Paraovarian cyst

Paraovarian cysts are epithelium-lined fluid-filled cysts in the adnexa adjacent to the fallopian tube and ovary. The terms are used interchangeably.[1]

Paraovarian cyst
Other namesParatubal cyst, hydatid cyst of Morgagni
SpecialtyGynecology

Pathophysiology

PTCs originate from the mesothelium and are presumed to be remnants of the Müllerian duct and Wolffian duct.[1]

Diagnosis

Most cysts are small and asymptomatic.[1] Typical sizes reported are 1 to 8 cm in diameter.[1] PTCs may be found at surgery or during an imaging examination that is performed for another reason. Larger lesions may reach 20 or more cm in diameter and become symptomatic exerting pressure and pain symptoms in the lower abdomen.[2] Large cysts can lead to torsion of the adnexa inflicting acute pain.[2][3]

Prior to surgery, PTCs are usually seen on ultrasonography. However, because of the proximity of the ovary that may display follicle cysts, it may be a challenge to identify a cyst as paratubal or paraovarian.[4]

Malignancy

PTCs are generally benign, but may, on rare occasions, give rise to borderline tumors and malignancies.[5]

Management

Smaller lesions can be followed expectantly. Larger lesions, lesions that are growing or symptomatic, and lesions with sonographically suspicious findings (septation, papillations, fluid and solid components) are generally surgically explored and removed.

Epidemiology

PTCs have been reported in all female age groups and seem to be most common in the third to fifth decades of life.[1][6] A study in Italy estimated their incidence to be about 3%,[1] while an autopsy study of postmenopausal women detected them in about 4% of cases.[7]

These cysts constitute about 10% of adnexal masses.[4]

Hydatid cysts of Morgagni

Hydatid cysts of Morgagni, also hydatids of Morgagni or Morgagni's cysts, are common and appear as pedunculated, often tiny, frequently multiple cysts connected to the fimbriae of the fallopian tubes. They thus appear to be a specific variant of paratubal cysts.[8] They are named after Giovanni Battista Morgagni.

While usually asymptomatic, it has been noted that these cysts tend to be more common in women with unexplained infertility (52.1% versus 25.6% in controls, p<0.001) and suggested that they may play a role in infertility.[9] It has been proposed that these cysts interfere with tubal pick-up and function.[10][11]

gollark: High failure rate initially as the bad ones initially break, then low, then it goes up again as they begin hitting end of life.
gollark: They follow a bathtub curve IIRC.
gollark: The failure rate isn't constant over time.
gollark: Wrong.
gollark: Oh hey, *I* have a 4TB Seagate.

References
  1. Kiseli M, Caglar GS, Cengiz SD, Karadag D, Yilmaz MB (2012). "Clinical diagnosis and complications of paratubal cysts: Review of the literature and report of uncommon cases". Arch Gynecol Obstet. 285: 1563–69. doi:10.1007/s00404-012-2304-8.
  2. Varras M, Akrivis C, Polyzos D, Frakala S, Samara C (2003). "A voluminous twisted paraovarian cyst in a 74-year-old patient: case report and review of the literature". Clin Exp Obstet Gynecol. 30 (4): 253–6. PMID 14664426.
  3. Thakore SS, Chun MJ, Fitzpatrick K (2012). "Recurrent ovarian torsion due to paratubal cysts in an adolescent female". J Pediatr Adolesc Gynecol. 25 (4): 85–7. doi:10.1016/j.jpag.2011.10.012. PMID 22840942.
  4. Barloon TJ, Brown BP, Abu-Yousef MM, Warnock NG (1966). "Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography". J Clin Ultrasound. 24 (3): 117–22. doi:10.1002/(SICI)1097-0096(199603)24:3<117::AID-JCU2>3.0.CO;2-K. PMID 8838299.
  5. Suzuki S, Furukawa H, Kyozuka H, Watanabe T, Takahashi H, Fujimori K (2013). "Two cases of paraovarian tumor of borderline malignancy". J Obstet Gynaecol Res. 39: 437–41. doi:10.1111/j.1447-0756.2012.01953.x. PMID 22889349.
  6. Damle F, Gomez-Lobo V (2012). "Giant paraovarian cysts in young adolescants: a report of three cases". J Reprod Med. 57: 65–7.
  7. Dorum A, Blom GP, Ekerhovd E, Granberg S (2005). "Prevalence and histologic of adnexal cysts in postmenopausal women: an autopsy study". Am J Obstet Gynecol. 192 (1): 48–54. doi:10.1016/j.ajog.2004.07.038. PMID 15672002.
  8. Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. p. 272. ISBN 9780071716727.
  9. Rasheed SM, Abdelmonem AM (2011). "Hydatid of Morgagni: a possible underestimated cause of unexplained infertility". Eur J Obstet Gynecol Reprod Biol. 158 (1): 62–6. doi:10.1016/j.ejogrb.2011.04.018. PMID 21620555.
  10. Abd-el-Maeboud KH (1997). "Hydatid cyst of Morgagni: any impact on fertility?". J Obstet Gynaecol Res. 23 (5): 427–31. doi:10.1111/j.1447-0756.1997.tb00868.x. PMID 9392907.
  11. Cebesoy FB, Kutlar I, Dikensoy E, Yazicioglu C, Lalayci H (2010). "Morgagni hydatids: a new factor in infertility?". Arch Gynecol Obstet. 281 (6): 1015–7. doi:10.1007/s00404-009-1233-7. PMID 19774388.
Classification
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