Paratubal cysts are frequently discovered during female pelvic imaging, often causing worry when first identified. While the word “cyst” can trigger concern, these specific fluid-filled sacs are overwhelmingly benign and usually silent. Understanding the nature of these growths can alleviate the anxiety associated with their detection.
Understanding Paratubal Cysts
A paratubal cyst is a thin-walled sac filled with clear fluid that develops in the adnexa, the region near the uterus. They exist adjacent to the fallopian tube and ovary but are distinctly separate from the ovarian tissue. This anatomical distinction is important because it confirms they do not originate from the ovary, differentiating them from ovarian cysts.
These growths arise from remnants of embryonic structures that did not fully regress during fetal development. They form from vestiges of the Wolffian or Müllerian ducts, which are involved in forming reproductive organs. Paratubal cysts are congenital in origin, typically benign, and constitute about 10% of all adnexal masses.
Assessing the Risk of Complications
The most reassuring aspect of paratubal cysts is their overwhelmingly benign status; they are non-cancerous in the vast majority of cases. Malignancy is reported in less than 2% of these masses, and they do not pose a risk of developing into ovarian cancer. Many cysts are small, often ranging from two to 20 millimeters, and cause no noticeable symptoms.
The primary concern is the rare mechanical complication of adnexal torsion, where the cyst twists on its vascular stalk. Torsion cuts off blood supply to the fallopian tube and sometimes the ovary, requiring emergency surgery. This acute event causes a sudden onset of severe pelvic pain, often accompanied by nausea and vomiting.
Other uncommon complications include rupture, where the cyst wall breaks, or hemorrhage, which is bleeding into the cyst. Both can cause acute pelvic pain but are less frequent than torsion. For most people, the cyst remains small and asymptomatic throughout life, never requiring intervention beyond initial diagnosis.
Diagnostic Procedures and Treatment
Paratubal cysts are most frequently discovered incidentally during routine gynecological examinations or imaging. The primary diagnostic tool is a pelvic ultrasound, which clearly visualizes the thin-walled, fluid-filled nature of the growth. Imaging is crucial for confirming the mass is separate from the ovary, distinguishing it from potentially more complex ovarian masses.
For small, asymptomatic cysts, the standard protocol is watchful waiting, involving periodic follow-up ultrasounds. This monitoring approach recognizes that many small paratubal cysts may regress or remain stable. Monitoring tracks the size and appearance of the cyst over time.
Intervention is generally reserved for cysts causing persistent pain or those reaching a significant size, often greater than 7 to 10 centimeters. Surgical removal, typically performed using minimally invasive laparoscopic techniques, is recommended to relieve symptoms or prevent complications like torsion. Surgery is also necessary if imaging suggests suspicious features that could indicate a rare borderline tumor or malignancy.