Part of “CHAPTER 102 – FUNCTIONING TUMORS AND TUMOR-LIKE CONDITIONS OF THE OVARY“

Follicular and luteal cysts are the most frequent cause of an ovarian mass in women of reproductive age.32 Follicular cysts are lined by granulosa cells that secrete estrogen. Luteal cysts contain luteinized granulosa cells that produce progesterone. A minority secrete sufficient estrogen and progesterone to cause symptoms. Typically, patients of reproductive age become anovulatory and present with menometrorrhagia. An endometrial biopsy or curettage performed for abnormal bleeding reveals endometrial stromal breakdown resulting from fluctuating levels of estrogen. In infants and prepubertal girls, precocious pseudopuberty may result from a functioning follicular cyst. These cysts often resolve spontaneously; consequently, conservative management is indicated. Patients with cysts that do not disappear after observation for 3 months require further studies, possibly surgical or laparoscopic exploration, to rule out neoplasm.

Multiple luteinized thecal cysts (hyperreactio luteinalis) cause bilateral ovarian enlargement and occur primarily in women with elevated levels of hCG in association with gestational trophoblastic disease. Hyperreactio luteinalis is also occasionally seen in normal pregnancies, multiple pregnancies, or ovulation induction therapy. Rarely, virilization occurs. Surgical removal is unwarranted because the cysts resolve once hCG levels normalize.