts) usually don’t produce symptoms unless torsion or rupture occurs. The patient may report mild pelvic discomfort, low back pain, dyspareunia, or abnormal uterine bleeding secondary to a disturbed ovulatory pattern. Inspection may reveal signs of an acute abdomen similar to that which occurs in appendicitis (abdominal tenderness, distention, and rigidity).
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