| January 2006 · Vol. 18, No. 1 CASE-BASED LEARNING
Ovaries make cysts for a living: When to do no harm
How to distinguish cysts that require surgery from those that don’t
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Fast Track
Ovarian cancer is unlikely to cause sudden pain
In a premenopausal woman presumed to have a benign cyst, surgery for pain or failure to resolve should conserve the ovary if at all possible
In postmenopausal women, repeat sonograms and observation are justified unless CA 125 is elevated or the cyst’s size or complexity increases
When surgery is necessary in postmenopausal women, remove the entire ovary for complete pathologic analysis
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William
H.
Parker,
MDChair, Obstetrics and Gynecology, Saint John’s Health Center,
Santa Monica, Calif
Clinical Professor of Obstetrics and Gynecology, UCLA School of Medicine,
Los Angeles
CASE Should you remove a 6-cm cyst?
Mrs. M, 34, complains of sudden-onset, left lower quadrant pain that woke her from sleep. She has no nausea, vomiting, fever, or abnormal bleeding. Vital signs and temperature are normal. She has a tender left lower quadrant with normal bowel sounds. The pelvic exam reveals a 6-cm tender, but mobile, left adnexal mass, and transvaginal pelvic sonography shows a 6.3-cm cystic mass with a thick septation and some internal echoes. Is surgery necessary?
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