Del Pozo Roselló Javier

Si bien casi todos los quistes de ovario son benignos, la característica más desfavorable es que clínicamente son indistinguibles de los tumores ováricos malignos. El diagnóstico diferencial es muy difícil, por lo que es primordial la importancia de diagnosticar de forma adecuada y precoz cualquier quiste para prevenir el cáncer de ovario.

Es recomendable un buen conocimiento de los síntomas y de los diferentes tipos de quistes y recordar las revisiones ginecológicas periódicas.

The ovaries normally increase in size every month and produce cysts known as follicles, which produce hormones (oestrogen and progesterone). The ovary releases an ovum during ovulation, while the follicular cyst continues to grow. When this occurs, it is known as a functional cyst, and this is a normal process within the menstrual cycle.The following types are distinguished:

• Follicular cyst: when the follicle does not break open, but continues to grow and becomes a cyst full of transparent fluid. This type of cyst rarely causes pain and disappears spontaneously over two or three menstrual cycles.
• Corpus luteum cyst: the opening through which the ovum emerges sometimes closes and fluid accumulates inside the follicle. Normally, this disappears after a few weeks, but it may grow and either cause bleeding within or twisting of the ovary, which in turn leads to pain in the pelvis or abdomen. If it fills with blood, the cyst may burst, causing haemorrhage and acute pain.

There are other type of cysts:

• Serous cystadenoma: smooth surface, thin wall cyst containing fluid. Can be quite large – from 5 cm to 20 cm – and liable to cause twisting of the ovary.
• Mucinous cystadenoma: ovarian tumours of greater size, sometimes affecting both ovaries. They are round or oval-shaped translucent tumours of a blush-grey colour containing a thick fluid.
• Endometriomas: contain a thick, chocolate-coloured fluid.
• Dermoid cysts or teratomas: mainly benign due to their embryonic origin. Contain sebaceous material together with hair, cartilage, bone and teeth. They appear during the first three decades of life and may grow until causing torsion or pain.
• Solid tumours: the least frequent, the best known type being the ovarian fibroid, which is sometimes associated with accumulation of fluid in the pleura (membrane investing the lungs) and the peritoneum (membrane investing the intestines).

Diagnosis is performed with an examination of the pelvis by palpating the ovaries. In the suspected presence of a cyst, the examination is completed with other tests to determine its type and to assess the treatment required. Characteristics such as the shape, size and content (liquid, solid or mixed) of the cyst will be taken into account.

Diagnosis can be confirmed according to different variables:

• Rule out pregnancy: pregnancy suggests a corpus luteum cyst, which is normal during gestation.
• Transvaginal pelvic ultrasound: a painless test to provide an image of the uterus and ovaries in order to identify the location of the cyst and to determine whether its content is solid, liquid or mixed.
• CA 12-5 blood test: performed in patients with ovarian cancer or any image suspicious of malignancy.
• Magnetic resonance in cases where malignity is suspected or those with diagnostic uncertainty.
• Laparoscopy: it is the recommended treatment.