Paraovarian cyst

Paraovarian cysts are non-functional, benign cysts situated in the adnexa of the uterus, specifically in the broad ligament which is part of the female reproductive system. These cysts are located adjacent to the ovary and fallopian tube, hence the name paraovarian. They account for approximately 10-20% of all adnexal masses. Paraovarian cysts are most commonly diagnosed in women of reproductive age but can occur at any age.

Etiology and Pathogenesis

The exact cause of paraovarian cysts is not well understood. They are thought to originate from the remnants of the Wolffian duct (mesonephric duct) or the Müllerian duct. These cysts are filled with a clear, serous fluid and are typically asymptomatic. However, they can become symptomatic if they grow large enough to cause mass effect or undergo complications such as rupture, torsion, or hemorrhage.

Clinical Presentation

Most paraovarian cysts are asymptomatic and are often discovered incidentally during routine pelvic examinations or imaging studies for unrelated reasons. When symptoms do occur, they may include:

• Pelvic pain or discomfort
• Abdominal fullness or bloating
• Dyspareunia (pain during sexual intercourse)
• Urinary frequency or urgency if the cyst is pressing on the bladder

Diagnosis

The diagnosis of a paraovarian cyst is primarily based on imaging techniques. Ultrasound, especially transvaginal ultrasound, is the first-line imaging modality due to its convenience and high sensitivity in detecting adnexal masses. Paraovarian cysts appear as simple, anechoic (clear), and well-circumscribed cysts adjacent to the ovary. Magnetic resonance imaging (MRI) can be used for further evaluation if the ultrasound findings are inconclusive or to differentiate paraovarian cysts from other adnexal masses.

Management

The management of paraovarian cysts depends on the size of the cyst, the presence of symptoms, and whether there are any signs of complications. Asymptomatic cysts that are small in size may be managed conservatively with regular follow-up and monitoring for any changes in size or appearance. Surgical intervention may be considered in the following scenarios:

• Symptomatic cysts causing significant discomfort or pain
• Large cysts with a risk of torsion or rupture
• Cysts with suspicious features on imaging that raise concerns for malignancy

Surgical options include laparoscopy for cystectomy or oophorectomy, depending on the cyst's relationship to the ovary and the patient's desire for fertility preservation.

Prognosis

The prognosis for women with paraovarian cysts is generally excellent. Most cysts are benign and can be effectively managed with either conservative monitoring or surgery. The risk of malignancy in paraovarian cysts is very low. However, regular follow-up is important to monitor for any changes in the size or characteristics of the cyst.

Conclusion

Paraovarian cysts are a common type of adnexal mass that are usually benign and asymptomatic. They are most often diagnosed incidentally during imaging studies for other reasons. Management strategies range from conservative monitoring to surgical intervention, depending on the individual case. With appropriate management, the prognosis for women with paraovarian cysts is favorable.