Paratubal cysts are fluid-filled sacs that can develop in the female reproductive system. These cysts are a common finding and are typically benign, meaning they are not cancerous. Many individuals with paratubal cysts may not even be aware of their presence.
Understanding Paratubal Cysts
Paratubal cysts are located near the fallopian tubes and ovaries, though distinct from ovarian cysts. They form within the adnexa, which includes the ovaries, fallopian tubes, and the broad ligament, a protective tissue layer. These cysts are usually single, thin-walled, and filled with clear fluid. They are often small, typically ranging from 2 to 20 millimeters, though some can grow much larger.
These cysts often originate from remnants of embryonic structures, specifically the Wolffian (mesonephric) or Müllerian (paramesonephric) ducts. During fetal development, all fetuses initially have both sets of ducts. In females, the Wolffian duct typically regresses, while the Müllerian duct develops into female reproductive organs like the fallopian tubes and uterus. If small pieces of these ducts remain, they can later form paratubal cysts.
Identifying and Diagnosing Cysts
Paratubal cysts are frequently asymptomatic. They are often discovered incidentally during routine gynecological examinations or imaging procedures performed for other reasons. When symptoms do occur, they are typically associated with larger cysts or complications.
Possible symptoms include pelvic pain, pressure, or discomfort. If a cyst grows large enough, it can press on surrounding organs, potentially leading to abdominal distention, fullness, or, rarely, issues with bladder or bowel function. More acute symptoms, such as severe pain, nausea, and vomiting, can arise if the cyst twists on its stalk (torsion) or ruptures.
Diagnostic methods primarily involve imaging techniques. Transvaginal or transabdominal ultrasound is the most common tool to visualize the pelvic region and identify them. Magnetic resonance imaging (MRI) or computed tomography (CT) scans may also be used to obtain clearer images, especially for larger cysts or to differentiate them from other pelvic masses.
Treatment and Prognosis
Most paratubal cysts do not require active treatment as they often do not cause symptoms. For small, asymptomatic cysts, a “watchful waiting” approach is commonly recommended. This involves periodic monitoring with follow-up ultrasounds to observe the cyst’s size and characteristics over time. Many small cysts may resolve on their own or remain stable without causing issues.
Intervention may be considered if a cyst is large, causes persistent symptoms, or if there is a rare suspicion of malignancy. Surgical removal, often via minimally invasive laparoscopy, is an option for symptomatic or complicated cysts. During laparoscopy, small incisions allow a surgeon to remove the cyst, typically preserving the fallopian tube and ovary. Rarely, if a cyst is very large, twisted, or damaged, removal of the affected fallopian tube or, less commonly, the ovary might be necessary.
Paratubal cysts generally have an excellent prognosis. Small cysts usually do not impact fertility, and even with the removal of a fallopian tube or ovary, pregnancy is often still possible as these cysts are typically unilateral. Recurrence after removal is uncommon.