ovarian cyst

Fibrous
dysplasia for radiologists: beyond ground glass bone matrix. Bilateral ovarian cysts in McCune-Albright syndrome (red arrows)
insightsimaging.springeropen.com • Open Access
Teenager
after a motor vehicle accident. Axial CT with contrast of the pelvis shows a distended contrast-filled bladder in the center of the image and contrast in the distal left ureter adjacent to the normal left ovary and contrast in the distal right ureter adjacent to the right ovary which contains a round low density lesion in its center. There is also a small amount of physiologic free fluid in the pelvisThe diagnosis was right ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Female
teenager with right lower quadrant pain, normal WBC and a negative pregnancy test. Transverse transabdominal US of the pelvis (above) shows a round mass of mixed echogenicity that is inferior to the bladder and to the right of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature with several much smaller cysts around it.The diagnosis was a simple ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Female
teenager with pelvic pain, normal WBC and a negative pregnancy test. Transverse transabdominal US of the pelvis (above) shows a round anechoic mass that is inferior to the bladder and to the left of midline uterus. Sagittal magnified US of the mass (below) shows it to be within the ovary and anechoic in nature.The diagnosis was a simple ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Female
teenager with right lower quadrant and pelvic pain, normal WBC and a negative pregnancy test. Sagittal transabdominal US of the pelvis shows a diffusely hyperechoic mass in the right adnexa that was within the right ovary.The diagnosis was hemorrhagic ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Female
teenager with left lower quadrant pain. Coronal (left) and axial (above left) CT with contrast of the abdomen shows a large, simple, fluid-filled structure above the bladder which is arising from the left ovary. Axial CT (below right) obtained more inferiorly shows a second, smaller, fluid-filled structure in the midline between the uterus and rectum which is in close association with the right ovary which is just to the right of the uterus.The diagnosis was a large left ovarian cyst and a right paraovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Female
teenager with acute right lower quadrant pain. Sagittal grayscale US of the right ovary (above) shows the right ovary to be enlarged and to contain a large central hypoechoic cyst. The right ovary was 4 times larger in size than the normal left ovary. Sagittal spectral doppler US of the right ovary (below) shows arterial flow to be present in the right ovary, but the amount of arterial flow was decreased when compared to the arterial flow to the left ovary.The diagnosis was ovarian torsion around an ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Teenager
female with acute right lower quadrant pain. Surgical laparoscopic image (above) shows an enlarged grayish-white necrotic appearing right ovary in the midline of the pelvis in the center of the image. Upon closer inspection (below) the pedicle of the right ovary is seen to be twisted.The diagnosis was right ovarian torsion due to an ovarian cyst.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Ovarian cysts are commonly encountered in gynecological imaging, and vary widely in etiology, from physiologic, to complex benign, to neoplastic.

Pathology

Small cystic ovarian structures should be considered normal ovarian follicles unless the patient is pre-pubertal, post-menopausal, pregnant, or the mean diameter is >3 cm (see the 1-2-3 rule).

Types of cysts

Radiographic features

Ultrasound is usually the first imaging modality for assessment of ovarian lesions.

Imaging features of simple ovarian cysts:

A cyst may become large enough to obscure the ovary from which it is arising.

Radiology report

The Society of Radiologists in Ultrasound made in 2019 the following recommendations regarding reporting of simple adnexal cysts of suspected ovarian origin based on size and menopausal status :

  • premenopausal women
    • ≤3 cm: no need to report; if described, consider calling a "follicle" rather than a "cyst" to reduce patient anxiety
      • impression: normal ovaries/adnexa
      • recommendation: no follow-up
    • >3 to ≤5 cm: report presence of simple cyst(s) and largest cyst diameter
      • impression: benign finding in the physiologic size range
      • recommendation: no follow-up
    • >5 cm: report with all cyst diameters
      • impression: benign simple cyst
      • recommendation:
        • >5 to ≤7 cm: follow-up either in 2-6 months for resolution/re-characterization or in 6-12 months for growth rate assessment, but no follow up is needed if the cyst is exceptionally well-visualized/characterized and documented with confidence by the imager
        • >7 cm: follow-up either in 2-6 months for resolution/re-characterization or in 6-12 months for growth rate assessment
    • follow-up of cyst (previously >5 cm): describe in report with all cyst diameters if not resolved
      • decreased in size
        • impression: benign inconsequential finding; decrease in size excludes neoplasm
        • recommendation: no further follow-up needed
      • similar in size
        • impression: benign simple cyst with stability over ≥12 months, most likely nonneoplastic or very slow growing benign neoplasm
        • recommendation: follow-up at 2 years from initial study to document stability and understand growth rate
      • increased in size
        • impression: enlarging simple cyst, most likely a benign neoplasm
        • recommendation: follow-up in 1 year to evaluate any further changes in size
  • postmenopausal women
    • ≤1 cm: no need to report
      • impression: normal ovaries/adnexa
      • recommendation: no follow-up
    • >1 to ≤3 cm: report presence of simple cyst(s) and largest cyst diameter
      • impression: benign inconsequential finding
      • recommendation: no follow-up
    • >3 cm: report with all cyst diameters
      • impression: benign simple cyst
      • recommendation:
        • >3 to ≤5 cm: follow-up either in 3-6 months for resolution/re-characterization or in 6-12 months for growth rate assessment, but no follow up is needed if the cyst is exceptionally well-visualized/characterized and documented with confidence by the imager
        • >5 cm: follow-up either in 3-6 months for resolution/re-characterization or in 6-12 months for growth rate assessment
    • follow-up of cyst (previously >3 cm): describe in report with all largest cyst diameters if not resolved
      • decreased in size
        • impression: benign simple cyst; decrease in size excludes neoplasm
        • recommendation: no further follow-up needed
      • similar in size
        • impression: benign simple cyst
        • recommendation: follow-up at 2 years from initial study to document stability
      • increased in size
        • impression: enlarging simple cyst, most likely a benign neoplasm
        • recommendation: follow-up in 1 year to evaluate any further changes in size

Note that these guidelines do not apply to hemorrhagic ovarian cysts.

Treatment and prognosis

  • large (>3 cm) or symptomatic cysts may undergo surgical resection
  • smaller asymptomatic cysts are treated conservatively
  • risk of malignancy in septated ovarian cysts with no papillary projections or solid components are also considered low and are usually followed up on ultrasound

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Ovarialzyste:
eingeblutete
Ovarialzyste
Wikipedia • CC0
Corpus luteum
 
Wikipedia • CC0
Ovarialtorsion
 
pediatricimaging.org • CC-by-nc-sa 4.0
Corpus luteum
Zyste
Wikipedia • CC0
Ovarielles
Hyperstimulationssyndrom
Wikipedia • CC0
neonatale
Ovarialzyste
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