Dr Amr Adeel
TUMOR-LIKE OVARIAN SWELLING
MD Obs&Gyn
Domiat 2019
TRUE OVARIAN CYSTS
(I) FUNCTIONAL OVARIAN CYST:  retension cysts :
(all are cysts except Luteoma of pregnancy)
♠♠ common characters: ( why functional )
1.related to menstrual cycle events – due to ↑↑ Gn – occur in childbearing period or precocious puberty
2.small (< 6 cm) – don′t ↑ in size but resolve spontaneously / after ttt of cause.
Follicular cyst
Corpus luteum cyst
Aetiology continous Gn stim. ovarian
CLdoesnt regress after
luteal phase cyst
Occur in *Metropathia hgica 
occurs in nonpregnant or
early in pregnancy
follicles don′t rupture cyst
continue to produce E
continous endom.proliferation
(single large FC secrete E)
*PCO 
(multiple small FCsecrete A)
*induction è CC / HMG
1.small – single – unilat
Characters 1.small – single/multiple
2.unilocular - filled è clear fluid 2. unilocular - filled è
3.lined è granulosa,theca interna& yellowish serous fluid
externa cells (as G.F)
3. corrigated bright yellow
resolve spontaneously or may be hge hemoperitoneum
Fate
Follow up for 2 m.(U/S) for spontaneous regressionif no 
OCP(↓Gn) for 3 m  if no  surgical removal (or if > 7cm)
ttt
Theca lutin cysts
Luteoma of pregnancy
response of ovarian
stroma to ↑↑↑ HCG 
LH like distension of
cells by cholesterol , P.L ,
carotene lutinized mass
HCG producing lesions:
-vesicular mole - twins
-choriocarcinoma
-hyperstimulation
(CC / HMG / HCG)
1.multiple – bilat.
2.multilocular
exaggerated response of
ovarian stroma to normal
HCG  lutinized mass
Androstendionematernal
& ♀fetus virilization
Pregnancy
resolve spontaneously
after ttt of cause
resolve spontaneously
after delivery (virilizing
signs resolve also)
nothing
nothing
1.large ( +up to 16cm ) –
unilat.(commonly)
2.SOLID
N.B: D.D ( ) hge in CL cyst & disturbed ectopic pregnancy:
- Both are similar in: History: short period of amenorrhea folloewd by pain then bleeding
Examination: PVcervical motionmarked tenderness to one side of uterus
Investigation: +ve ß-HCG + I.U sac (if the cyst occures in early pregnancy)
- Differentiated only by: Laparoscope
(II) ORGANIC OVARIAN CYST:
1. Simple cyst:
- small – unilateral – thin transluscent wall – unilocular – contain serous fluid – lined by cuboidal epith.
- never turn Mg.
2. Inclusion cyst:
3.
4.
5.
- downward growth of surface epith. Into substance of ovary microscopic cysts
- remain quiesent or turn Mg (surface epith. tumors)
Inflammatory cyst: tubo-ovarian cyst & abscess ‫( اشرح‬see PID)
Endometriotic cyst: choclate cyst ‫( اشرح‬see endometriosis)
Haemorrhagic cyst: hge in any type of cysts
PARAOVARIAN (BROAD LIGAMENT) CYSTS
* Aetiology: cystic dilatation of embrionic remnants of W.D / M.D present ( ) the 2 layers of broad ligament:
♠ Wolffian Duct:
Appendix vesiculosa(cephalic end of WD) – Kobelt cyst – Epoophoric cyst – Paraophoric cyst – WD cyst
♠ Mullerian Duct:
Hydatid cyst of Morgagni (cephalic end of MD small , smooth , contain clear fluid , attached to fimbrial end ) – MD cyst.
* Characters: – thin wall , unilocular , lined by flat epith. , contain serous fluid , fixed .
– push the uterus to the opposite side , can reach large size filling the abdomen .
– streach the fallopian tube (detected by HSG) differentiate it from ovarian mass .
* ttt: surgical removal after incising the peritoneum of the broad ligament.