ovarian cyst; adnexal cyst; includes ovarian incidentalomas

Epidemiology

• 15% of postmenopausal women at autopsy have cysts > 4 mm in diameter (> 95% benign)
  • ovarian cancer is rare in premenopausal women

Pathology

• most ovarian masses in pregnancy resolve spontaneously, especially if 1st trimester, < 5-6 cm, simple (smooth, thin walls, no septations)

Diagnostic procedures

• pelvic ultrasound
  • repeat in 3 months to evaluate growth of cyst
• do NOT aspirate cyst
  • cyst fluid reaccumulates in ~25% of patients within 1 year
  • aspiration of a malignant cyst can cause seeding of the abdomen & spread of malignancy

Complications

• ovarian hemorrhage
• ovarian torsion, rupture
• obstruction of labor

Management

• observation
  • an asymptomatic unilateral ovarian cyst <10 cm with no concerning features on ultrasound may be observed
• oral contraceptives
• referral to gynecologist
• surgical evaluation when cyst is symptomatic or when it has septations, thickened walls, or a mix of solid & cystic components
  • an otherwise benign-appearing cyst with a single septation in an asymptomatic woman does not require surgical evaluation

More general terms

• cyst
• ovarian neoplasm
• incidentaloma

More specific terms

• corpus luteum cyst

Additional terms

• pelvic pain
• Stein-Leventhal (polycystic ovary) syndrome