From the Guidelines
Paraovarian cysts are typically benign and can be managed conservatively with regular ultrasound follow-ups for asymptomatic small cysts (less than 5 cm), while symptomatic, large, or complex cysts may require surgical removal via laparoscopy or laparotomy. According to the most recent and highest quality study 1, the risk of malignancy in simple cysts, including paraovarian cysts, is extremely low, and therefore, a conservative approach can be taken. The study suggests that simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer.
Diagnosis
The diagnosis of a paraovarian cyst can be made using ultrasound, which can accurately diagnose benign adnexal lesions, including simple cysts, hemorrhagic cysts, endometriomas, and dermoids, as well as extraovarian cystic lesions such as paraovarian cysts, hydrosalpinx, and peritoneal inclusion cysts 1. The O-RADS US Risk Stratification and Management System can also be used to diagnose and manage paraovarian cysts, which recommends that simple paraovarian cysts be managed with no follow-up or an optional single follow-up study in a year 1.
Treatment
The treatment of a paraovarian cyst depends on the symptoms and characteristics of the cyst. Asymptomatic small cysts (less than 5 cm) can be monitored with regular ultrasound follow-ups, while symptomatic, large, or complex cysts may require surgical removal via laparoscopy or laparotomy. The prognosis is excellent, with low recurrence rates after surgical removal and no impact on fertility.
Key Points
- Paraovarian cysts are typically benign and can be managed conservatively with regular ultrasound follow-ups for asymptomatic small cysts (less than 5 cm) 1.
- Symptomatic, large, or complex cysts may require surgical removal via laparoscopy or laparotomy.
- The O-RADS US Risk Stratification and Management System can be used to diagnose and manage paraovarian cysts 1.
- The risk of malignancy in simple cysts, including paraovarian cysts, is extremely low 1.
- Preservation of the ovary and fallopian tube is usually possible during surgery since the cyst is separate from these structures.
Management
The management of paraovarian cysts should be individualized based on the symptoms and characteristics of the cyst. According to the study by Gupta et al 1, the risk of malignancy in classic “benign”-appearing lesions is < 1%, and therefore, a conservative approach can be taken. The study also suggests that unilocular cysts, as a whole, in the premenopausal population have a very low risk of malignancy, with a recent meta-analysis by Parazzini et al demonstrating that the risk of malignancy was 0.6% in 987 unilocular cysts removed surgically in premenopausal women 1.
From the Research
Diagnosis of Paraovarian Cysts
- Paraovarian cysts are usually diagnosed using ultrasound, which can help differentiate them from ovarian cysts by recognizing their extraovarian location 2.
- The differential diagnosis for paraovarian cysts includes simple ovarian cysts, peritoneal inclusion cysts, and hydrosalpinx 2.
- Transvaginal ultrasonography (TVS) can be used to detect paratubal or paraovarian cysts, but its accuracy may vary 3.
- Laparoscopy can enable immediate diagnosis and appropriate management of complicated paraovarian cysts 4.
Treatment of Paraovarian Cysts
- The management of paraovarian cysts depends on the presence and severity of symptoms, cyst size, ultrasound characteristics, CA 125 results, patient age, and the risk of malignancy 2.
- Simple paraovarian cysts can be expected to regress and may be managed expectantly 2.
- Laparoscopic surgery can be safely applied in patients with giant and benign paraovarian cysts 5.
- Laparoscopic management of paratubal and paraovarian cysts can be performed using techniques such as puncture and coagulation, or cystectomy and extraction 3.
- Fertility-sparing surgery can be considered in the management of paraovarian cysts, especially in younger patients 6.
Complications of Paraovarian Cysts
- Complications of paraovarian cysts can include cyst enlargement, adnexal torsion, hemorrhage, rupture, and benign tumors 6.
- The importance of differentiating paraovarian cysts from ovarian cysts cannot be overemphasized, as it can affect the management and treatment of the condition 6.
- Laparoscopic approach is often preferred in the management of complications of paraovarian cysts 6.