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Ovarian cyst

Synonym: functional cyst
German: Ovarialzyste

1 Definition

An ovarian cyst is a begnin, fluid filled tumor located in womens ovaries.

2 Etiology and pathogenesis

Ovarian cysts have various causes. This is used for the classification of different types of functional cysts:

2.1 Follicular cyst

In case of an absent ovulation, the Graafian follicle is maintained and keeps filling up with liquids. This leads to the development of a follicular cyst. This type of ovarian cyst is especially common for women with irregular menstrual cycles (young girls and older women who have reached menopause. Usually the follicular cysts regress spontaneously after 6-8 weeks.

2.2 Corpus luteum cyst

Corpus luteum cysts are formed from the yellow body of the ovary (corpus luteum). They can develop during pregnancy as well as during regular cycles. The content of the cysts is clear and shaded yellow. In general, the cysts to not become larger than 8cm.

Progesteron is produced by the granulosa cells which are located within the walls of the cyst. This leads to an absence of menstruation. This is also the reason why corpus luteum cysts should not be removed during early pregnancy. The progesterone is an important pregnancy maintaining hormone.

2.3 Granulosa theca lutein cyst

These types of cysts are caused by an imbalance of hormones. The most common cause is the artificial triggering of ovulation through the administration of hormones (most often HCG). Lutein cysts can become quite large (up to 20cm). They do however normally disappear after discontinuation of the hormone administration.

2.4 Chocolate cysts

Cause for the formation of chocolate cysts is endometriosis. The cysts are formed by blood of endometriosis locations. The name references the viscous, brownish content of the cysts.

2.5 Paraovarial cyst

The paraovarial cyst is a remnant of the embryological Wolffian duct and the mesonephros.

2.6 Polycystic ovaries

Polycystic ovaries are ovaries that contain multiple cysts. Even though it is a criterion for the polycystic ovary syndrome (PCOS), it should not be used as a synonym. PCOS can also be diagnosed in patients without any ovarian cysts.

With the PCOS, a dysfunction of the hormone balance leads to premature luteinizing. Within the walls of the cyst theca cells are present. These produce male sex hormones (androgens). This leads to an ovarian hyperandrogenaemia which disrupts the menstrual cycle and has the effect of virilization. Polycystic ovaries appear mostly bilaterally.

3 Symptoms

Functional Cysts are often an auxiliary finding. The patients often complain about irregular menstrual cycles including hypermenorrhea and amenorrhea. These are formed because of hormonal imbalances caused by the production of androgens and estrogens by the epithelial cells of the cysts.

Large Cysts can lead to discomfort and pain. There is also the danger of a cyst rupture.

4 Diagnosis

Important for diagnosing ovarian cysts is a detailed medical history of the patient. This should include questions about age, regularity of the menstrual cycle and about possible external intake of hormones (i.e. oral contraceptives). Sometimes cysts can be palpated during the bimanual, gynecological examination.

The best possibility for diagnosis is with vaginal ultrasound. The cyst presents as a smooth walled, space-occupying lesion with low echogenic content.

5 Therapy

Follicular cysts, corpus luteum cysts and follicular lutein cysts most often regress spontaneously and thus make a specific therapy obsolete. The sonographic follow up should happen after 6-8 weeks. When patients are experiencing pain spasmolytics can be administered.

Ovulation inhibitors prevent the development of cysts. They are indicated in the cases of recurring functional cysts.

In the case of very large cysts or if no spontaneous regress occurs, a laparoscopic removal of the cyst should be performed. Complications make an immediate therapy imperative.

6 Complications

6.1 Cyst rupture

When the thin wall of a cyst ruptures, its liquid content is released into the abdominal cavity. This leads to an irritation of the peritoneum which is accompanied by strong, acutely beginning pain (peritonism).

6.2 Cysts with ovarian torsion

It can happen that the ovary rotates around its own axis along the suspensory ligament of the ovary. This leads to clamping of the ovarian artery and ovarian vein. The patients suffer from severe pain that often suddenly occurs after a change in position or a quick movement. This torsion has the danger of leading to hemorrhagic infarction and an irreversible necrosis of the ovary. This makes an immediate laparoscopy to reduce torsion necessary in order to save the ovary.

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