1. OVARIAN CYSTS
Fahad zakwan

2. Introduction
• Ovarian enlargements can be cystic or
solid but in most cases ovarian
enlargement are cystic.
Non-neoplastic
Neoplastic (Ovarian Tumors)

3. Non-neoplastic cysts of the ovary
• An ovarian cyst is a sac filled with liquid or semi-liquid
material arising in an ovary.
• The number of diagnoses of ovarian cysts has increased with
the widespread implementation of regular physical
examinations and ultrasound technology.
• 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.

4. TYPES OF OVARIAN CYSTS.
1. POLYSTIC OVARIAN SYNDROME (PCOS)
2. ENDOMETRIOMATOUS CYSTS
3. FUNCTIONAL CYSTS (commonest)
–Follicular cysts
–Theca lutein cysts
–Corpus luteum cysts.

6. 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).

7. • Multiple functional cysts can occur as a result of
excessive gonadotropin stimulation or sensitivity
• This stimulation may occurs in cases of
 GTDs (hydatiform mole and choriocarcinoma)
 multiple pregnancy.
In patients being treated for infertility, ovulation induction
with gonadotropins (FSH and luteinizing hormone [LH]), and
clomiphene citrate, may lead to ovarian hyperstimulation
syndrome, especially if accompanied by hCG administration

8. 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.

9. POLYCYSTIC OVARIAN SYNDROME (PCOS)

11. 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 may lead to formation of corpus luteum
cyst.

12. 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

13. 2. Hyperandrogenism. Patients may either show
signs of clinical hyperandrogenism or have
biochemical hyperandrogenism:
–Clinical hyperandrogenism: e.g hirsutism, acne, or
male pattern hair loss.
–Biochemical hyperandrogenism: Up to 90% of
women with PCOS have elevated serum androgen
concentration. However, the androgen levels may
be normal.

14. 3. 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
–Transvaginal ultrasound is more sensitive, but may
not be appropriate to perform in a young female.

15. History: Clinical presentation of ovarian
cysts
• The majority of ovarian cysts are asymptomatic.
• Pain or discomfort may occur in the lower abdomen.
Torsion (twisting) or rupture may lead to more severe pain.
• Patients may experience discomfort with intercourse,
particularly deep penetration.
• Having bowel movements may be difficult, or pressure may
develop, leading to a desire to defecate.

16. • Micturition may occur frequently and is due to pressure on
the bladder.
• Patients may experience abdominal fullness and bloating.
• Endometriomas are associated with endometriosis, which
causes a classic triad of painful and heavy periods and
dyspareunia.
• Patients with polycystic ovary syndrome presents
hirsutism, infertility, oligomenorrhea, obesity, and acne.
Note that infertility is not a rule.

17. 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.

18. Laboratory Studies:
• No laboratory tests are diagnostic for ovarian cysts except for
PCOS for which hormone assays are done:
FSH
LH
Testosterone
Oestradiol

19. Imaging Studies:
•Ultrasonography
•Doppler flow studies
•MRI
•CT scan

20. Medical Care:
•Many patients with simple
ovarian cysts based on
ultrasonography findings do not
require treatment.

21. Surgical Care:
• Persistent simple ovarian cysts larger
than 5-10 cm and complex ovarian cysts
should be removed surgically.
Laparotomy
Laparascopically

22. 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).

23. • Blood test - if there is a tumor 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.

24. • 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.

25. •Pregnancy test - a positive
result may suggest the
patient has a corpus luteum
cyst

26. Complications of ovarian cysts
• Torsion
• Rupture
• Hemorrhage
• ?Malignant change :remains unproven

27. Prognosis:
The prognosis for
benign cysts is
excellent