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Benign ovarian pathologies

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Incidence of benign ovarian tumors
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- Benign ovarian cysts are common and often asymptomatic, resolving spontaneously.
- Therefore, despite being a frequent cause for admission to hospital, their exact incidence is unknown.
(up to 10% of women will have surgery for an ovarian mass of some sort)
- Almost all ovarian masses and cysts are benign in premenopausal women with an incidence of malignancy of 1:1000 which increases to 3:1000 at the age of 50.
- Ovarian tumours can be physiological (functional) or pathological (benign or malignant).
- Classification depends on the ovarian tissue from which they arise.
- Excluding the physiological group, a germ cell tumour is the more common diagnosis in a woman less than 40 years of age, whereas an epithelial cell tumour is more likely in an older woman.
- Risk factors for ovarian tumours include 1) obesity
2) infertility
3) hypothyroidism
4) early menarche
5) tamoxifen therapy
These are often asymptomatic and occur commonly in younger women. No follow up needed if <5cm and most resolve within 2-3 months. COCPs not effective.

1) Follicular cysts
- These are the result of either non-rupture of the dominant follicle during the normal ovarian cycle or failure of atresia of a non-dominant follicle.
- Smaller cysts might resolve spontaneously, but intervention could be necessary if the cyst causes symptoms or if ultrasound follow-up shows an increase in size.

2) Luteal cysts
- Less common
- However, they are more likely to present with intraperitoneal bleeding secondary to rupture.
- This occurs more commonly on the right side and typically rupture occurs on day 20 to 26.
- OHSS - enlarged ovaries with multiple luteinised cysts or corpora lutea with ascites.
- Torsion: areas of swelling, haemorrhage or necrosis can be seen within the parenchyma of the torted ovary
- Use of assisted reproductive technology is associated with an 11-fold increased risk of ovarian torsion
- Conservative unless torsion

3) Theca lutein cysts
- Least common of the functional ovarian cysts - They are usually bilateral and occur with pregnancy including molar pregnancy (luteomas of pregnancy).
- They may be large, up to 30 cm, they are usually multicystic and regress spontaneously.