7. ovarian cysts

Ovarian cysta are either physiological or benign or malignant ones.

1. Ovarian Masses or Enlargement Dr.Chaduvula Suresh Babu Professor Department of OBGYN GIMSR Visakhapatnam, AP, India

2. Ovary Develops from “ Genital ridge ”

3. Anatomy It is suspended in the pelvis between uterus and pelvic wall b y a suspensory ligament laterally and ovarian ligament medially It I supplied by ovarian arteries Venous drainage – Left renal vein and right aortic vein Lymphatic – Para aortic lymph nodes

4. Ovary

5. Ovarian masses 1. Non- Neoplatic 2. Neoplastic

6. Ovarian Masses I. Non-Neoplastic : A] Functional : 1. Follicular cyst, 2. Corpus Luteal Cyst 3. Theca Lutein Cyst 4. Haemorrhagic Cyst 5. Luteoma of Ovary in Pregnancy B] Pathological : 1. PCOS 2. Chocolate cyst or Endometriotic cyst 3. Tubo -ovarian mass

7. Ovarian Masses C ] Others : [Embryological defect] 1. Para-ovarian Cyst 2. Para- fimbrial Cyst II. Neoplatic : A] Benign tumours B] Borderline or Tumours of Lo Malignant PotentialPM C] Malignant tumours

8. Cyst Collection or retention of excess fluid in preformed cavities resulting in enlargement of ovary Not capable of proliferation [mostly]

9. Follicular Cyst Functional Cyst Failure to break – 3 to 6 cm, unilocular, thin walled, straw coloured fluid Persistence of Immature follicles Asymptomatic , regress in 6 weeks Accidental/ incidental pick TA/TV USG Conservative treatment OC pills

10. Corpus luteum cyst Persistence of corpus luteum 3-6 cm Unilocular, thick wall, yellowish orange colour Asymptomatic, resolves in 6 – 12 weeks Pain DD – Ectopic pregnancy. Diagnosis – TA/TV UG Conservative S urgery

11. Theca Lutein Cysts Bunch of Cyst, grey – blue, honey combed pic Straw coloured fluid Bilateral 2mm to 30 cm Asymptomatic Pain abdomen Asso.with – Hydatidiform mole Twin Pregnancy HCG therapy in infertility Conservative treatment

12. Hemorrhagic Cyst Bleeding into either corpus luteum or follicular cyst Acute Pain abdomen Diagnosis – USG Expectant treatment Surgery – like cystectomy

13. Torsion Cyst Any cyst with a long pedicle Complete or partial Acute abdomen Diagnosis – UG Treatment – Salipingooopherectomy

14. Pregnancy Luteoma Asso . with pregnancy Androgen production Virilisation of mother and masculinization of female foetus Presents as discrete, single or multiple nodules in luteinized stroma Recur in subsequent pregnancy Conservative / Cystectomy

15. PCOS Enlarged ovaries with peripherally situated cysts Each cyst measures from 2-9 mm with stromal hyperplaia Infertility, Hirsutism , menstrual disturbances Diagnosis – UG – necklace pattern distribution of cysts Hormonal assay Metabolic profile

16. PCOS Treatment Life style modification OC Pills OC pill with cyproterone acetate or spironolactone Metformin and Clomiphene citrate for infertility Lap. Ovarian drilling

17. Endometriotic or Chocolate Cyst Asso . w ith endometriosis Sampon’s theory Cyst with tarry or chocolate coloured fluid Few cm to 20 cm Pain, Infertility, Dyspareunia Diagnosis - USG Enucleation or Cystectomy GnRH analogues or Danazole

18. Massive oedema of Ovary Partial obstruction of the vessels and lymphatics in torsion ovary, unilateral Accumulation of fluid in ovarian stroma soft, pearly white cyst Diffuse edema in medulla and inner cortex Few cm to 25 cm Pain abdomen/ menses disturbed Diagnosis - USG with doppler Enucleation or cytectomy

19. Paratubal and Paraovarian Cysts Located adjacent to fallopian tube or ovary Arises from remnants of either proximal or distal wolfian duct epithelium Asymptomatic or Pain abdomen Diagnosis - USG Cytectomy

20. Hydatid Cyst of Morgagni Evaginations from the tube single or multiple Few mm to 2cm Asymptomatic Infertility Excision

21. Thank You All