Ovarianwhat is a cyst?
Ovarian cysts are ball-shaped structures that are inside one or both ovaries of the woman, usually containing liquid or hard structures of different consistency.
Not all ovarian cysts are the same, there are different types.
They are mostly temporary. They are filled with clear liquid. They rarely go above 3 cm. They have smooth edges, there are no hard structures in them. Only follow-up is sufficient for treatment. They usually disappear after menstruation. In cases that do not pass, combined birth control pills for 3-6 months can be considered.
-Bleeding cysts: 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 finding of these cysts is severe inguinal pain. If the bleeding has stopped, the cyst will not grow, but if the bleeding continues, the cyst may enlarge to approximately 6-10 cm. As a result of blood leakage into the abdominal cavity, it can be life-threatening, nausea, vomiting, severe abdominal pain can be seen. The patient’s condition is evaluated. In general, in cysts smaller than 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 draw blood and the cyst will disappear. If the patient’s vital condition is deteriorating, if the cyst is larger than 6 cm, if the patient’s complaints worsen instead of improving, treatment with laparoscopy can be planned.
-Simple Cysts: They are usually over 4-5 cm and do not disappear on their own. It contains clear liquid. They do not contain hard tissues and have smooth edges. Severe groin pain may be felt with the eruption of the cyst. The cyst can cause the ovary to rotate around itself. The cyst may need to be removed laparoscopically for treatment.
Click to watch the laparoscopic (closed) ovarian cyst removal surgery.
Simple cyst in a young girl
-Dermoid Cyst (Mature cystic teratoma): Dermoid cysts contain embryological tissues. Usually, it can be tissues such as adipose tissue, hair, skin, teeth and thyroid tissue. It is more common in young girls. It develops from inside the ovary. It is the most common ovarian cyst that causes the ovary to rotate around itself. They do not melt on their own and can reach gigantic sizes by constantly growing. They have very typical appearances on USG. However, in doubtful cases, MRI examination can be performed for definitive diagnosis. Regardless of their diameter (even 1 cm), they should be removed laparoscopically.
Click to watch the laparoscopic (closed) removal surgery of dermoid cyst.
A dermoid cyst with hair in it
-Chocolate Cyst (Endometrioma): It is called endometrioma cyst (chocolate cyst) when the tissue covering the inner wall of the uterus, known as endometriosis, is in the ovaries where it should not be, and forms a chocolate-colored, dense cyst over time, causing bleeding here. The incidence of endometriosis in women of reproductive age is around 7%. In other words, 7 out of every 100 women have endometriosis. About half of patients with endometriosis develop a chocolate cyst. It can be single or double sided.
Persistent groin pain, severe groin pain during menstruation, groin pain during intercourse and difficulty conceiving. If the cyst is opened and the chocolate liquid spreads to the abdominal cavity, it may cause severe inguinal pain, mild fever, nausea-vomiting, an increase in the number of white blood cells in the blood, which may require emergency treatment.
The appearance of the chocolate cyst on USG is very typical and usually diagnostic. The blood marker called Ca-125 is high in these patients. Ca-125 is actually elevated in ovarian cancer, but may also be elevated in conditions such as endometrioma. Therefore, there is no need to worry.
Endometrioma cyst with very typical appearance on USG
In the treatment, planning is made according to whether the patient wants a child, the status of his complaints and the size of the cyst. Chocolate cyst does not dissolve on its own, it does not disappear. If left untreated, on the contrary, it can grow even larger and reach gigantic sizes. With the growth of the cyst, it causes a decrease in the ovarian reserve by reducing the intact ovarian tissue. Ovarian cancer may develop at the base of 1%.
If there is a complaint of inguinal pain in those who are single or do not want children, or if the size of the cyst is over 4 cm, the chocolate cyst should be removed laparoscopically. If there is no IVF plan in those who want a child, chocolate cysts should be removed regardless of the diameter. In those whose chocolate cysts were removed laparoscopically, the rate of achieving pregnancy in the case of sexual intercourse for 2 years is much higher than those without surgery. If the patient has an IVF plan, cysts larger than 4 cm should be removed laparoscopically. Cysts smaller than 4 cm do not need to be removed before in vitro fertilization. Before IVF, chocolate cysts smaller than 4 cm are not recommended to be emptied with a needle.
Click to watch the laparoscopic (closed) removal surgery of the chocolate cyst.
-tumoral Cysts: They are known as cystadenomas. They do not dissolve on their own. They’re getting bigger. Most are over 6 cm. They should be removed by performing a laparoscopic cystectomy. Pathological examination should confirm whether there is cancer or not.
Although the word cyst is mentioned in it, structures with a diameter of 2-9 mm in polycystic ovarian disease are not cysts and should definitely not be removed.
your ovaryturning around itself, disrupting the blood supply and having gangrene
Cysts can cause the ovary to rotate around itself. The blood flow of the ovary, which has rotated around itself, is reduced and the ovary becomes gangrene. Severe inguinal pain, nausea, vomiting, mild fever can be observed. The absence of blood flow in the ovaries on USG supports the diagnosis. The ovary, which turned around and became bloodless, should be operated very urgently. If possible, laparoscopy should be preferred because of its advantages. With laparoscopy, the ovary, which has rotated around itself, is reversed and blood supply is provided again. It is checked whether there is blood supply by waiting for a certain period of time. It should not be rushed to retrieve the ovary. If the blood supply does not improve despite waiting, it is necessary to remove the ovary. But in most cases, blood flow comes back normally and the ovary can be saved. The ovary can be sutured to the pelvic side wall to prevent the egg from returning.