‫بسم ال الرحمن الرحيم‬

NON NEOPLASTIC CYSTS

OF THE OVARY
NON NEOPLASTIC CYSTS
OF THE OVARY
 Enlargement of the ovary is one of
the common gynaecological
conditions encountered in clinical
practice.
 Ovarian cysts could be either non
neoplastic or neoplastic cysts.
 Non neoplastic cysts of the ovary
are by far more common than
neoplastic cysts
 Non neoplastic cysts of the
ovary include:
1. Follicular cysts
2. Corpus luteum cysts
3. Theca lutein cysts
4. Endometriotic cysts
5. Inflammatory cysts
6. Germinal inclusion cysts
7. Polycystic ovary
I. FOLLICULAR CYSTS
 the commonest non neoplastic
cysts of the ovary.
 They may arise either from cystic
over-distension of an atretic
follicle, or a dominant Graafian
follicle that failed to rupture.
 Pathology:

usually single
 unilateral

 small in size (<7 cm)

 unilocular, containing clear fluid.

 The cyst wall is thin, lined by

granulosa cells.
 Commonly encountered with:

a) Metropathia Haemorrhagica (MH)
 b) Polycystic ovarian syndrome

(PCOS)
 c) In association with fibroids and

endometriosis.
 Fate & Complications:
 rupture spontaneously
 haemorrhage

Spontaneous resolution
Clinical picture:
 Asymptomatic
 Menstrual disturbance

 Pain (rarely acute abdomen

Diagnosis:
 Abdominal palpation
 Bimanual examination

 Ultrasonography: Pelvic TAS or TVS,

it is the gold standard in diagnosis

 Pathology:
 lined by leutinized granulosa
cells
 usually unilateral, single,
unilocular, small sized (3-7 cm),
containing either bloody fluid or
clear content.
 D.D.: From simple serous
cystadenoma

 Treatment:
• Conservative by follow up
• Surgery (ovarian
cystectomy)
II. CORPUS LUTEUM
CYSTS
 They arise from excessive
haemorrhage inside the corpus
luteum during the stage of
vascularization.
 They are less common than
follicular cysts
 Pathology:usually

Unilateral
 Single

 Unilocular

 Small sized (3-7 cm)

 Containing either bloody fluid or

clear content.

Lined by leutinized granulosa
cells
 Fate & Complications:

Spontaneous resolution
 Spontaneous rupture

 Haemorrhage

 Clinical picture:
 Asymptomatic
 Menstrual disturbance

 Acute lower abdominal pain

 Diagnosis:
is settled by detection of the cyst by
pelvic TAS, or TVS.
 Treatment:
A) Conservative
B) Surgery
III. THECA LUTEIN
CYSTS
 They commonly arise due to
ovarian hyperstimulation by
either:
 a. Excessive amounts of hCG in
the circulation: or
 b. Excessive amounts of
Pituitary gonadotropins:
 Pathology:

usually multiple
 commonly bilateral

 bluish in colour

 thin walled, containing clear fluid

 they may reach a large size > 20

cm

lined by leutinized theca cells.
 Fate & complications:
 The majority undergo spontaneous
regression whenever hCG levels
fall.

Less commonly cysts may undergo
torsion or haemorrhage
 Diagnosis: Pelvic Ultrasonography:
Multilocular, bilateral, echolucent cysts
in a patient with a history suggestive of
abnormally elevated hCG levels, or
ovarian stimulation by HMG or CC
 Treatment:
 Expectant treatment after removal of
the source of gonadotropin
stimulation

 Laparotomy should always be

avoided, unless cysts are
complicated.
IV. ENDOMETRIOTIC
CYSTS
 Incidence & Origin:
Not uncommon especially with
infertility and pelvic endometriosis.
 Pathology:
 haemorrhagic cysts of the ovary lined
by endometrial tissue (glands &
stroma).
 They have a relatively thick wall.
 Their size is rarely large, and
spontaneous rupture is uncommon.
 The contents are characteristic
with thick chocolate appearance
(chocolate cysts):
 Blood accumulates within the cyst
 By time, absorption of the serous

element of the retained blood

occurs leaving behind RBCs
 Treatment:
 Superficial ovarian lesions can be
vaporized.
 Small endometriomas <3 cm can be
aspirated, irrigated, and the interior
wall vaporized.
 Large endometriomas >3 cm require
removal of the cyst wall to prevent
recurrence.
V. INFLAMMATORY CYSTS
OF THE OVARY

 Origin:

These may be in the form of Tubo-
ovarian cysts or Tubo-ovarian abscess.
 Infection may reach the ovary either by

lymphatics or a nearby- infected organ.

Tubo-ovarian cyst
Tubo-ovarian abscess
 Clinically:
 usually bilateral,

 the patient usually presents

with a history of recent

delivery or abortion, a recent
surgical pelvic operation or
IUD insertion.
VI. GERMINAL
INCLUSION CYSTS
 They are microscopic cysts that result from
invagination of the germinal epithelium
into the substance of the ovary near or after
menopause.
 Previously they were considered of no
clinical importance, but now they are
regarded as forerunners for ovarian
epithelial cancers.
Thank you