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PARAOVARIAN CYST

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PARAOVARIAN CYST

DEF:

A paraovarian cyst is defined as a closed fluid-filled sac that grows beside or near to ovary and fallopian tube, but it is never attached to them. It is located with broad connection (ligament) between the uterus and ovary and is found on only one side (unilateral) of uterus. It develops from embryological vestiges (Wolffian structures), external covering of the Fallopian tubes (tubal epithelium) or smooth serous membrane that lines the cavity of abdomen (peritoneum). Paraovarian cysts are very small ranges from 2 to 20 cm.

CAUSES:

Although known for their small size, paraovarian cysts will sometimes grow larger, especially during pregnancies. Unlike small cysts, the larger cysts are symptomatic. Depending on their size and location, large paraovarian cysts will put pressure on the bladder or bowel and will cause pelvic pain or pain during sexual intercourse (dyspareunia). The smaller cysts are commonly found in middle-aged women (in the 30 to 40 years of age group) and are often indistinguishable from simple ovarian cysts. Larger paraovarian cysts will tend to develop in younger women quite oftenly during pregnancy, at that time they have a tendency to grow rapidly. Paraovarian cysts account for 10% of all pelvic masses (Barloon).

SYMPTOMS:

Many individuals with small paraovarian cysts will report no symptoms.

However, individuals with larger paraovarian cysts will show some symptoms:

  • Frequent complain of pelvic pain usually on one side (unilateral)

  • Irregular periods

  • Abnormal uterine bleeding

  • Pain during sexual intercourse (dyspareunia).

DIAGNOSIS:

  1. Physical exam: Paraovarian cysts are discovered when physician presses with his hands (palpation) on the lower abdomen or when she inserts one or two fingers into vagina while pressing with other hand on the abdomen.

  2. Tests needed includes:

  • Diagnostic ultrasound (sonography) is a noninvasive diagnostic imaging technique which uses high-frequency sound waves to produce images of structures within the body. The sound waves are passed through the body tissues with a device called transducer. Objects inside the body will reflect a part of sound waves back to the sensor, where the waves are recorded, analyzed and displayed for viewing on a screen. Modern sonographic equipment will display live images of moving tissues (real-time viewing) and will also provide 3-dimensional reconstruction information about different structures. The area covered by the ultrasound beam will depends on equipment design.

  • Doppler sonography (duplex Doppler sonography) will enables the visualization of blood flow in both arteries and veins (vascular systems) as well as in organs. It reveals changes in the pitch of sound waves (Doppler effect) as they bounce off circulating blood cells. When combined with the technology of advanced data processing, color Doppler can acquire data fast enough to study the complex flow of blood in the heart and other organs. A computer image will represents the speed and direction of blood flow is then generated from the data. Power Doppler sonography is a new technique is about 5 times more sensitive than color Doppler. It is useful in measuring the blood flow in blood vessels traversing solid organs.

  • Visual exam by using a thin, lighted microscope inserted into the abdomen or by a laparoscopic process used to confirm diagnosis, size and location of a paraovarian cyst.

TREATMENT:

  • Most paraovarian cysts that are small and asymptomatic will not require any treatment as they disappear on their own.

  • Surgical removal of cysts is done to young girls under the age of puberty, those with an ovarian mass and for postmenopausal women by a process called laparscopic cystectomy.

  • A laparoscopic cystectomy will enables the surgeon to insert a small scope into the abdomen to know whether more extensive surgery if required. Sometimes, it is possible to remove the cyst while during laparoscopic procedure.
    However, if the cyst size is greater than 4 inches (10 cm) in complex and increasing in size will persists after several months and is a solid, dense and irregularly shaped, or gets infected, bleeding or ruptured then more invasive surgery like cystectomy may be required.

  • Such cysts will pose a problem if they put pressure on pelvic structures and thus cause damage to them and causes pelvic pain or pain during sexual intercourse (dyspareunia).

PREVENTION:

Little medical information is available for prevention of ovarian cysts. Smoking is not a risk factor for their development.

PROGNOSIS:

In situations where the individual is not pregnant, a complete recovery is expected with surgical removal of the cyst is curative and no recurrence is expected.

In situations where the individual is pregnant, a complete recovery is expected if surgery to remove the cyst is performed between 14 to 20 weeks gestation (particularly if it is very large, low in the pelvis, and not movable).

 

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