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Benign Lesions of the Ovaries

Dysfunctional Ovarian Cysts

Follicle cysts of the ovary are the most common cystic structures found in healthy ovaries. These cysts arise from temporary pathologic variations of a normal physiologic process and are not neoplastic. The tumors result from either failure of a dominant mature follicle to rupture or failure of an immature follicle to undergo the normal process of atresia. Many follicle cysts lose the ability to produce estrogen; in other instances, the granulosa cells remain productive, with prolonged secretion of estrogen.

Solitary follicle cysts are common and occur during all stages of life, from the fetal stage to the postmenopausal period. Follicle cysts are lined with an inner layer of granulosa cells and an outer layer of theca interna cells. The cysts are thin-walled and unilocular, usually ranging from several millimeters to 8 cm in diameter (average, 2 cm). Usually, cysts with dimensions less than 2.5 cm are classified as follicles and therefore are not of clinical significance.

Corpus luteum cysts are less prevalent than follicular cysts. They mainly result from intracystic hemorrhage and may be seen in the second half of the menstrual cycle. They are hormonally inactive but may tend to rupture with intraperitoneal bleeding, especially in patients on anticoagulant therapy.

Treatment

Generally, no treatment is required, and many of these cysts resolve spontaneously within 6-12 weeks.

In all postmenopausal women with a pelvic mass, the cancer antigen 125 (CA-125) level, though an imprecise indicator, should be ordered and pelvic ultrasonography performed. (Newer markers for ovarian cancer are on the horizon.) If the CA-125 level is elevated or the ultrasonographic features of the mass suggest malignancy, the patient should be referred for evaluation by a gynecologic oncologist. In premenopausal women with a pelvic mass, an ultrasonogram generally suffices for the initial evaluation and often for follow-up as well.

In rare situations (eg, torsion, rupture, and hemorrhage), operative intervention may be needed to treat these cystic masses.

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