Corpus luteum cyst
This type of mass forms exclusively during a biphasic menstrual cycle as a result of impaired lymph and blood circulation in the corpus luteum, leading to fluid accumulation. Lutein and theca-lutein cells are identified in the wall. Clinically, the process is most often asymptomatic, although lower abdominal pain may occur at the time of formation. The most frequent complication is hemorrhage into the cavity, which can lead to an "acute abdomen" presentation. On ultrasound, the structure may be anechoic or contain blood clots, while sound transmission always remains high. Color Doppler mapping demonstrates avascularity of the central structures and intense peripheral ("coronary") blood flow.
Retention cysts and management
Retention cysts have a thin, transparent wall and homogenous contents that acquire a bluish tint under lateral lighting. An important diagnostic sign when using contrast-enhanced techniques is that these formations do not accumulate the contrast agent.
Patient management tactics include follow-up observation for 1–3 menstrual cycles with mandatory ultrasound and color Doppler mapping control during the first phase. If spontaneous regression does not occur, surgical treatment is indicated—laparoscopic cyst enucleation within healthy tissue.
Paraovarian cysts
These masses are localized between the leaves of the broad ligament of the uterus and originate from the remnants of the mesonephric duct, epoophoron, or coelomic epithelium. Sizes vary from small to giant. A structural feature is that the fallopian tube is located along the upper pole of the mass, while the ovary itself is situated at the posteroinferior pole.
The main specific sign during an ultrasound examination is the visualization of the separately located ovary. The masses are avascular, have a thin wall, and are filled with uniform fluid. The method of choice is organ-preserving laparoscopy with cyst enucleation.
Epidemiology and morphology of true neoplasms
Over the past decade, the proportion of ovarian tumors among genital neoplasms has risen to 19–25%. The morphological diversity is due to the complexity of embryogenesis and ovarian functions. Sources of formation can include:
- Surface epithelium
- Oocyte and its derivatives
- Granulosa cells and theca tissue
- Connective tissue, blood vessels, and nerves
- Embryonic remnants and metaplastic epithelium
Risk factors include early or late menarche, late menopause (after 50 years of age), and menstrual irregularities.
Briefly: answers to topical questions
What types of ovarian retention cysts are distinguished in gynecology?
In gynecology, five main types of ovarian retention cysts are distinguished. These include:
- Follicular cysts — occur most frequently (73%).
- Endometrioid cysts — account for 10% of cases.
- Paraovarian cysts — also account for 10%.
- Corpus luteum cysts — are diagnosed in 5% of cases.
- Theca-lutein cysts — occur least frequently (2%).
Their sources of formation are the follicle, corpus luteum, parovarium, and endometrioid heterotopias.
Which conditions require differential diagnosis with a corpus luteum cyst?
Differential diagnosis of a corpus luteum cyst must be performed with ovarian tumors. A corpus luteum cyst can mimic a tumor if its cavity is completely filled with echogenic contents (blood); intense peripheral blood flow may resemble malignant neovascularization. A distinctive feature is the absence of vascularization within the internal structures of the cyst.
What clinical symptoms are characteristic of paraovarian cysts?
Paraovarian cysts are asymptomatic in the majority of cases. As the mass grows, lower abdominal pain and enlargement of the abdomen appear. Menstrual irregularities and infertility are rarely observed. When the "stalk" twists, the clinical picture of an "acute abdomen" develops.
What complications can occur with ovarian tumor-like lesions?
Ovarian tumor-like lesions can lead to urgent conditions manifesting with the clinical picture of an "acute abdomen." The main complications include:
- Hemorrhage into the cyst cavity — the most frequent complication for corpus luteum cysts, capable of causing intense bleeding.
- Torsion of the cyst stalk — typical for paraovarian and follicular cysts, leading to impaired venous circulation, edema, and necrosis.
- Rupture of the cyst wall — accompanied by severe lower abdominal pain, nausea, and vomiting.
How does a follicular cyst differ from a corpus luteum cyst on ultrasound imaging?
A corpus luteum cyst has a more varied ultrasound appearance: from a completely uniform anechoic structure to a fine- or medium-reticular structure; irregular movable septa and echogenic inclusions (blood clots) are possible. Its internal structures are avascular, and intense "coronary" blood flow is determined along the periphery.
A follicular cyst is described as a thin-walled anechoic mass with transparent fluid; in most cases, it is unilocular.
High sound transmission is characteristic of a corpus luteum cyst.
POLs: Paraovarian — separate ovary, Corpus luteum — high peripheral blood flow, Retention — does not accumulate contrast.
Class and exam questions
What are the main differences in the blood flow of a corpus luteum cyst on color Doppler mapping?
The internal structures of the corpus luteum cyst are completely avascular, whereas intense "coronary" blood flow with low vascular resistance is determined along the periphery.
What is the main ultrasound sign of a paraovarian cyst?
The main and practically the only specific sign is the clear visualization of the ovary located separately from the cyst.
What is the timeline for follow-up observation of a corpus luteum cyst?
Observation is carried out for 1–3 menstrual cycles with control ultrasound and color Doppler mapping in the first phase to assess possible spontaneous regression.
What else to study on this topic
- Pathogenesis of impaired lymph and blood circulation in the corpus luteum
- Differential diagnosis of malignant neovascularization and blood flow in a corpus luteum cyst
- Features of the formation of the paraovarian cyst "stalk"
- Histogenesis of sex cord-stromal tumors and androblastomas
- The role of embryonic remnants in the development of ovarian neoplasms
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