Ovarian Cysts for PA
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Ovarian Cysts for the Physician Assistant Licensing Exam
- Definition:
- Ovarian cysts are fluid-filled sacs that form on or within an ovary. Most cysts are benign and either functional (related to the menstrual cycle) or pathologic, with functional cysts being most common in reproductive-aged women.
- Types of Ovarian Cysts:
Functional Cysts
Follicular Cysts:
- Develop when a follicle does not release an egg and grows larger.
- Usually asymptomatic and resolves within one to three menstrual cycles.
- Form when the corpus luteum seals and fills with fluid after ovulation.
- May cause mild pain or irregular periods but generally resolve on their own.
- Related to elevated hCG, often in pregnancy or with fertility treatments.
- Typically regress when hCG levels normalize.
Pathologic Cysts
Dermoid Cysts (Mature Cystic Teratomas):
- Contain various tissue types (e.g., hair, skin, teeth) and are usually benign.
- Often asymptomatic but can cause pain if they undergo torsion.
- Result from endometriosis and contain thick, dark blood.
- Associated with pelvic pain, dysmenorrhea, and infertility.
- Symptoms:
- Many ovarian cysts are asymptomatic, discovered incidentally on imaging.
- Symptomatic cysts may cause:
- Pelvic Pain: Often if the cyst is large, ruptures, or causes torsion.
- Menstrual Irregularities: With some functional cysts.
- Acute Pain: Suggestive of complications like torsion or rupture.
Diagnosis
- Pelvic Ultrasound: First-line imaging to evaluate cyst characteristics.
- Functional cysts are simple and thin-walled.
- Dermoid cysts show echogenic materials, while endometriomas show “ground-glass” echogenicity.
- Laboratory Tests:
- Serum hCG to rule out pregnancy.
- CA-125 for cancer risk, particularly in postmenopausal women.
Management
- Observation for small, asymptomatic functional cysts, which often resolve spontaneously.
- Hormonal Contraceptives: Used to prevent recurrent functional cysts.
- Surgical Intervention for large, symptomatic, or complex cysts, or for cases with acute complications.
Key Points
- Ovarian Cysts are often functional and resolve without treatment, though pathologic cysts may require further evaluation.
- Diagnosis is primarily based on ultrasound, with CA-125 used in postmenopausal women to assess cancer risk.
- Management includes observation for simple cysts, hormonal therapy to prevent recurrence, and surgery for symptomatic or suspicious cysts.
- Complications like torsion or rupture may require emergency surgical intervention.