Obstetrics and Gynaecology · MU Sofia

54. Ovarian tumors - benign

Covers functional cysts such as follicular, corpus luteum, theca-lutein and endometrioma, then the main benign epithelial, germ cell and sex cord-stromal tumours, with a table for each group. It goes on to ultrasound and marker assessment, including the Risk of Malignancy Index, then torsion and rupture as complications and the management thresholds by cyst size and menopausal status.

Inside: 6 sections · 2 tables · 15 flashcards · 2 min

Topic 54 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 6 sections, about 204 words (2 min of reading), with 15 flashcards.

In this note

  1. Introduction
  2. Functional (non-neoplastic) cysts
  3. Benign neoplasms
  4. Assessment
  5. Complications
  6. Management

Introduction

Ovarian masses are common, and in women of reproductive age most are benign. The task is to tell benign from malignant and to recognise emergencies (torsion, rupture, haemorrhage).

Assessment

  • Symptoms: often none; pain, pressure, abdominal swelling, menstrual change, hormonal effects.
  • Transvaginal ultrasound: simple cysts are almost always benign; worrying features are solid parts, papillary projections, thick septa, high blood flow, ascites, bilaterality (IOTA simple rules, O-RADS).
  • Markers: CA-125 (postmenopausal especially); in women under 40 with a complex mass, also AFP, hCG, LDH (germ cell).
  • Risk of Malignancy Index (RMI) = ultrasound score × menopausal score × CA-125; > 200 → refer to a gynaecological oncology centre.

Complications

  • Torsion: sudden severe one-sided pain, nausea, vomiting; usually a 5–10 cm cyst (dermoid). Emergency laparoscopy and detorsion to save the ovary.
  • Rupture or haemorrhage: acute pain, peritonism, haemoperitoneum.

Management

  • Simple cyst < 5 cm in premenopausal women: no follow-up; 5–7 cm: yearly ultrasound; larger or symptomatic: surgery.
  • Postmenopausal simple cyst < 5 cm with normal CA-125: follow-up with ultrasound and CA-125.
  • Surgery: laparoscopic ovarian cystectomy (keeps ovarian tissue) in young women; oophorectomy in older women; no spill of contents.

Sudden one-sided pelvic pain with vomiting in a woman with a known cyst is torsion: operate quickly to save the ovary.

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