2. Ovarian cycle
01.
I’m bored already….
The disease
02.
Clinical features
03.
Diagnosis
04.
All types can be diagnosed via
pelvic ultrasound
Treatment
05.
Complications
06.
1. Ovarian torsion
2. Ruptured ovarian cyst
Table of contents
• Overview of the
disease
• Types
4. ● Follicle: nang noãn
- women begin puberty with about 300,000 to 400,000 of them
● Primary oocyte: noãn bào I
● Granulosa cells: tế bào hạt
- Produce sex steroids: estrogen, progesterone, inhibin
● Theca cells: tế bào vỏ nang
- Receptors for LH
Follicles compete to grow FASTEST = DOMINANT FOLLICLE
Others die off = atresia
6. - Ovarian cysts are fluid-filled sacs within the ovary
02. The disease
Ovarian cyst
Functional Non - Functional
1. Follicular cyst
2. Corpus luteum cyst
3. Theca lutein cyst
1. Cystadenoma (serous or
mucinous)
2. Dermoid cysts (teratoma)
3. Chocolate cysts
7. 1. Follicular cyst
- De Graff follicle does not rupture and release the egg but continues
to grow
- Eventually develops into a large cyst (7cm)
- Associated with hyperestrogenism and endometrial hyperplasia
-Functional-
•thin walled and unilocular
•usually range around 3 to 8 cm
in size
•there is typically posterior
acoustic enhancement and an
absence of internal echoes
•there should be no color flow,
nodules or or any solid
components.
8. 2. Corpus luteum cyst
- Enlargement and buildup of fluid in the corpus luteum
- Produces progesterone, which may delay menses
- Associated with progesterone-only contraceptive pills and
ovulation-inducing medication
- Common during pregnancy
-Functional-
• a thick walled cyst with
characteristic "ring of fire"
peripheral vascularity.
• It usually has a crenulated
inner margin and internal
echoes.
9. 3. Theca lutein cyst
- Result from exaggerated stimulation of the theca cells due to
excessive amounts of circulationg gonadotropins such as beta-hCG
- Often multiple cysts that typically develop bilaterally
- Strongly associated with gestational trophoblastic disease and
multiple gestations
- Usually resolve once beta-hCG levels have normalized
-Functional-
Bilateral enlarged, multicystic ovaries. The cysts are
classically thin walled and have clear contents.
10. 1. Cystadenoma
(serous or mucinous)
- A benign ovarian tumor of epithelial origin
- Frequently bilateral
-NonFunctional-
typically small (i.e. less than
5 cm), smooth walled and
have no septations or solid
components
11. 2. Dermoid
cysts/Teratoma
- These cysts may contain hair, teeth or nerves
- Can form not only in ovary but on the head, neck or spine
- High risk of malignant so usually treated with complete surgical
excision
-NonFunctional-
• a cystic adnexal mass with some
mural components.
• Most lesions are unilocular
12. 3. Chocolate cysts
- A cyst-like ovarian structure that contains blood, fluid and
menstrual debris
- Caused by endometriosis
-NonFunctional- • solid, hypoechoic, irregular masses
• little or no blood flow on color Doppler
13. 03. Symptoms of the disease
• Usually asymptomatic unless complications occur
• Adnexal mass that is sometimes palpable
• Possibly signs of the underlying cause, such as:
- Menorrhagia in endometriosis
- Hirsutism, acne and infertility in polycystic ovary syndrome
14. 04. Diagnosis:
Pelvic ultrasound
General findings
- Smooth lining on all sides
- Single (eg: follicular cyst, corpus luteum
cyst) or multiple (eg: polycystic ovary,
multilocular theca lutein cysts)
15. IOTA Simple rules
On ultrasound
Tumor marker
1. CA 125
2. HE4
3. AFP
MRI
• prediction of the histologic nature
of a variety of benign adnexal
masses
• Superior in diagnosing tumor
invasion and adhesion
Biopsy
Exact answer to the origin of the mass
Malignant or benign?
ROMA test
16. 05. Treatment
Non-surgical Surgery
• Functional cysts: watchful
waiting, as cysts often regress
spontaneously
• NSAID: painful cysts
• Complications
• Large cysts
• Persistent cysts that are
painful
• Cancerous
01. 02.
20. 06. Ovarian torsion
01 β-hCG
To rule out pregnancy
02
Transabdominal
/transvaginal
pelvic ultrasound
• Enlarged, edematous ovary with decreased blood flow
03
CT abdomen and
pelvis with IV
contrast
• Enlarged ovary
• Deviation of the uterus to the same side
• Decreased contrast enhancement of the affected ovary
21. Etiology
● Rupture is caused by an increase in
intracystic pressure
● Most common type of ruptured cyst:
corpus luteum cyst
● Risk factors:
- Vigorous physical activity
- Vaginal intercourse
- Large cysts
- Reproductive age
06. Ruptured ovarian cyst
22. Cause pain
Sudden-onset unilateral
lower abdominal pain
06. Ruptured ovarian cyst
Cause bleeding
Minimal vaginal bleeding may
occur. In case of significant
hemorrhage: hypovolemic
shock
Cause pelvic pain Sharp pain on one side of the
pelvis
Cause nausea
and vomiting
23. 06. Ruptured ovarian cyst: diagnotics
01 β-hCG
Obtain in all patients to exclude intrauterine or ectopic
pregnancy
02 CBC
May show anemia
03
Transabdominal
/transvaginal
pelvic ultrasound
• Free fluid, most commonly in the pouch of Douglas
• An adnexal mass may be visualized if the cyst is large
• Disadvantage: cannot reliably distinguish between
ruptured ovarian cyst or ruptured ectopic pregnancy in
pregnant patient
04
CT pelvis with IV
contrast
• Consider in nonpregnant patients if ultrasound findings
are inconclusive
• Pelvic hemoperitoneum
25. Ovarian torsion Ruptured ovarian cyst
Surgery with adnexal detorsion and
preservation of ovaries
- Hemodynamically unstable: suturing the
ruptured section /ovary
- Hemodynamically stable: conservation
management with analgesics and
observation
Treatment
26. CREDITS: This presentation template was created by Slidesgo,
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CREDITS: This presentation template was created by Slidesgo,
including icons by Flaticon and infographics & images by Freepik
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