Ovarian Cysts Clinical Presentation

  • Author: C William Helm, MB, BCh, MA, FRCS(Edin), FRCS; Chief Editor: Michel E Rivlin, MD   more...
 
Updated: Apr 22, 2011
 

History

  • Most patients with ovarian cysts are asymptomatic but some cysts may be associated with a range of symptoms, sometimes severe.[8] Even malignant ovarian cysts commonly do not cause symptoms until they reach an advanced stage.
  • Pain or discomfort may occur in the lower abdomen. Torsion (twisting) or rupture may lead to more severe pain. An ovarian cyst that has undergone torsion is shown in the image below. An ovarian cyst that has undergone torsion (twistiAn ovarian cyst that has undergone torsion (twisting of the vascular pedicle). The patient presented with a short history of severe lower abdominal pain. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. No viable epithelial lining was available for histologic diagnosis.
  • 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.
  • Micturition may occur frequently and is due to pressure on the bladder.
  • Irregularity of the menstrual cycle and abnormal vaginal bleeding may occur. Young children may present with precocious puberty and early onset of menarche.
  • Patients may experience abdominal fullness and bloating.
  • Patients may experience indigestion, heartburn, or early satiety.
  • Endometriomas are associated with endometriosis, which causes a classic triad of painful and heavy periods and dyspareunia.
  • Polycystic ovaries may be part of the polycystic ovary syndrome, which includes hirsutism, infertility, oligomenorrhea, obesity, and acne.
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Physical

  • Advanced malignant disease may be associated with cachexia and weight loss, lymphadenopathy in the neck, shortness of breath, and signs of pleural effusion.
  • A large cyst may be palpable on abdominal examination. Gross ascites may interfere with palpation of an intra-abdominal mass.
  • Although normal ovaries may be palpable during the pelvic examination in thin premenopausal patients, a palpable ovary should be considered abnormal in a postmenopausal woman. If a patient is obese, palpating cysts of any size may prove difficult.
  • Sometimes, discerning the cystic nature of an ovarian cyst may be possible, and it may be tender to palpation. The cervix and uterus may be pushed to one side.
  • Other masses may be palpable, including fibroids and nodules in the uterosacral ligament consistent with malignancy or endometriosis.
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Causes

  • Multiple functional cysts can occur as a result of excessive gonadotropin stimulation or sensitivity.
    • In gestational trophoblastic neoplasia (hydatidiform mole and choriocarcinoma) and rarely in multiple or diabetic pregnancy, hCG is the stimulating gonadotropin. The condition is called hyperreactio luteinalis.
    • Patients being treated for infertility by ovulation induction with gonadotropins or other agents, such as clomiphene citrate or letrozole, may develop cysts as part of ovarian hyperstimulation syndrome.
  • Tamoxifen can cause benign functional ovarian cysts that usually resolve following discontinuation of treatment.
  • Risk factors for ovarian cystadenocarcinoma include strong family history, advancing age, white race, infertility, nulliparity, a history of breast cancer, and BRCA gene mutations.
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Contributor Information and Disclosures
Author

C William Helm, MB, BCh, MA, FRCS(Edin), FRCS  Professor, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St. Louis, MO

C William Helm, MB, BCh, MA, FRCS(Edin), FRCS is a member of the following medical societies: American College of Obstetricians and Gynecologists, European Society of Gynaecologic Oncology, and International Gynecologic Cancer Society

Disclosure: ThermaSolutions, Inc Grant/research funds Research Registry of patients treated with hyperthemic intraperitoneal chemotherapy; Sanofi-Aventis, Inc Grant/research funds Support for and investigator initiated research study of HIPEC for consolidation in ovarian cancer; ThermaSolutions, Inc Honoraria Speaking and teaching; UpToDate Royalty Online Text Book Chapters; Genzyme, Inc Honoraria Speaking and teaching

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

A David Barnes, MD, PhD, MPH, FACOG  Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)

A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD  Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

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An ovarian cyst that has undergone torsion (twisting of the vascular pedicle). The patient presented with a short history of severe lower abdominal pain. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. No viable epithelial lining was available for histologic diagnosis.
Endovaginal sonogram shows a striking echogenic mass lateral to the uterus, with posterior acoustic shadowing giving a "tip-of-the-iceberg" appearance. This is pathognomonic for dermoid cyst. Occasionally, this appearance may be mistaken for gas-filled bowel. Courtesy of Patrick O'Kane, MD.
A dermoid cyst (mature cystic teratoma) after opening the abdomen. Note the yellowish color of the contents seen through the wall.
A dermoid cyst has been opened in the operating room to reveal copious sebaceous fluid. This cyst also contained hair.
A dermoid cyst has been opened and contains teeth.
Theca-lutein cysts replacing an ovary in a patient with a molar pregnancy. Despite their size these cysts are benign and usually resolve after treatment of the underlying disease.
A 24-cm diameter multilocular right ovarian cyst is seen with adjacent Fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. Histology reported a mucinous cystadenocarcinoma of low malignant potential.
Transabdominal sonogram of a 24-cm diameter multilocular right ovarian cyst with adjacent Fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. This sonogram demonstrates a large, complex, cystic mass with vascularity within the septations. Red and blue colors show blood flow towards and away from the transducer. The resistive index was low. Histology reported a mucinous cystadenocarcinoma of low malignant potential. Courtesy Patrick O'Kane, MD.
The cyst in Images 7-8 has been removed and cut open. It has a smooth surface and a multicystic internal structure.
Cross-section of a clear cell carcinoma of the ovary. Note the cystic spaces intermingled with solid areas.
 
 
 
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