Based on Russian literature and english literature DC Dutta.

1. Functional ovarian cyst and its
differential diagnosis
функциональная киста яичников и
дифференциальная диагностика с кистой
By Cheng Jin Ting (Group 85)

2. Anatomy of Ovary
The functional unit of the ovary containing
a primary oocyte surrounded by one or
more layers of supportive cells; they
develop during embryonic life, but remain
dormant until puberty; at puberty, under
the influence of FSH and LH from the
anterior pituitary, they begin a sequential
developmental cycle, the ovarian cycle,
and a few each month, begin the cycle
leading to ovulation; the developmental
stages consist of the primordial follicle,
primary follicle, secondary follicle, and
Graafian follicle.

3. Enlargement Of Ovary
➔ Non-neoplastic: Its usually due to accumulation of fluid inside
the functional unit of the ovary.
➔ Neoplastic

4. Characteristic
➔Related to temporary hormonal disorders.
➔Sometimes confused with neoplastic cyst but can
be distinguished by the following features: •
◆ Usually 6–8 cm in diameter, asymptomatic. •
◆ Spontaneous regression usually following correction
of the functional disturbances to which it is related. •
◆ Unilocular. •
◆ Contains clear fluid inside unless hemorrhage
occurs. •
◆ Lining epithelium corresponds to the functional
epithelium of the unit from which it arises.

5. Type of Ovarian cyst
Cyst is not capable of proliferation, formed as a result of the retention of excess
fluid in the preformed cavities and cause enlargement of ovary.
❖ Follicular cyst
❖ Corpus luteum cyst
❖ Theca lutein cyst
❖ Paraovarian cyst
❖ Endometrial cyst

6. Follicular Cyst
➢ More than 3cm (Follicle <3cm), may reach up to 10cm, normally 6-
8cm
➢ Result of persistant unrupture Graafian follicle, and become larger in
size
➢ Usually multiple and small as seen in cases of cystic glandular
hyperplasia of the endometrium or in association of fibroid.
➢ Cause hyperestrogenism and chronic anovulation (single-phase
menstrual cycle)
➢ Detection is made accidentally on bimanual examination,
sonography, laparoscopy or laparotomy.
➢ May remain asymptomatic/ produce vague pain

7. Follicular cyst (cont.)
● Complication: cyst torsion (as a result of impaired venous circulation, edema
of the tissue and hemorrhage), cyst wall rupture, hemorrhage
● Clinical manifestation: severe lower abdominal pain a/w nausea+ vomit
● Gynecological examination: the follicular cyst is palpable laterally or anterior
to the uterus- elastic consistency, more often one-sided, rounded, with a
smooth surface, 5-6 cm in diameter, mobile, and not very painful. Bilateral
follicular cysts are often the result of ovarian hyperstimulation in the treatment
of infertility.
● Diagnosis: doppler, ultrasound, laparoscopy

9. Follicular cyst (cont.)
➔Uncomplicated cyst
 observed for 6-8 weeks with anti-inflammatory or (according to indications) hormonal therapy
➔Increase size (ineffective medical treatment)/ rupture case causing acute abd
pain: surgical treatment (laparotomy)
◆ After surgical treatment: (normalize menstrual cycle)
● Cyclic vitamin therapy (folic acid, ascorbic acid, vitamin E),
● Nootropic drugs (piracetam)
● Contraceptive drugs for 3 months
 Perimenopausal period: the uterine appendages cyst side are removed.

10. Laparotomy

11. Corpus luteum cyst

12. Corpus luteum cyst (cont.)
● Fail to regress after releasing of ovum (14th day) due to excessive
hemorrhage, instead enlarge with or without hemorrhage
● Found at 16-45 yrs old
● Secretion of progestrone and estrogen continue, in spite of blood filled cyst
○ As a result, the menstrual cycle may be normal or there may be amenorrhea or delayed cycle.
● Clinical manifestation:
○ Heavy or continued bleeding
○ Acute abdomen

13. Corpus luteum (cont.)
● Bimanual examination: the cyst of the yellow body is located mainly on the
side or back from the uterus
● Investigation:
❖Ultrasound
❖Color doppler
❖CT
❖MRI

14. Ultrasound
Corpus luteum body
filled with blood

15. Color doppler
May show no vascularity or low resistance of blood flow, also known as hypervascular-
ring of fire.

16. Theca lutein cyst (cont.)
● Usually bilateral
● Due to high secretion of hCG (human chorionic gonadotropin) in cases of:
○ Hydatidform mole
○ Administration of gonadotropin or clomiphene (induce ovulation)
○ Multiple gestation
○ Choriocarcinoma
● Regress after gonadotropin fall
● Bilateral enlarged, multicystic
ovaries.
● Multilocular appearance

17. ● Bilateral enlarged,
multicystic ovaries.
● Multilocular appearance

20. Paraovarian cyst
● Located between the sheet of the broad ligament
of the uterus. They arise from the rudiments of the
mesonephric duct (epoophoron=paraovary) and
coelomic epithelium.
● Mainly in women 20-40yrs old
● Asymptomatic, pelvic pain in pt with large lesion
● Acute abdomen
● Since paraovarian cysts are observed in young
patients, operative laparoscopy is preferable to
prevent adhesion. With an uncomplicated cyst,
the operation is reduced to its enucleation
★ Thin walled, smooth margin,
unilocular cyst
★ 5-15cm
★ Round or oval shape

21. Endometroid cyst (Chocolate cyst)
●Bilateral, size: 10-12cm
●Due to endometriosis. The resulting endometriotic foci are functionally active and hormone
dependent, so they are cyclically subjected to a menstrual-like reaction
●develops in women of reproductive age (30-50 years)
●Symptoms: dyspareunia, dysmenorrhea, lower abdomen and lower back pain, acute
abdomen (rupture of cyst capsule), intoxication sx ( weakness, nausea and fever), prolonged
case- with bowel and bladder impairment ( constipation, urination disorder)
●Treatment: conservative (hormonal, nonspecific anti-inflammatory and analgesic therapy,
administration of immunomodulators, vitamins, enzymes), surgical (organ-preserving
removal of endometriotic foci with laparoscopic or laparotomic access) or combined.

22. Endometroid cyst
● Complication: peritonitis, infertility
● Diagnosis: ultrasound, MRI, color doppler

23. Differential diagnosis
● Ectopic pregnancy
● Ovarian tumor
● Acute appendicitis
● Genitourinary disease
● Gastrointestinal disease

24. Differential Diagnosis with ovarian cancer
●Dense consistency, which can reach huge proportions.
●It is usually located behind the uterus in the region of the posterior fornix,
●Often ascites
●The reliability of the diagnosis is estimated by the duration of the disease, given
by ultrasound, CT, CA-125, laparoscopy. X-ray examination of the stomach,
EGDS, intestines is mandatory in detecting ovarian tumors.

26. Reference
●http://www.krasotaimedicina.ru/diseases/zabolevanija_gynaecology/endometrioi
d-ovarian-cyst
● Doctrina perpetua gynaecology
● Dutta gynaecology
●http://vmede.org/sait/?page=18&id=Ginekologija_baisova_2011&menu=Ginekolo
gija_baisova_2011