From the Guidelines
For a 91-year-old female with a left adnexal simple 1.7 cm cyst, observation is the recommended approach. This small, simple cyst is most likely a physiologic or functional cyst that does not require intervention, as supported by the American College of Radiology's O-RADS US risk stratification and management system 1. The patient should have a follow-up ultrasound in 3-6 months to ensure the cyst has not grown or changed in appearance. No medications or surgical interventions are needed at this time. Simple cysts under 5 cm in postmenopausal women have a very low risk of malignancy (less than 1%), especially when they have no complex features like solid components, thick septations, or nodules 1. If the patient experiences new symptoms such as pelvic pain, bloating, or changes in bowel or bladder habits, she should seek medical attention sooner. The conservative approach is particularly appropriate given the patient's advanced age, as the risks of surgical intervention would likely outweigh the benefits for this incidental finding. According to the O-RADS guidelines, for cysts greater than 3 cm but less than 10 cm, at least 1-year follow-up showing stability or decrease in size is recommended with consideration of annual follow-up for up to 5 years, if stable 1.
Some key points to consider in the management of this patient include:
- The size and characteristics of the cyst, which suggest a low risk of malignancy
- The patient's age and potential risks associated with surgical intervention
- The importance of follow-up imaging to monitor the cyst's size and appearance
- The need for the patient to seek medical attention if new symptoms develop. Given the low risk of malignancy and the patient's advanced age, a conservative approach with observation and follow-up imaging is the most appropriate management strategy.
From the Research
Treatment for a 91-year-old female with a left adnexal simple 1.7 cm cyst
- The patient's age and the size of the cyst are important factors in determining the treatment approach 2, 3.
- For postmenopausal women with simple cysts less than 3 cm in diameter, observation may be considered, provided the serum CA-125 level is not elevated and the patient has no signs or symptoms suggestive of malignancy 2.
- Transvaginal ultrasonography is the imaging test of choice for evaluating adnexal masses for size and complexity 4, 3.
- In this case, the cyst is 1.7 cm in diameter, which is less than 3 cm, and is described as simple, suggesting a low risk of malignancy.
- The patient's serum CA-125 level should be measured to help assess the risk of ovarian malignancy 2, 3.
- If the CA-125 level is not elevated and the patient has no symptoms suggestive of malignancy, observation or expectant management may be considered 2, 4.
- Regular follow-up with serial ultrasonography and periodic measurement of CA-125 levels may help in monitoring the cyst and detecting any changes that may indicate malignancy 3.