Chapter 136 Ovarian Cysts
THE CHALLENGE
Description: An ovarian cyst is a cystic growth within the ovary, generally arising from epithelial components and most often benign.
Scope of the Problem: Benign ovarian tumors are most frequently diagnosed at the time of routine examination and are asymptomatic. When symptoms do occur, they generally are either catastrophic (as when bleeding, rupture, or torsion occur) or indolent and nonspecific (such as a vague sense of pressure or fullness).
Objectives of Management: The most important objective of the management of an ovarian cyst is the timely diagnosis of its type and origin. Subsequent therapy and assessment of risk is based on the correctness of the diagnosis. For acutely symptomatic cysts, rapid evaluation and intervention may be necessary.
TACTICS
Relevant Pathophysiology: Approximately 90% of ovarian tumors encountered in younger women are benign and metabolically inactive. More than 75% of the benign adnexal masses are functional. Functional cysts are not true neoplasms; rather, they are anatomic variants resulting from the normal function of the ovary. Follicular cysts occur when ovulation fails to take place, leaving the developing follicle to continue beyond its normal time. In a similar manner, the corpus luteum may persist or, through internal bleeding, enlarge and become symptomatic. Approximately 25% of ovarian enlargements in reproductive-age women represent true neoplasia, with only approximately 10% being malignant. The largest group of benign ovarian tumors is those that arise from the epithelium of the ovary and its capsule. Despite the diversity of tumors with epithelial beginnings, the most common ovarian tumor in young reproductive-age women is the cystic teratoma, or dermoid, which is germ cell in origin. These tumors are derived from primary germ cells and include tissues from all three embryonic germ layers (ectoderm, mesoderm, and endoderm).
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