ovarian cyst

Ovarian cysts are classified as functional (follicular cyst - failure of follicle rupture; corpus luteum cyst - failure of corpus luteum regression, may hemorrhage) or pathologic (endometrioma 'chocolate cyst', dermoid/mature cystic teratoma, cystadenoma serous/mucinous, or malignant neoplasms). Follicular cysts are the most common type, typically <3 cm, lined by granulosa cells, and often incidental findings. Corpus luteum cysts may cause delayed menses and can rupture causing hemoperitoneum, especially with anticoagulation. Clinical presentation ranges from asymptomatic to acute pelvic pain (rupture, hemorrhage, or torsion), bloating, or menstrual irregularities. Ovarian torsion is a surgical emergency presenting with sudden severe unilateral pain, nausea/vomiting; risk increases with cyst size >5 cm. Workup includes transvaginal ultrasound (simple vs complex cyst features), pregnancy test to rule out ectopic pregnancy, and CA-125 if malignancy suspected (though nonspecific, elevated in endometriosis, PID, and other benign conditions too). Management is often expectant with repeat ultrasound in 6-8 weeks for simple cysts; OCPs may prevent new functional cysts but don't shrink existing ones. Surgical intervention (cystectomy or oophorectomy) is indicated for large (>5-10 cm), complex, symptomatic, or persistent cysts, or in postmenopausal women with any adnexal mass due to higher malignancy risk. Key exam associations: McBurney's-like pain mimicking appendicitis, Meigs syndrome (ovarian fibroma with ascites and pleural effusion), and polycystic ovarian syndrome (multiple small follicular cysts with anovulation, hyperandrogenism, insulin resistance).