Paraovarian cysts are a common finding, often discovered incidentally during routine medical evaluations. While the term “cyst” can sound concerning, these growths are typically benign and usually require no intervention.
What Are Paraovarian Cysts?
A paraovarian cyst is a fluid-filled sac that develops near the ovary or fallopian tube, but not on or within the ovary itself. These cysts originate from embryonic remnants within the broad ligament, a protective tissue layer covering reproductive organs. This distinction in origin and location differentiates them from ovarian cysts, which arise directly from ovarian tissue.
Paraovarian cysts primarily contain fluid. Their size can vary, with most measuring between 1 and 8 centimeters, though some can grow larger, occasionally reaching up to 20 centimeters. Many paraovarian cysts remain asymptomatic and are discovered by chance during imaging for unrelated conditions. They account for approximately 5% to 20% of all masses found in the adnexal region, which includes the ovaries, fallopian tubes, and surrounding tissues.
When Paraovarian Cysts Cause Concern
While generally benign, paraovarian cysts can sometimes lead to complications requiring medical attention. One complication is torsion, where the cyst twists around its supporting stalk, potentially cutting off its blood supply. This twisting causes sudden, severe abdominal pain, often accompanied by nausea and vomiting, and pain might radiate to the lower back. Torsion is a medical emergency, as prompt intervention is necessary to preserve the affected ovary and fallopian tube.
Another issue is cyst rupture, which occurs when the fluid-filled sac breaks open. A ruptured cyst can result in sudden, sharp pain in the abdomen and, in some instances, internal bleeding. Depending on symptom severity and bleeding extent, management ranges from pain relief to urgent surgical intervention.
Although exceedingly rare, paraovarian cysts can exhibit malignant changes. The vast majority of these cysts are non-cancerous, even if they contain some solid components. When malignancy is observed, it is typically in the form of borderline tumors rather than aggressive cancers.
Identifying and Diagnosing Paraovarian Cysts
Paraovarian cysts are often found incidentally during routine gynecological examinations or imaging studies, as they frequently cause no symptoms. However, if a cyst grows large enough, it may exert pressure on surrounding organs, leading to symptoms such as a feeling of pressure or heaviness, a dull ache or sharp pain in the pelvis, constipation, or frequent urination.
Pelvic ultrasound is the primary method for identifying paraovarian cysts, performed either transvaginally or transabdominally. Ultrasound imaging can show the cyst as a distinct structure separate from the ovary, aiding in proper diagnosis. For larger or more complex cysts, magnetic resonance imaging (MRI) may be utilized for more detailed views. Differentiating paraovarian cysts from ovarian cysts can sometimes be challenging.
Treatment Approaches
For small, asymptomatic paraovarian cysts that appear benign on imaging, watchful waiting is often recommended. This approach involves periodic follow-up ultrasounds to monitor the cyst’s size and characteristics.
Surgical removal may be advised if the cyst causes persistent pain or pressure, is growing rapidly, or if there is any suspicion of complications like torsion or rupture. If imaging suggests potential for malignancy, surgical intervention becomes necessary. Laparoscopy, a minimally invasive keyhole procedure, is the preferred surgical technique, involving small incisions and generally allowing for quicker recovery.