Paraovarian cyst
Updates to Article Attributes
Paraovarian cysts (POCs) are remnants of Wolffian duct in the mesosalpinx that do not arise from the ovary. They account for ~10-20% of adnexal masses 3-4.
Epidemiology
They typically occur in women at the ages of 20-40 years old.
Clinical presentation
Most are asymptomatic, although patients with large lesions can present with pelvic pain.
Pathology
They usually occur around the broad ligament and arise from paramesonephric, mesothelial, or mesonephric remnants. They are usually simple cysts (although some authors include paraovarian cystadenomas under the umbrella of paraovarian cysts).
Radiographic features
A paraovarian cyst is easier to recognise if the ipsilateral ovary is demonstrated to be separate from it.
Pelvic ultrasound
- typically thin-walled and smoothly marginated
- most often appear as unilocular 'simple' cysts (in ~66%) and rarely as multilocular (~4%)
- a soft tissue nodule in the cyst may indicate the development of a neoplasm (rare) 9
Pelvic MRI
Often seen located close to the ipsilateral round ligament and are often of homogenous signal intensity.
In uncomplicated cases, signal characteristics usually follow that of fluid 12.
-
T1
- hypointense
- can be hyperintense if complicated by haemorrhage
-
T2
- hyperintense
Other features include
- may show a beak sign 11
Treatment and prognosis
Paraovarian cysts occasionally can be complicated by rupture, torsion, or hemorrhagehaemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively.
For simple paraovarian cysts with no suspicious features on ultrasound, follow-up recommendations are the same as for ovarian cysts. According to a consensus statement by the Society of Radiologists in Ultrasound 13, follow-up is recommended for cysts that are:
- 5 to 7 cm in a woman of reproductive age
- 1 to 7 cm in a postmenopausal woman
Irrespective of age, cysts larger than 7 cm warrant further evaluation (with MRI) or surgical review.
History and etymology
Paraovarian cysts are also sometimes referred to as paratubal cysts or hydatid cysts of Morgagni 14,
Differential diagnosis
For an adnexal cystic lesion consider:
- true ovarian cyst
- ovarian cystic neoplasm: typically has a solid component
- paraovarian cystadenoma: typically has a small solid nodule or septum
- pelvic peritoneal inclusion cyst
-</li></ul><h4>Treatment and prognosis</h4><p>Paraovarian cysts occasionally can be complicated by rupture, torsion, or hemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively. </p><p>For simple paraovarian cysts with no suspicious features on ultrasound, follow-up recommendations are the same as for <a href="/articles/ovarian-cyst-2">ovarian cysts</a>. According to a consensus statement by the Society of Radiologists in Ultrasound <sup>13</sup>, follow-up is recommended for cysts that are:</p><ul>- +</li></ul><h4>Treatment and prognosis</h4><p>Paraovarian cysts occasionally can be complicated by rupture, torsion, or haemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively. </p><p>For simple paraovarian cysts with no suspicious features on ultrasound, follow-up recommendations are the same as for <a href="/articles/ovarian-cyst-2">ovarian cysts</a>. According to a consensus statement by the Society of Radiologists in Ultrasound <sup>13</sup>, follow-up is recommended for cysts that are:</p><ul>
Image 6 MRI (T2) ( create )
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