A 2 cm left<unk> an cyst as seen on ultrasound Four kinds of<unk> an cysts on MRI<unk> an cysts are usually diagnosed by ultrasound, CT scan, or MRI, and correlated with clinical presentation and endocrinologic tests as appropriate. Ultrasound Follow-up imaging in women of reproductive age for incidentally discovered simple cysts on ultrasound is not needed until 5 cm, as these are usually normal<unk> an follicles. Simple cysts 5 to 7 cm in premenopausal females should be followed yearly. Simple cysts larger than 7 cm require further imaging with MRI or surgical assessment. Because they are large, they cannot be reliably assessed by ultrasound alone; it can be difficult to see posterior wall soft tissue nodularity or thickened septation due to limited ultrasound beam penetrance at this size and depth. For the corpus luteum, a dominant ovulating follicle that typically appears as a cyst with circumferentially thickened walls and crenulated inner margins, follow up is not needed if the cyst is less than 3 cm in diameter. In postmenopausal patients, any simple cyst greater than 1 cm but less than 7 cm needs yearly follow-up, while those greater than 7 cm need MRI or surgical evaluation, similar to reproductive age females. An Axial CT demonstrating a large hemorrhagic<unk> an cyst. The cyst is delineated by the yellow bars with blood seen anteriorly. For incidentally discovered dermoids, diagnosed on ultrasound by their pathognomonic echogenic fat, either surgical removal or yearly follow up is indicated, regardless of patient age. For peritoneal inclusion cysts, which have a crumpled tissue-paper appearance and tend to follow the contour of adjacent organs, follow up is based on clinical history. Hydrosalpinx, or fallopian tube dilation, can be mistaken for an<unk> an cyst due to its anechoic appearance. Follow-up for this is also based on clinical presentation. For multiloculate cysts with thin septation less than 3 mm, surgical evaluation is recommended. The presence of multiloculation suggests a neoplasm, although the thin septation implies that the neoplasm is benign. For any thickened septation, nodularity, vascular flow on color doppler, or growth over several ultrasounds, surgical removal may be considered due to concern of cancer. Scoring systems There are several systems to assess risk of an<unk> an cyst of being an<unk> an cancer, including the RMI (risk of malignancy index), LR2 and SR (simple rules). Sensitivities and specificities of these systems are given in tables below: Scoring systems Premenopausal Postmenopausal Sensitivity Specificity Sensitivity Specificity RMI I 44% 95% 79% 90% LR2 85% 91% 94% 70% SR 93% 83% 93% 76%<unk> an cysts may be classified according to whether they are a variant of the normal menstrual cycle, referred to as a functional or follicular cyst.<unk> an cysts are considered large when they are over 5 cm and giant when they are over 15 cm. In children,<unk> an cysts reaching above the level of the umbilicus are considered giant. Associated conditions In juvenile hypothyroidism multicystic<unk> es are present in about 75% of cases, while large<unk> an cysts and elevated<unk> an tumor marks are one of the symptoms of the Van Wyk and Grumbach<unk> . The CA-125 marker in children and adolescents can be frequently elevated even in absence of malignancy and conservative management should be considered.<unk> <unk> an<unk>  involves the development of multiple small cysts in both<unk> es due to an elevated ratio of leutenizing hormone to follicle stimulating hormone, typically more than 25 cysts in each<unk> , or an<unk> an volume of greater than 10 mL. Larger bilateral cysts can develop as a result of fertility treatment due to elevated levels of HCG, as can be seen with the use of clomifene for follicular induction, in extreme cases resulting in a condition known as<unk> an hyperstimulation<unk> . Certain malignancies can mimic the effects of clomifene on the<unk> es, also due to increased HCG, in particular gestational trophoblastic disease.<unk> an hyperstimulation occurs more often with invasive moles and choriocarcinoma than complete molar pregnancies. Risk of cancer A widely recognised method of estimating the risk of malignant<unk> an cancer based on initial workup is the risk of malignancy index (RMI). It is recommended that women with an RMI score over 200 should be referred to a centre with experience in<unk> an cancer surgery. The RMI is calculated as follows: :RMI = ultrasound score × menopausal score × CA-125 level in U/ml. There are two methods to determine the ultrasound score and menopausal score, with the resultant RMI being called RMI 1 and RMI 2, respectively, depending on what method is used: Feature RMI 1 RMI 2 Ultrasound abnormalities: * Multilocular cyst * Solid areas * Bilateral lesions * Ascites * Intra-abdominal metastases Menopausal score CA-125 Quantity in U/ml Quantity in U/ml An RMI 2 of over 200 has been estimated to have a sensitivity of 74 to 80%, a specificity of 89 to 92% and a positive predictive value of around 80% of<unk> an cancer. RMI 2 is regarded as more sensitive than RMI 1. Histopathology In case an<unk> an cyst is surgically removed, a more definite<unk>  can be made by histopathology: Type Subtype Typical microscopy findings Image Functional cyst Follicular cyst * A variable inner layer of granulosa cells which are luteinized after puberty * An outer layer of usually luteinized theca interna 100px Corpus luteum cyst * A convoluted cyst lining of luteinized granulosa cells * A prominent inner layer of fibrous tissue * An outer layer of theca cells 150px Cystadenoma Serous cystadenoma Cyst lining consisting of a simple epithelium, whose cells may be either: * columnar and tall and contain cilia, resembling normal tubal epithelium * cuboidal and have no cilia, resembling<unk> an surface epithelium 150px Mucinous cystadenoma Lined by a mucinous epithelium 200px Dermoid cyst Well-differentiated components from at least two germ layers (ectoderm, mesoderm and/or endoderm). 150px Endometriosis At least two of the following three criteria: * Endometrial type stroma * Endometrial epithelium with glands * Evidence of chronic hemorrhage, mainly hemosiderin deposits 150px Borderline tumor Atypical epithelial proliferation without stromal invasion. 120px<unk> an cancer Many different types, but generally severe dysplasia/atypia and invasion. Serous carcinoma. Simple squamous cyst Simple squamous epithelium and not conforming to<unk>  above (a<unk>  of exclusion) 150px
medical diagnosis of Polycystic ovary syndrome
symptom of Polycystic ovary syndrome
medical cause of Precocious puberty
symptom of Ovarian cancer
symptom of Klinefelter syndrome
symptom of Cystadenocarcinoma
symptom of Testicular cancer
symptoms of Endometriosis