Types of ovarian cysts

 

The most common cysts in women of reproductive age are: the endometriotic (endometriomas), the dermoid and the cysts with clear content (bloody or mucoid).

Dermoid cysts

Removal of a dermoid cyst with laser laparoscopic surgery (laparoscopic image).

Removal of a dermoid cyst with laser laparoscopic surgery (laparoscopic image).

Dermoid cysts or mature teratomas are in general benign cysts. They comprise of a single cavity that is usually filled with puss, hair, bone tissue elements, teeth etc. These findings are usually mature tissue, while other types of tissue may also be found. Very rarely, there is the possibility of malignant cells to be found in its contents and that is why the histological examination is of great importance.

VIDEO: Dermoid cyst.

Their removal with laser laparoscopic surgery has an advantage over laparotomy as almost the entire healthy tissue remains untouched. Sometimes, the detachment of the cyst can be hard and thus great experience is required from the surgical team. The removal of the cyst from the abdomen is done with its placement in a special endoscopic pouch.

Paraovarian cysts

Paraovarian cysts develop in the mesosalpinx (the space between each fallopian tube and its neighbouring ovary) and they are embryonic remnants of the Wolf's and Gartner's ducts (structures equivalent to the spermatic duct in men). They constitute benign cysts and they should be differentiated from paratubal cysts.

Special attention is needed for paraovarian cysts in women of reproductive age in order to avoid any trauma in the fallopian tube, which is elongated and sometimes hard to distinguish on the surface of the cyst.

Laser laparoscopic surgery is the ideal solution for the removal of such cysts.

A: Left paraovarian cyst. The uterus, left ovary and oviduct are also visible. B,C: Removal of the cyst cortex using laser CO2. D: End of operation. All anatomical relations have been reinstated and the left oviduct remains untouched.

A: Left paraovarian cyst. The uterus, left ovary and oviduct are also visible.
B,C: Removal of the cyst cortex using laser CO2.
D: End of operation. All anatomical relations have been reinstated and the left oviduct remains untouched.

Paratubal cysts

Cystic degeneration of the fimbriae (laparoscopic image).

These cysts are a continuation of the fallopian tubes, they are usually found in the fimbrial part of the fallopian tube and they represent cystic degeneration of the cilia of the fimbriae and hydatid cysts of Morgani.

These cysts do not constitute an indication for surgical approach and they are only treated laparoscopically if they are found during a laparoscopy performed due to another reason.

Functional cysts

Functional cysts of the ovaries are managed conservatively, unless complications arise, such as torsion, rupture and haemorrhage, which are treated laparoscopically. The term functional cysts of the ovaries, refers to the cysts of the follicle and the cysts of the corpus luteum.

Follicular cysts

Cysts of the follicle appear quite often during reproductive age range and are a result of Graafian follicle rupture failure in cases of unovulation. Their diameter ranges between 4-10 cm. They usually absorb on their own after 2-3 menstrual cycles or they rupture and they rarely persist. The administration of contraceptive pills or progesterone preparations may aid their disappearing. In young women of reproductive age, the contents of the cysts can be aspirated via a transvaginal, ultrasound guided paracentesis and sent for cytological examination. Ofcourse, criteria for the exclusion of any malignancy (ultrasound criteria for vascularisation with transvaginal Doppler ultrasound and indicators such as CA-125) should be taken in mind. However, generally none of these criteria can totally ensure that the cysts are functional and benign.

Corpus luteum cysts

They develop after ovulation and they represent the cystic transformation of the corpus luteum. Usually, they do not cause any symptoms or they may appear as a persistent corpus luteum and also they subside on their own.

They are of unknown cause and when they are many, they are usually seen after administration of ovulation induction drugs. They are more common in women with unexplained subfertility and high FSH values on day 3 of the menstrual cycle. The diagnosis is usually made with ultrasound, hormone assessment and clinical examination. In rare instances of cyst rupture, when it is haemorrhagic, the symptoms are caused by large intra-abdominal haemorrhage and they are similar to those of ectopic pregnancy. Such conditions are mainly managed laparoscopically.

Luteinized unruptured follicle syndrome (LUFS)

This refers to a disorder of the follicle and not the corpus luteum. In such instance, the follicle may luteinize and differentiate to corpus luteum (secreting progesterone) without rupturing and without allowing the oocyte to be released. The luteinized unruptured follicle syndrome may occasionally occur but it is not clear whether it constitutes a major cause of subfertility.

Persistent corpus luteum

It is a prolongation of the life span of the corpus luteum. The corpus luteum does not subside after around 14 days following ovulation, although no pregnancy has been established. The end of the corpus luteum functioning is known as luteolysis. The causes of luteolysis are many, although its mechanism remains unclear. The persistent corpus luteum causes a prolongation of variant time span of the secretive phase of the menstrual cycle. Clinically, this condition shows up with amenorrhoea. The continually produced progesterone supports the endometrium in a secretive phase. The diagnosis is made from the medical history and the aid of an ultrasound. The persistent corpus luteum results in a menstrual cycle disorder, although it does not constitue a major cause of subfertility.