Benign ovarian masses include functional cysts and tumors; most are asymptomatic.
There are 2 types of functional cysts:
Most functional cysts are < 1.5 cm in diameter; few exceed 5 cm. Functional cysts usually resolve spontaneously over days to weeks. Functional cysts are uncommon after menopause.
Benign ovarian tumors usually grow slowly and rarely become malignant. They include the following:
Symptoms and Signs
Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Ascites and rarely pleural effusion may accompany fibromas.
Masses are usually detected incidentally but may be suggested by symptoms and signs. A pregnancy test is done to exclude ectopic pregnancy. Transvaginal ultrasonography can usually confirm the diagnosis. If results are indeterminate, MRI or CT may help.
Masses with radiographic characteristics of cancer (eg, cystic and solid components, surface excrescences, multilocular appearance, irregular shape) require excision. Tumor markers may help in the diagnosis of specific tumors (see Gynecologic Tumors: Diagnosis). In women of reproductive age, simple, thin-walled cystic adnexal masses 5 to 8 cm (usually follicular) without characteristics of cancer do not require further evaluation unless they persist for > 3 menstrual cycles.
Most ovarian cysts < 8 cm resolve without treatment; serial ultrasonography is done to document resolution. If technically feasible, cyst removal from the ovary (ovarian cystectomy) via laparoscopy or laparotomy may be necessary for the following:
Oophorectomy is done for the following:
Last full review/revision December 2008 by S. Gene McNeeley, MD