What is an ovarian cyst?
Ovarian cysts are ball-shaped structures inside one or both ovaries of a woman, usually containing liquid or hard structures of different consistencies.
Not every ovarian cyst is the same and there are different types.
Follicle cysts
They are mostly temporary. They are filled with clear liquid. They rarely exceed 3 cm. They have smooth edges and do not have hard structures inside them. Only follow-up is sufficient for treatment. They usually disappear after menstruation. In cases that do not go away, giving a combined birth control pill for 3-6 months may be considered.
-Cysts with bleeding inside: It is one of the most common cysts. If there is excessive bleeding into the corpus luteum cyst formed by ovulation, a blood-filled cyst may form. The most important symptom of these cysts is severe groin pain. If the bleeding has stopped, the cyst will not grow, but if the bleeding continues, the cyst may grow up to approximately 6-10 cm. It may be life-threatening as a result of blood leaking into the abdominal cavity; nausea, vomiting, and severe abdominal pain may occur. The patient's condition is evaluated. In general, for cysts below 4 cm, if the patient's condition is good and there is no blood in the abdomen, follow-up can be done. The body will withdraw blood and the cyst will disappear. If the patient's vital condition is worsening, the cyst is over 6 cm, and the patient's complaints worsen instead of improving, treatment can be planned with laparoscopy. -Simple cysts: They are usually over 4-5 cm and do not disappear spontaneously. . It contains clear liquid. They do not contain hard tissues and have smooth edges. Severe groin pain may be felt when the cyst bursts. The cyst may cause the ovary to rotate around itself. Treatment may require laparoscopic removal of the cyst.
Simple cyst in a young girl
-Dermoid cyst (Mature cystic teratoma): Dermoid cysts contain embryological tissues. It can usually be tissues such as fatty tissue, hair, skin, teeth and thyroid tissue. It is more common in young girls. It develops inside the ovary. It is the most common ovarian cyst that causes the ovary to rotate around itself. They never melt spontaneously and can constantly grow and reach giant sizes. They have very typical appearances on USG. But In suspicious cases, MRI examination can be performed for definitive diagnosis. Regardless of their diameter (even 1 cm), they must be removed laparoscopically.
A dermoid cyst with hair in it
-Chocolate cyst (Endometrioma): The tissue covering the inner wall of the uterus, known as endometriosis, is in the ovaries where it should not be, causing bleeding here over time and forming a chocolate-colored cyst with a dense consistency, which is called endometrioma cyst (chocolate cyst). The prevalence of endometriosis in women of reproductive age is around 7%. In other words, endometriosis occurs in 7 out of every 100 women. Approximately half of patients with endometriosis develop chocolate cysts. It may be unilateral or bilateral.
Chocolate cyst-Complaints:
Continuous groin pain, severe groin pain during menstruation, groin pain during intercourse and pregnancy. there will be difficulty. If the cyst opens and chocolate fluid spreads into the abdominal cavity, it may cause conditions that require urgent treatment, such as very severe groin pain, mild fever, nausea-vomiting, and increase in the number of white blood cells in the blood.
Chocolate cyst-Diagnosis:
The appearance of chocolate cyst on USG is very typical and is usually diagnostic. The blood marker called Ca-125 is high in these patients. Ca-125 is actually elevated in ovarian cancer, but it can also be elevated in conditions such as endometrioma. Therefore, there is no need to worry.
Very typical looking endometrioma cyst on USG
Chocolate cyst-Treatment:
Treatment planning is made according to whether the patient wants a child or not, the status of the complaints and the size of the cyst. Chocolate cysts do not dissolve or disappear on their own. If left untreated, it may grow larger and reach giant sizes. As the cyst grows, it reduces the healthy ovarian tissue and causes the ovarian reserve to decrease. Ovarian cancer may develop at the base at a rate of 1%. If those who are single or do not want children complain of groin pain or if the cyst size is over 4 cm, the chocolate cyst must be removed laparoscopically. If those who want children do not have an in vitro fertilization plan, chocolate cysts must be removed regardless of diameter. is. The rate of pregnancy in women whose chocolate cysts are removed laparoscopically, if they have sexual intercourse for 2 years, is much higher than in those who do not have surgery. If the patient has an in vitro fertilization plan, cysts larger than 4 cm should be removed laparoscopically. Cysts under 4 cm do not need to be removed before in vitro fertilization. It is definitely not recommended to drain chocolate cysts smaller than 4 cm with a needle before in vitro fertilization.
-Tumoral cysts: They are known as cystadenomas. They do not melt spontaneously. They grow bigger and bigger. Most of them are above 6 cm. They must be removed by performing a laparoscopic cystectomy. It should be confirmed by pathological examination whether cancer has occurred.
Polycystic ovarian disease
Although the word cyst is used, the structures with a diameter of 2-9 mm in polycystic ovarian disease are not cysts and It should never be removed.
The ovary may rotate around itself, disrupting its blood supply and causing gangrene.
Cysts may cause the ovary to rotate around itself. The blood flow of the ovary, which has rotated around itself, is reduced and the ovary becomes gangrenous. Severe groin pain, nausea, vomiting and mild fever may be observed. The absence of blood flow in the ovaries on USG supports the diagnosis. The bloodless ovary, which rotates around itself, must be operated on urgently. If possible, laparoscopy should be preferred due to its advantages. With laparoscopy, the ovary, which has rotated around itself, is reversed and its blood supply is ensured again. It is checked whether there is bleeding by waiting for a certain period of time. There should be no rush to remove the ovary. If blood flow does not improve despite waiting, the ovary must be removed. But in most cases, blood flow returns normally and the ovary can be saved. The ovary may be sutured to the pelvic side wall to prevent the egg from returning.
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