Ovarian cyst

The ovaries are two small organs located on either side of the uterus within the abdominal cavity.

An ovarian cyst is a formation on the ovary. It can be liquid content or other tissues.
Ovarian cysts are very common in young women. In most cases are benign cysts, but on rare occasions may be malignant.

Adnexal mass is a nonspecific term that refers to enlargement in the area adnexal, (including the ovaries and fallopian tubes) and can be felt in the exploration or detected on imaging tests.

There are several types of ovarian cyst:

  • Functional cysts: follicular cysts, corpus luteum
  • Dermoid cysts
  • Cystadenomas
  • Endometriomas
  • Cysts or malignant Borderline
  • Other

Functional cysts

Hormonal origin are cysts that occur most often in young women. They occur in the normal ovarian cycle of women, They can be follicular cysts and corpus luteum cysts.

Follicular cysts

The follicle fails to break open to release the egg, the liquid remains deltro follicle and follicular cyst forms. They are liquid content.

Corpus luteum cysts

They occur when the egg has already been released from the follicle and , menodo to have a small amount of blood inside. They appear after ovulation and take time (until months) disappear.


  • If the cyst is small it can be asymptomatic.
  • Generally they produce few symptoms.
  • Usually they disappear 1-3 months.

Dermoid cysts

Also called mature teratoma. This type of cyst is of embryonic origin. It presents components of tissues originating from all three germ layers. They may contain skin, fur, fat, teeth. They can be present at birth, and affect young women. They can affect both ovaries. They can grow very large and cause pain.


Such cysts arise from the cells that line the surface of the ovary. They may have a liquid content or mucosal dense. They are benign tumors.


Cyst Endometrioma is formed by the presence of endometriosis in the ovary. Also it called "chocolate cyst". Endometriomas are formed by the bleeding from the peeling endometrial tissue within the ovary.


  • If the cyst is small it can be asymptomatic
  • Pain
  • Ovarian cysts can be twisted, causing pain. It requires surgical treatment.
  • They may bleed or figure, resulting in irritation of the peritoneum. Requiuere immediate surgical treatment.

Malignant tumors of the ovary

Although most ovarian cysts are benign, It is very important to rule that it is borderline malignant tumors or tumors. (Of low malignant potential).

There are a number of warning signs that women should consider and consult a specialist:

Alarm signs and symptoms of ovarian cancer

  • Bloating
  • Pelvic or abdominal pain
  • LBP
  • Abdominal circumference growth
  • Inappetence, inability to eat
  • Unexplained weight loss
  • Need to urinate more frequently or incontinence
  • Constipation
  • Fatigue
  • Digestive problems.

Diagnosis of ovarian cysts

  • Clinical examination: The pelvic exam in preventive visit may reveal enlargement of the ovary
  • Transvaginal ultrasound / abdominal:It is the most appropriate initial diagnostic test for the characterization of an adnexal mass. It can be combined with ultrasound through the abdomen if necessary.

Sonographic detection of high risk of malignancy

Size greater 10 mm

No hyperechoic solid component: Buds or nodular inside the cyst

Thick septa

Irregular masses, ill-defined boundaries

Presence of vascularization in the solid component.

Ascites (free fluid within the abdominal cavity)


Peritoneal masses or lymphadenopathy

There are some recommendations terminology, basic definitions and measurements to describe the sonographic features of ovarian tumors, and the systematic exploration. These recommendations have been proposed by the IOTA group (International Ovarian Tumor Analysis), which brings together an international group of experts.

The IOTA group has proposed a predictor risk index (IOTA LR2) what includes 6 variables: age 5 sonographic parameters. This index IOTA LR2 has a very high sensitivity to detect malignant lesions. The IOTA group also proposes a simpler model "Simple Rules" of such utility and LR2, easier to perform.

The model "Simple Rules" has been developed to help classify as benign adnexal masses (B-Rules) or malignant (M-Rules). The presence of a variable included in M- rules recommended referral to specialist center.

ADNEX model. It is a recently proposed model for the IOTA group to facilitate the classification of benign adnexal tumors, borderline, invasive cancer in advanced stages and initials, metastasis. It includes variables: age, CA125, type of school and 6 sonographic variables. With the calculation result a risk percentage of benign or malignant is obtained. It is available online.

Risk of Malignancy Index (MRI) .Other scores have been proposed, as the risk of malignancy index. An estimated variables including ultrasound, Serum CA125 and menopausal status. Its application in many centers is not routine, not getting enough sensitivity.

  • Laparoscopy. It allows the diagnosis of security, and performing treatment in some cases.
  • Tumor marker determinations: Serum levels may suggest that it is a benign or malignant tumor, and can help determine the type of tumor.
  • Tumor markers

THAT 125. There are multiple tumor markers, However, THAT 125 remains the reference marker now, although it has some limitations. It is recommended to determine in postmenopausal women with ovarian mass, and in premenopausal women with suspected ovarian mass. Recommended not perform in premenopausal women with low-risk simple cyst.

HE4. (Human epididymal protein.) It is a marker on which attention has recently. Its sensitivity is similar or slightly higher than CA125. However, It is more specific, in post and premenopausal. It can be used in premenopausal patients.

ROMA (Algorithm risk of ovarian malignancy). CA125 is combined algoritmo, HE4 along with status of pre or post menopause. This is a recent proposal of great interest, but it has its limitations.

Test OVA1. It is a test that includes 5 serum biomarkers. Currently it is not included in our recommendations, by low availability and price.

The aim of Rome and OVA 1 It is to detect the likelihood of malignancy of adnexal mass suspicious, to refer to a specialized center.

LDH, βHCG, αFP. They are markers of germ cell tumors and sex cord. Solictarlos recommended in children and adolescents with mass determination anexiales.RCOG recommends every woman < 40 years with complex adnexal masses.

  • Other tests of diagnostic imaging: MRI, allows the differential diagnosis of ovarian tumors. 3D ultrasound.


There are several treatment options, depending on the age of the woman, risk factor's, the characteristics of the cyst, producing symptoms, tumor marker levels.

  • Watchful: Functional cysts and cysts in low risk.
    Oral contraceptives
  • Surgery. Surgery is indicated in low-risk cysts large size, or cyst that causes symptoms.
  • In the case of suspicious or malignant ovarian tumors Borderline has to perform a specific treatment management and clinical guidelines for ovarian cancer.

The type of surgery and the surgical approach in case of low-risk cysts depends on

  • Cyst size and type
  • Age of the patient
  • Gestational desire of women

You can be performed:

  • Cystectomy (cyst excision without removing the ovary).
  • Ovariectomía u ooforectomía (removal of the whole ovary with the cyst.
  • It can also be done adnexectomy (removal of the ovary with the fallopian tube).

Generally, the approach of choice is laparoscopic, although sometimes it may be necessary to open surgery (laparotomy).