Materiały źródłowe

• #1 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Ovarian cysts are fluid-filled structures that may be simple or complex. They are common findings usually discovered incidentally on physical examination or imaging. Ovarian cysts can cause complications, including rupture, hemorrhage, and torsion, which are considered gynecological emergencies. Therefore, it is essential to promptly diagnose and treat them to avoid high morbidity and mortality. […] The etiology of ovarian cysts or adnexal masses ranges from physiologically normal (follicular or luteal cysts) to ovarian malignancy. Ovarian cysts can occur at any age but are more common in reproductive years and increase in menarchal females due to endogenous hormone production. […] During the normal menstrual cycle, the follicular phase is characterized by increasing follicle-stimulating hormone (FSH) production. That leads to the selection of dominant follicles for priming to release from the ovary. In a normal functioning ovary, estrogen production from the dominant follicle leads to a luteinizing hormone surge (LH), resulting in ovulation. After ovulation, follicular remnants form a corpus luteum, which produces progesterone. This inhibits FSH and LH production. If pregnancy does not occur, the progesterone declines, FSH and LH rise, and the next cycle begins.

• #1 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. […] The median menstrual cycle lasts 28 days, beginning with the first day of menstrual bleeding and ending just before the subsequent menstrual period. The variable first half of this cycle is termed the follicular phase and is characterized by increasing follicle-stimulating hormone (FSH) production, leading to the selection of a dominant follicle that is primed for release from the ovary. […] Different kinds of functional ovarian cysts can form during this cycle. In the follicular phase, follicular cysts may result from a lack of physiologic release of the ovum due to excessive FSH stimulation or lack of the normal LH surge at midcycle just before ovulation. Hormonal stimulation causes these cysts to continue to grow. Follicular cysts are typically larger than 2.5 cm in diameter and manifest as a discomfort and heaviness. Granulosa cells that line the follicle may also persist, leading to excess estradiol production, which, in turn, leads to decreased frequency of menstruation and menorrhagia.

• #1 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  In the absence of pregnancy, the lifespan of the corpus luteum is 14 days. If the ovum is fertilized, the corpus luteum continues to secrete progesterone for 5-9 weeks, until its eventual dissolution in 14 weeks time, when the cyst undergoes central hemorrhage. Failure of dissolution to occur may result in a corpus luteal cyst, which is arbitrarily defined as a corpus luteum that grows to 3 cm in diameter. The cyst can cause dull, unilateral pelvic pain and may be complicated by rupture, which causes acute pain and possibly massive blood loss. […] Theca-lutein cysts are caused by luteinization and hypertrophy of the theca interna cell layer in response to excessive stimulation from human chorionic gonadotropin (hCG). These cysts are predisposed to torsion, hemorrhage, and rupture. […] Neoplastic cysts arise via the inappropriate overgrowth of cells within the ovary and may be malignant or benign. Malignant neoplasms may arise from all ovarian cell types and tissues. The most frequent by far, however, are those arising from the surface epithelium (mesothelium); most of these are partially cystic lesions.

• #1 Hemorrhagic Ovarian Cyst: A Sonographic Perspective

  https://www.contemporaryobgyn.net/view/hemorrhagic-ovarian-cyst-sonographic-perspective

  When a graafian follicle ruptures to release an oocyte, it is transformed into a corpus luteum. The corpus luteum is lined by a layer of granulose cells which rapidly become vascularized; some of these thin-walled vessels can rupture. This causes bleeding into the corpus luteum, resulting in the formation of a hemorrhagic cyst of the ovary. […] When internal hemorrhage occurs into functional cysts of the ovary it is called a hemorrhagic ovarian cyst. This occurs most commonly into a corpus luteal cyst, and less often in a follicular cyst. […] When a graafian follicle ruptures to release an oocyte, it is transformed into a corpus luteum. The corpus luteum is lined by a layer of granulose cells which rapidly become vascularized; some of these thin-walled vessels can rupture. This causes bleeding into the corpus luteum, resulting in the formation of a hemorrhagic cyst of the ovary.

• #1 Hemorrhagic ovarian cyst | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hemorrhagic-ovarian-cyst-2?lang=us

  Hemorrhagic ovarian cysts usually result from hemorrhage into a corpus luteum or other functional cyst. Radiographic features are variable depending on the age of the hemorrhage. They typically resolve within 8 weeks. […] Hemorrhagic ovarian cysts typically develop as a result of ovulation. Secondary to a hormone response the stromal cells surrounding a maturing Graafian follicle become more vascular, and after the oocyte has been expelled, the Graafian follicle develops into a corpus luteum with a highly vascular and fragile granulosa layer, which ruptures easily, forming a hemorrhagic ovarian cyst.

• #1

  https://www.nhs.uk/conditions/ovarian-cyst/causes/

  Ovarian cysts are linked with the menstrual cycle and often go away without causing any problems. […] Pathological cysts are caused by abnormal cell growth and are not related to the menstrual cycle. […] Pathological cysts develop from either the cells used to create eggs or the cells that cover the outer part of the ovary. […] In some cases, ovarian cysts are caused by an underlying condition, such as endometriosis. […] Polycystic ovary syndrome (PCOS) is a condition that causes lots of small, harmless cysts to develop on your ovaries.

• #1 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Neoplastic cysts arise from the inappropriate overgrowth of cells within the ovary and may be malignant or benign. They may arise from the surface epithelium, and the benign lesions include serous and mucinous tumors. Other cystic lesions can include stromal or germ cell elements. […] Endometriosis is the presence of endometrial glands and stroma at extrauterine sites, with the ovary being one of the most common sites. Endometriomas (common in endometriosis) arise from ectopic growth of endometrial tissue and are often referred to as chocolate cysts because they contain dark, thick, gelatinous aged blood products.

• #1 Ovarian Cysts

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/

  Provided below is a brief description of the pathophysiology of various types of physiologic and neoplastic ovarian cysts and the potential complications that may arise. […] During normal ovulation, a follicle matures and then ruptures, releasing an oocyte. After ovulation, the corpus luteum forms and subsequently involutes. When the follicle fails to rupture and continues to grow, a follicular cyst occurs. When the corpus luteum fails to involute and continues to grow, a corpus luteum cyst occurs. Both types of cysts are considered physiologic or functional and neither have any malignant potential. Either type of cyst can become a hemorrhagic cyst (see below). […] Studies suggest that some seemingly ovarian serous carcinomas actually originate in the fallopian tubes and then spread to the ovary. These tubal lesions have also been found to spread to the peritoneum, leading to an apparent peritoneal carcinoma. Germ cell and stromal tumors do arise from the ovary itself.

• #1 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  Dermoid cysts or mature cystic teratomas contain elements from all three differentiated germ layers (ectodermal, mesodermal, and endodermal) and appear complex but can have a variety of appearances due to the tissue they contain. […] Endometriosis is the presence of endometrial glands and stroma at extrauterine sites, with the ovary being one of the most common sites. Endometriomas (common in endometriosis) arise from ectopic growth of endometrial tissue and are often referred to as chocolate cysts because they contain dark, thick, gelatinous aged blood products.

• #1 Overview: Ovarian cysts – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539572/

  Corpus luteum cysts: These occur when a corpus luteum fills with blood. The corpus luteum develops from the follicle that released the egg cell during ovulation. It secretes the sex hormones known as progesterone and estrogen. […] Theca lutein cysts: These mainly occur after infertility treatment with hormones. The hormones stimulate the growth of egg cells in the ovaries. Cysts may develop as a side effect. […] There is also a special type of cyst known as chocolate cysts (endometriomas). These are filled with dark, thick blood. They can develop as a result of endometriosis, for example. […] Dermoid cysts (which are not functional cysts) are less common. They may develop if a non-cancerous tumor grows and it contains things like skin cells and sebaceous glands. […] In another illness known as polycystic ovary syndrome (PCO), there are a lot of small cysts in the ovaries. Women who have PCO produce too many male sex hormones (androgens), which prevent the egg cells from maturing properly.

• #1 Ovarian Cyst Rupture: Background, Pathophysiology, Prognosis

  https://emedicine.medscape.com/article/253620-overview

  Each month, a mature ovarian follicle ruptures, releasing an ovum so the process of fertilization can begin. […] The etiology of this increased bleeding is unknown, although abdominal trauma and anticoagulation treatments may increase the risk. […] Nonphysiologic cysts, such as cystadenomas and mature cystic teratomas (dermoid cysts), may, in rare cases, rupture and cause symptoms. […] In addition to hemorrhage, significant pain can accompany rupture of a dermoid cyst, presumably from spillage of sebaceous fluid, resulting in a diffuse chemical peritonitis. Chemical peritonitis can lead to further complications, such as fistula and adhesion formation.

• #1 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Endometriomas are blood-filled cysts arising from the ectopic endometrium. Endometriomas are associated with endometriosis, which can cause dysmenorrhea and dyspareunia. […] In polycystic ovarian syndrome, the ovary often contains multiple cystic follicles 2-5 mm in diameter as viewed on sonograms. The cysts themselves are never the main problem, and discussion of this disease is beyond the scope of this article.

• #1 Ovarian Cysts and Pelvic Mass – Seckin Endometriosis Center

  https://drseckin.com/ovarian-cyst-pelvic-mass/

  Ovarian cysts can also arise after ovulation when the egg is released and the follicular breakage reforms to make the corpus luteum. […] Blood and other forms of bodily debris such as ectopic endometrium or even neoplastic tissue also play a role in the formation of several other forms of ovarian cysts. […] Polycystic ovarian syndrome (PCOS) is a hormonal disorder that causes small, benign cysts to arise throughout the ovaries. […] Endometriosis is one known cause of abnormal ovarian cysts, specifically endometriomas. […] The combination of these fragments of endometrial tissue, old thickened blood, and inflammatory enzymes combine together within the ovary to create an endometrioma or chocolate cyst. […] Endometriomas can be very harmful, as they can leak and rupture into the pelvic cavity, causing deep infiltrating endometriosis. […] Another concern is the risk of ovarian torsion. If the ovary gets large enough due to inflammation and cyst growth, it will begin to turn on itself. […] Research has shown that patients with ovarian endometriosis or endometrioma have a greater risk of developing certain types of ovarian cancer.

• #1 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  Theca lutein cysts are luteinized follicle cysts that form as a result of overstimulation in elevated human chorionic gonadotropin (hCG) levels. They can occur in pregnant women, women with gestational trophoblastic disease, multiple gestation, and ovarian hyperstimulation. […] Polycystic ovary syndrome is a disorder affecting 5 to 10% of women of reproductive age and is one of the primary causes of infertility. It is associated with diabetes mellitus and cardiovascular disease most of the time. Polycystic ovary syndrome (PCOS) appears as enlarged ovaries with multiple small follicular cysts. The ovaries appear enlarged due to excess androgen hormones in the body, which cause the ovaries to form cysts and increase in size. […] Neoplastic cysts arise from the inappropriate overgrowth of cells within the ovary and may be malignant or benign. They may arise from the surface epithelium, and the benign lesions include serous and mucinous tumors. Other cystic lesions can include stromal or germ cell elements.

• #1 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Follicular and corpus luteal cysts are considered functional or physiologic cysts, and both occur during the normal menstrual cycle. Follicular cysts arise when follicles fail to rupture during ovulation and can appear smooth, thin-walled, and unilocular. In the follicular phase, follicular cysts may form because of a lack of physiological release of the ovum due to excessive FSH stimulation or the absence of the usual LH surge at mid-cycle just before ovulation. These cysts continue to grow because of hormonal stimulation. […] Polycystic ovary syndrome is a disorder affecting 5 to 10% of women of reproductive age and is one of the primary causes of infertility. It is associated with diabetes mellitus and cardiovascular disease most of the time. Polycystic ovary syndrome (PCOS) appears as enlarged ovaries with multiple small follicular cysts. The ovaries appear enlarged due to excess androgen hormones in the body, which cause the ovaries to form cysts and increase in size.

• #1 Cysts vs. Cancer: Clearing the Air – Ovarian Cancer Research Alliance

  https://ocrahope.org/news/science-made-simple-ovarian-cysts-and-ovarian-cancer/

  Ovarian cysts that form as a result of the menstrual process are called functional cysts. […] Pathological cysts are caused by abnormal cell growth. These types are less common and are often benign, but they can carry a higher likelihood of malignancy. […] Most ovarian cysts are not harmful, dont cause symptoms and are not indicative of risk for future ovarian cancer, though some complex ovarian cysts may raise the risk. A 2019 study found that a higher percentage of complex ovarian cysts may be cancerous, estimating that among those age 50 or older, 6.5% of individuals with complex ovarian cysts may be diagnosed with ovarian cancer within 3 years. […] Different factors can predispose some people to certain types of cysts. For instance, a hormonal imbalance, often caused by drugs that promote conception, can lead to functional cysts. Endometriosis, severe pelvic infections, complications in early pregnancy, and Polycystic Ovary Syndrome can all lead to formation of cysts. […] In short, presence of an ovarian cyst is not cause for alarm ovarian cancer and ovarian cysts are not the same but it is cause for vigilance.

• #1 Ovarian Cysts

  https://www.csh.org.tw/dr.tcj/educartion/f/web/Ovarian%20tumor/index.htm

  Each month, normally functioning ovaries develop small cysts called Graafian follicles. […] Ovarian cysts arising in the course of ovarian function are called functional cysts and are always benign. […] Multiple functional cysts can occur as a result of excessive gonadotrophin stimulation or sensitivity. […] Neoplastic cysts arise by inappropriate overgrowth of cells within the ovary and may be malignant or benign. […] The benign counterparts of these cancers are serous and mucinous cystadenomas. […] Endometriomas are cysts filled with altered blood arising from ectopic endometrium. […] Risk factors for ovarian cystadenocarcinoma include strong family history, advancing age, Caucasian ethnicity, infertility, nulliparity, a history of breast cancer, and BRCA gene mutations. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but is unproven to date. Malignant change can occur in a small percentage of dermoid cysts and endometriomas.

• #1 Ovarian cysts in infants, children, and adolescents – UpToDate

  https://www.uptodate.com/contents/ovarian-cysts-and-neoplasms-in-infants-children-and-adolescents

  Epidemiology and pathogenesis — Follicular ovarian cysts are common in fetuses and neonates. They increase in frequency with advancing gestational age and some maternal complications (eg, diabetes mellitus, preeclampsia, Rh isoimmunization). Although the true incidence of fetal ovarian cysts is unknown, they have been detected in approximately 30 percent of female fetuses on necropsy and 30 to 70 percent of fetuses on routine prenatal ultrasonography. Among live-born female infants, incidence of clinically important ovarian cysts is estimated to be 1 in 2500. There is no increased risk of recurrence in subsequent pregnancies. […] Fetal and neonatal ovarian cysts most likely arise from ovarian stimulation by maternal and fetal gonadotropins, although the pathogenesis is uncertain.

• #1 Ovarian Cysts: A Review

  https://www.uspharmacist.com/article/ovarian-cysts-a-review

  A thorough history may reveal other risk factors for ovarian cancer, such as a family history of ovarian or breast cancer, other hereditary cancer syndromes, infertility, and nulliparity. […] Findings on ultrasound that are suspicious for malignancy include the presence of solid components, papillary projections, thick walls, thick septations, increased vascularity within the cyst, bilaterality, and ascites. […] It is difficult to distinguish a functional ovarian cyst from an ovarian neoplasm based on signs and symptoms alone. […] Although ovarian malignancy is less likely in women of reproductive age, any suspicion arising from patient history, signs and symptoms, imaging findings, or serologic testing should be further investigated. […] In many cases, a definitive diagnosis of cyst type and status as malignant or benign cannot be made without surgical excision and histologic examination.

• #1 Recurrent Giant Ovarian Cysts in Biological Sisters: 2 Case Reports and Literature Review—Giant Ovarian Cysts in 2 Sisters

  https://www.mdpi.com/2227-9032/13/6/656

  […] […] The family history revealed no ovarian cysts in the grandmother or mother, and no mutations related to their clinical presentation were found through whole exome sequencing of the family, covering the exon regions of approximately 20,000 genes in the human genome, including the mitochondrial genome. From a genetic point of view, the fact that family exome sequencing revealed no significant findings reduces if not excludes the chance of the heritable nature of the underlying genetic defects leading to the observed susceptibility to ovarian cysts formation and recurrence. We can argue that the above results suggest the potential acquisition of the genetic anomalies during the pre and/or post-natal life while their co-occurrence in the two sisters could result from the exposure to similar environmental factors perhaps leading to epigenetic modifications (e.g., DNA methylation, histone modifications) affecting genes within the gonadal and/or extragonadal tissue.

• #1 Ovarian cysts – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/ovarian-cysts/

  Ovarian cysts are fluid-filled sacs within the ovary. […] Functional cysts result from a disruption in the development of follicles or the corpus luteum and often resolve on their own. […] Theca lutein cysts result from exaggerated stimulation of the theca interna cells of the ovarian follicles due to excessive amounts of circulating gonadotropins such as -hCG. […] Management and follow-up are usually determined by cyst appearance and size as well as menopausal status. […] Rupture is caused by an increase in intracystic pressure. […] Most common type of ruptured cyst: corpus luteum cyst. […] Characteristic findings include free fluid, most commonly in the pouch of Douglas (rectouterine pouch).

• #1 Ovarian cysts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405

  Ovarian cysts are sacs, usually filled with fluid, in an ovary or on its surface. […] A follicular cyst occurs when the follicle of the ovary doesn’t rupture or release its egg. Instead, it grows until it becomes a cyst. […] Changes in the follicle of the ovary after an egg has been released can cause the egg’s escape opening to seal off. Fluid builds up inside the follicle, and a corpus luteum cyst develops. […] Most ovarian cysts form as a result of your menstrual cycle. These are called functional cysts. Other types of cysts are much less common. […] A monthly follicle that keeps growing is known as a functional cyst. […] Functional cysts are usually harmless. They rarely cause pain and often disappear on their own within 2 to 3 menstrual cycles. […] Dermoid cysts and cystadenomas can become large and move the ovary out of position. This increases the chance of painful twisting of the ovary, called ovarian torsion. Ovarian torsion may reduce or stop blood flow to the ovary. […] Cysts that become large can cause the ovary to move. This increases the chance of painful twisting of the ovary (ovarian torsion). […] A cyst that bursts open (ruptures) can cause severe pain and bleeding inside the pelvis. The larger the cyst, the greater the risk of rupture.

• #1 Ovarian Cysts – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/ovarian-cysts-diagnosis-treatment/

  Ovarian cysts are benign tumors originating from one of three cell lines: epithelial, germ cell or sex cord stromal. […] Cysts can be classified as functional/physiologic (eg follicular or corpus luteum) or pathologic. […] Most ovarian cysts are functional as related to normal menstrual cycle: Follicular cyst: begins when the follicle doesn’t rupture and continues to grow. […] The biggest complication of large cysts is the development of ovarian torsion, a true gynecologic emergency.

• #1 Ovarian Cysts | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/ovarian-cysts

  Ovarian cysts can develop in response to fluctuating levels of female sex hormones during the menstrual cycle. […] Cysts are almost always benign but can develop into cancer. […] Complications of cysts can include disruption of the blood flow to an ovary (torsion) or rupture.

• #1 Ovarian Pathology – Dr Farjo

  https://drfarjo.com.au/ovarian-pathology/

  An ovarian cyst is a sac of tissue that develops inside an ovary. They are very common and many women will have ovarian cysts at some point in their life. […] The second main type is apathological ovarian cysts which forms as the result of abnormal cell growth. These can be either benign (harmless) or malignant (cancerous). […] Benign ovarian cysts do not usually affect a women’s ability to conceive even if they required surgery. However the surgical management of the cyst will largely depends on the ultrasound features, it’s size, the blood results and the clinical findings in each individual case.

• #1 Pathogenesis and pathophysiology of ovarian follicular…

  https://sciendo.com/article/10.2478/acb-2018-0019

  Ovarian cysts remain to be one of the most common and serious problems in reproduction of farm animals, as well as humans. […] Apart from causing the fall in reproductive potential of the ovaries, occupying the place in which folliculogenesis and oogenesis occur, they also cause hormone imbalances, by preventing corpus luteum formation, hence lowering the amount of steroid hormone production. […] While singular cysts rarely affect fertility, hormone fluctuations that are associated with their presence promotes their multiplication, which usually has more adverse effects. […] Continuous research, focused on natural examples of ovarian cysts should be conducted, in order to improve methods of detection, prevention, treatment and recovery from the effects of ovarian cysts.

• #1 Ovarian Cyst: Symptoms, Causes, & Treatment | University of Utah Health

  https://healthcare.utah.edu/womens-health/gynecology/ovarian-cyst

  Ovarian cysts are sacs or pockets of fluid that form on the ovaries. There are two types of cysts: simple and complex. […] A complex or non-functional cyst is one that isnt associated with ovulation. These are solid or partially solid and can grow to cause discomfort or pain. Most ovarian cysts are noncancerous, but a small percentage of complex cysts are cancerous. The cancer risk is somewhat higher for post-menopausal women. […] Most cysts will go away on their own. However, if an untreated cyst twists or ruptures, you could risk losing your ovary or bleeding excessively. These complications can affect your fertility and, in rare cases, lead to death. […] An ovarian cyst malignancy, or cancer, is rare, especially among premenopausal women. However, your doctor will want to rule out cancer if you have a complex ovarian cyst or are considered high-risk.

• #1 Ignored adult primary hypothyroidism presenting chiefly with persistent ovarian cysts: a need for increased awareness | Reproductive Biology and Endocrinology | Full Text

  https://rbej.biomedcentral.com/articles/10.1186/1477-7827-9-119

  Ovarian cysts are a common cause for gynecological surgery. However, some cysts are a direct result of endocrine disorders and do not require surgery. […] The possible mechanisms of the pathophysiology are discussed below. […] Hypothyroidism is another endocrine disorder associated with ovarian hyperstimulation, yet is often ignored in its evaluation. […] There are several hypotheses about the mechanism of ovarian cyst formation associated with hypothyroidism. […] First, TSH, FSH and their receptors have related structures. Extremely high concentrations of TSH in hypothyroidism may be sufficient to cause the activation of FSHR. […] A second possible mechanism may be related to a change in pituitary gonadotropin levels. […] A third possible mechanism has been hypothesized to be due to FSHR activating mutations permitting or amplifying the affect of hCG or TSH on the follicles.

• #1 Ignored adult primary hypothyroidism presenting chiefly with persistent ovarian cysts: a need for increased awareness | Reproductive Biology and Endocrinology | Full Text

  https://rbej.biomedcentral.com/articles/10.1186/1477-7827-9-119

  Fourth, TSH may sensitize the ovaries to gonadotropin stimulation by stimulating nuclear thyroid receptors in the granulosa cells, thereby exacerbating ovarian hyperstimulation. […] Fifth, myxedematous-type infiltration might also account for the interference of steroidogenesis in the ovary and contribute to ovarian cystic changes. […] Despite multiple hypotheses for the association between hypothyroidism and ovarian hyperstimulation, the exact mechanism is not yet clear. […] Although the precise etiopathology of this disorder remains speculative, the treatment approach is for ovarian hyperstimulation due to hypothyroidism is clear.

• #1 Follicular Cystic Ovary Disease in Cows – Reproductive System – Merck Veterinary Manual

  https://www.merckvetmanual.com/reproductive-system/cystic-ovary-disease/follicular-cystic-ovary-disease-in-cows

  Follicular cystic ovary disease may be defined by several observations. Essentially all signs relate to disruption of the normal endocrine events of the estrous cycle that results from this failure of ovulatory events. […] Cystic ovary disease or syndrome is commonly considered to be associated with negative energy balance and stress factors in high-milk-production dairy cows. […] An important component of the etiology of cystic ovary disease is the failure of positive feedback of follicular estrogen on the hypothalamus via estrogen receptor alpha to release sufficient gonadotropin-releasing hormone (Gn-RH) during estrus to trigger a luteinizing hormone surge. Metabolic compromise contributes to this failure through decreased Gn-RH activity and hence absence of the spike in luteinizing hormone. The end result is a failure of ovulation at the time of estrus.

• #1 Follicular Cystic Ovary Disease in Cows – Reproductive System – Merck Veterinary Manual

  https://www.merckvetmanual.com/reproductive-system/cystic-ovary-disease/follicular-cystic-ovary-disease-in-cows

  The actions of the various hormones produced or the absence of the stabilizing action of a large amount of progesterone from the normal corpus luteum during 75% of the estrous cycle (or both) is responsible for the changes observed in the genital tract, body conformation, and general behavior. Importantly, the absence of progesterone inhibits the normal upregulation of luteinizing hormone receptors required for delivering the luteinizing hormone surge that is necessary for achieving ovulation, so the reproductive cycle stalls.

• #1 Ovarian Cysts: A Review

  https://www.uspharmacist.com/article/ovarian-cysts-a-review

  Ovarian cysts may be classified as either functional ovarian cysts or ovarian cystic neoplasms. The most common functional ovarian cysts are follicular cysts and corpus luteum cysts, which develop as a result of ovulation. It is believed that follicular cysts occur when an ovarian follicle fails to rupture and continues to grow. Corpus luteum cysts may develop when the corpus luteum fails to regress normally after ovulation. […] Ovarian cystic neoplasms are derived from neoplastic growth. They may be categorized into three types based on their cells of origin: surface epithelial cell tumors, germ cell tumors, and sex cord-stromal tumors. The majority of these neoplasms are benign in women of reproductive age, but the risk of malignancy increases in postmenopausal women. […] The risk of ovarian malignancy increases dramatically with age. It is estimated that 13% of ovarian neoplasms in premenopausal women are malignant, compared with 45% in postmenopausal women.

• #1 Giant Ovarian Cyst That May Be Confused With Mesentery Cyst | Paltaci | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1776/1135

  Ultrasonography is useful for discrimination of solid and cystic intraabdominal masses. CT may be used for determination of borders and the origin of the mass lesion. […] The fertility of the patient should be considered when making a treatment plan. Although giant ovarian cysts always require resection, ooforectomy should usually be performed, due to suspicion of malignity.

• #1 Immunocytochemistry profiling of ovarian cysts: A review of its clinical utility, future direction, and challenges

  https://accscience.com/journal/TD/4/1/10.36922/td.5369

  Specific biomarkers play a significant role in distinguishing between benign and malignant ovarian cysts. Commonly used biomarkers include Cancer antigen 125, Ki-67, p53, HE4, and WT1. Future directions in this field are likely to focus on multiplex ICC, the discovery of novel biomarkers, the integration of artificial intelligence with other diagnostic modalities, and improving the standardization of ICC practice. Integrating these biomarkers into ovarian pathology will enable accurate diagnosis with reduced turnaround times, overcoming the limitations of hematoxylin and eosin staining methods.

• #1 Ovarian cyst | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ovarian-cyst-2?lang=us

  Ovarian cysts are commonly encountered in gynecological imaging and vary widely in etiology from physiological to complex benign to neoplastic. […] There are many types of ovarian cyst: physiological cysts, functional cysts (can produce hormones), and other cysts. […] Complications in functional cysts include hemorrhagic ovarian cyst, enlargement, rupture, and torsion. […] Risk of malignancy in septated ovarian cysts with no papillary projections or solid components are also considered low and are usually followed up on ultrasound. […] Large (3 cm) or symptomatic cysts may undergo surgical resection. […] Smaller asymptomatic cysts are treated conservatively.

• #2 Ovarian cysts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405

  Ovarian cysts are sacs, usually filled with fluid, in an ovary or on its surface. […] A follicular cyst occurs when the follicle of the ovary doesn’t rupture or release its egg. Instead, it grows until it becomes a cyst. […] Changes in the follicle of the ovary after an egg has been released can cause the egg’s escape opening to seal off. Fluid builds up inside the follicle, and a corpus luteum cyst develops. […] Most ovarian cysts form as a result of your menstrual cycle. These are called functional cysts. Other types of cysts are much less common. […] A monthly follicle that keeps growing is known as a functional cyst. […] Functional cysts are usually harmless. They rarely cause pain and often disappear on their own within 2 to 3 menstrual cycles. […] Dermoid cysts and cystadenomas can become large and move the ovary out of position. This increases the chance of painful twisting of the ovary, called ovarian torsion. Ovarian torsion may reduce or stop blood flow to the ovary. […] Cysts that become large can cause the ovary to move. This increases the chance of painful twisting of the ovary (ovarian torsion). […] A cyst that bursts open (ruptures) can cause severe pain and bleeding inside the pelvis. The larger the cyst, the greater the risk of rupture.

• #2 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. […] The median menstrual cycle lasts 28 days, beginning with the first day of menstrual bleeding and ending just before the subsequent menstrual period. The variable first half of this cycle is termed the follicular phase and is characterized by increasing follicle-stimulating hormone (FSH) production, leading to the selection of a dominant follicle that is primed for release from the ovary. […] Different kinds of functional ovarian cysts can form during this cycle. In the follicular phase, follicular cysts may result from a lack of physiologic release of the ovum due to excessive FSH stimulation or lack of the normal LH surge at midcycle just before ovulation. Hormonal stimulation causes these cysts to continue to grow. Follicular cysts are typically larger than 2.5 cm in diameter and manifest as a discomfort and heaviness. Granulosa cells that line the follicle may also persist, leading to excess estradiol production, which, in turn, leads to decreased frequency of menstruation and menorrhagia.

• #2 Hemorrhagic Ovarian Cyst: A Sonographic Perspective

  https://www.contemporaryobgyn.net/view/hemorrhagic-ovarian-cyst-sonographic-perspective

  When a graafian follicle ruptures to release an oocyte, it is transformed into a corpus luteum. The corpus luteum is lined by a layer of granulose cells which rapidly become vascularized; some of these thin-walled vessels can rupture. This causes bleeding into the corpus luteum, resulting in the formation of a hemorrhagic cyst of the ovary. […] When internal hemorrhage occurs into functional cysts of the ovary it is called a hemorrhagic ovarian cyst. This occurs most commonly into a corpus luteal cyst, and less often in a follicular cyst. […] When a graafian follicle ruptures to release an oocyte, it is transformed into a corpus luteum. The corpus luteum is lined by a layer of granulose cells which rapidly become vascularized; some of these thin-walled vessels can rupture. This causes bleeding into the corpus luteum, resulting in the formation of a hemorrhagic cyst of the ovary.

• #2 Hemorrhagic ovarian cyst: Causes, symptoms, and more

  https://www.medicalnewstoday.com/articles/hemorrhagic-ovarian-cyst

  Ovarian cysts are fluid-filled sacs that can develop inside a persons ovaries. They are typically harmless and do not tend to cause symptoms. […] A hemorrhagic ovarian cyst is a type of ovarian cyst that bleeds. Hemorrhagic ovarian cysts are typically functional cysts, which means they occur due to ovulation rather than due to disease. […] During menstruation, the body produces a temporary organ called the corpus luteum to help with fertility. Excessive bleeding into the corpus luteum can cause a hemorrhagic ovarian cyst to develop. […] Another type of ovarian cyst, called a follicular cyst, occurs when an ovary follicle does not release its egg. In this case, the follicle instead becomes a cyst. As with corpus luteal cysts, bleeding into a follicular cyst can cause a hemorrhagic ovarian cyst. […] A hemorrhagic ovarian cyst develops when blood enters a corpus luteal or follicular cyst.

• #2 Ovarian Cysts

  https://www.csh.org.tw/dr.tcj/educartion/f/web/Ovarian%20tumor/index.htm

  Each month, normally functioning ovaries develop small cysts called Graafian follicles. […] Ovarian cysts arising in the course of ovarian function are called functional cysts and are always benign. […] Multiple functional cysts can occur as a result of excessive gonadotrophin stimulation or sensitivity. […] Neoplastic cysts arise by inappropriate overgrowth of cells within the ovary and may be malignant or benign. […] The benign counterparts of these cancers are serous and mucinous cystadenomas. […] Endometriomas are cysts filled with altered blood arising from ectopic endometrium. […] Risk factors for ovarian cystadenocarcinoma include strong family history, advancing age, Caucasian ethnicity, infertility, nulliparity, a history of breast cancer, and BRCA gene mutations. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but is unproven to date. Malignant change can occur in a small percentage of dermoid cysts and endometriomas.

• #2 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  In the absence of pregnancy, the lifespan of the corpus luteum is 14 days. If the ovum is fertilized, the corpus luteum continues to secrete progesterone for 5-9 weeks, until its eventual dissolution in 14 weeks time, when the cyst undergoes central hemorrhage. Failure of dissolution to occur may result in a corpus luteal cyst, which is arbitrarily defined as a corpus luteum that grows to 3 cm in diameter. The cyst can cause dull, unilateral pelvic pain and may be complicated by rupture, which causes acute pain and possibly massive blood loss. […] Theca-lutein cysts are caused by luteinization and hypertrophy of the theca interna cell layer in response to excessive stimulation from human chorionic gonadotropin (hCG). These cysts are predisposed to torsion, hemorrhage, and rupture. […] Neoplastic cysts arise via the inappropriate overgrowth of cells within the ovary and may be malignant or benign. Malignant neoplasms may arise from all ovarian cell types and tissues. The most frequent by far, however, are those arising from the surface epithelium (mesothelium); most of these are partially cystic lesions.

• #2 Overview: Ovarian cysts – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539572/

  Corpus luteum cysts: These occur when a corpus luteum fills with blood. The corpus luteum develops from the follicle that released the egg cell during ovulation. It secretes the sex hormones known as progesterone and estrogen. […] Theca lutein cysts: These mainly occur after infertility treatment with hormones. The hormones stimulate the growth of egg cells in the ovaries. Cysts may develop as a side effect. […] There is also a special type of cyst known as chocolate cysts (endometriomas). These are filled with dark, thick blood. They can develop as a result of endometriosis, for example. […] Dermoid cysts (which are not functional cysts) are less common. They may develop if a non-cancerous tumor grows and it contains things like skin cells and sebaceous glands. […] In another illness known as polycystic ovary syndrome (PCO), there are a lot of small cysts in the ovaries. Women who have PCO produce too many male sex hormones (androgens), which prevent the egg cells from maturing properly.

• #2 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Endometriomas are blood-filled cysts arising from the ectopic endometrium. Endometriomas are associated with endometriosis, which can cause dysmenorrhea and dyspareunia. […] In polycystic ovarian syndrome, the ovary often contains multiple cystic follicles 2-5 mm in diameter as viewed on sonograms. The cysts themselves are never the main problem, and discussion of this disease is beyond the scope of this article.

• #2 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  The etiology of ovarian cysts or adnexal masses ranges from physiologically normal (follicular or luteal cysts) to ovarian malignancy. Ovarian cysts can occur at any age but are more common in reproductive years and increase in menarchal females due to endogenous hormone production. […] Simple cysts are the most likely to occur in all age groups, and mixed cystic and solid and completely solid ovarian lesions have a higher rate of malignancy than simple cysts. Although most ovarian cysts are benign, age is the most important independent risk factor, and post-menopausal women with any type of cyst should have proper follow-up and treatment due to a higher risk for malignancy. […] Follicular and corpus luteal cysts are considered functional or physiologic cysts, and both occur during the normal menstrual cycle. Follicular cysts arise when follicles fail to rupture during ovulation and can appear smooth, thin-walled, and unilocular. In the follicular phase, follicular cysts may form because of a lack of physiological release of the ovum due to excessive FSH stimulation or the absence of the usual LH surge at mid-cycle just before ovulation.

• #2 Ovarian Cysts: A Review

  https://www.uspharmacist.com/article/ovarian-cysts-a-review

  A thorough history may reveal other risk factors for ovarian cancer, such as a family history of ovarian or breast cancer, other hereditary cancer syndromes, infertility, and nulliparity. […] Findings on ultrasound that are suspicious for malignancy include the presence of solid components, papillary projections, thick walls, thick septations, increased vascularity within the cyst, bilaterality, and ascites. […] It is difficult to distinguish a functional ovarian cyst from an ovarian neoplasm based on signs and symptoms alone. […] Although ovarian malignancy is less likely in women of reproductive age, any suspicion arising from patient history, signs and symptoms, imaging findings, or serologic testing should be further investigated. […] In many cases, a definitive diagnosis of cyst type and status as malignant or benign cannot be made without surgical excision and histologic examination.

• #2 Ovarian Cysts and Pelvic Mass – Seckin Endometriosis Center

  https://drseckin.com/ovarian-cyst-pelvic-mass/

  Ovarian cysts can also arise after ovulation when the egg is released and the follicular breakage reforms to make the corpus luteum. […] Blood and other forms of bodily debris such as ectopic endometrium or even neoplastic tissue also play a role in the formation of several other forms of ovarian cysts. […] Polycystic ovarian syndrome (PCOS) is a hormonal disorder that causes small, benign cysts to arise throughout the ovaries. […] Endometriosis is one known cause of abnormal ovarian cysts, specifically endometriomas. […] The combination of these fragments of endometrial tissue, old thickened blood, and inflammatory enzymes combine together within the ovary to create an endometrioma or chocolate cyst. […] Endometriomas can be very harmful, as they can leak and rupture into the pelvic cavity, causing deep infiltrating endometriosis. […] Another concern is the risk of ovarian torsion. If the ovary gets large enough due to inflammation and cyst growth, it will begin to turn on itself. […] Research has shown that patients with ovarian endometriosis or endometrioma have a greater risk of developing certain types of ovarian cancer.

• #2 Ignored adult primary hypothyroidism presenting chiefly with persistent ovarian cysts: a need for increased awareness | Reproductive Biology and Endocrinology | Full Text

  https://rbej.biomedcentral.com/articles/10.1186/1477-7827-9-119

  Fourth, TSH may sensitize the ovaries to gonadotropin stimulation by stimulating nuclear thyroid receptors in the granulosa cells, thereby exacerbating ovarian hyperstimulation. […] Fifth, myxedematous-type infiltration might also account for the interference of steroidogenesis in the ovary and contribute to ovarian cystic changes. […] Despite multiple hypotheses for the association between hypothyroidism and ovarian hyperstimulation, the exact mechanism is not yet clear. […] Although the precise etiopathology of this disorder remains speculative, the treatment approach is for ovarian hyperstimulation due to hypothyroidism is clear.

• #2 Cysts vs. Cancer: Clearing the Air – Ovarian Cancer Research Alliance

  https://ocrahope.org/news/science-made-simple-ovarian-cysts-and-ovarian-cancer/

  Ovarian cysts that form as a result of the menstrual process are called functional cysts. […] Pathological cysts are caused by abnormal cell growth. These types are less common and are often benign, but they can carry a higher likelihood of malignancy. […] Most ovarian cysts are not harmful, dont cause symptoms and are not indicative of risk for future ovarian cancer, though some complex ovarian cysts may raise the risk. A 2019 study found that a higher percentage of complex ovarian cysts may be cancerous, estimating that among those age 50 or older, 6.5% of individuals with complex ovarian cysts may be diagnosed with ovarian cancer within 3 years. […] Different factors can predispose some people to certain types of cysts. For instance, a hormonal imbalance, often caused by drugs that promote conception, can lead to functional cysts. Endometriosis, severe pelvic infections, complications in early pregnancy, and Polycystic Ovary Syndrome can all lead to formation of cysts. […] In short, presence of an ovarian cyst is not cause for alarm ovarian cancer and ovarian cysts are not the same but it is cause for vigilance.

• #2 Ovarian Cysts | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/ovarian-cysts/

  The doctor may first detect an ovarian cyst during a routine pelvic exam. We can then use several tests to determine the cysts type, size, and composition (what its filled with). Cysts that are filled with fluid are less likely to be cancerous. Those that are solid or filled with fluid and solids may indicate cancer. […] If the diagnosis is ovarian cancer, consult a gynecologic oncologist for treatment options. […] How we treat an ovarian cyst depends on your age, the type and size of the cyst, and your symptoms. […] Cysts often go away on their own. If no symptoms are present and the cyst is small and fluid-filled, the doctor may recommend follow-up exams to ensure the cyst disappears or does not grow. […] Birth control pills can reduce the development of new cysts. […] The doctor can surgically remove a cyst that is large, growing, or causing pain. Some cysts can be removed without taking out the ovary. If the cyst is cancerous, your doctor will likely recommend a hysterectomy to remove the ovaries and uterus.

• #3 Overview: Ovarian cysts – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539572/

  Ovarian cysts are fluid-filled sacs in the ovaries. Some have tissue inside them. The cysts are surrounded by a capsule and usually about the size of a cherry. Most ovarian cysts go away on their own. […] These cysts often develop due to normal hormonal changes in puberty or during menopause. Sometimes ovarian cysts are already there at birth or are caused by something else, but that’s much less common. […] Most ovarian cysts develop during one part of the menstrual cycle (the growth and release of egg cells). Known as functional cysts, these mainly occur in puberty or during menopause. They may develop in one ovary or in both ovaries at the same time. […] These are the most common types of functional ovarian cysts: Follicular cysts: Each egg cell is surrounded by a capsule known as a follicle. If the follicle doesn’t open and release the egg cell (if ovulation doesn’t occur), the follicle might gradually become filled with a fluid and turn into a cyst.

• #3 Ovarian cysts: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001504.htm

  An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. […] This article is about cysts that form during your monthly menstrual cycle, called functional cysts. Functional cysts are not the same as cysts caused by cancer or other diseases. The formation of these cysts is a perfectly normal event and is a sign that the ovaries are working well. […] Each month during your menstrual cycle, a follicle (cyst) grows on your ovary. The follicle is where an egg is developing. […] If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cyst. This is called a follicular cyst. […] Another type of cyst occurs after an egg has been released from a follicle. This is called a corpus luteum cyst. This type of cyst may contain a small amount of blood. This cyst makes progesterone and estrogen hormones.

• #3 Overview: Ovarian cysts – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539572/

  Corpus luteum cysts: These occur when a corpus luteum fills with blood. The corpus luteum develops from the follicle that released the egg cell during ovulation. It secretes the sex hormones known as progesterone and estrogen. […] Theca lutein cysts: These mainly occur after infertility treatment with hormones. The hormones stimulate the growth of egg cells in the ovaries. Cysts may develop as a side effect. […] There is also a special type of cyst known as chocolate cysts (endometriomas). These are filled with dark, thick blood. They can develop as a result of endometriosis, for example. […] Dermoid cysts (which are not functional cysts) are less common. They may develop if a non-cancerous tumor grows and it contains things like skin cells and sebaceous glands. […] In another illness known as polycystic ovary syndrome (PCO), there are a lot of small cysts in the ovaries. Women who have PCO produce too many male sex hormones (androgens), which prevent the egg cells from maturing properly.

• #3 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  Theca lutein cysts are luteinized follicle cysts that form as a result of overstimulation in elevated human chorionic gonadotropin (hCG) levels. They can occur in pregnant women, women with gestational trophoblastic disease, multiple gestation, and ovarian hyperstimulation. […] Polycystic ovary syndrome is a disorder affecting 5 to 10% of women of reproductive age and is one of the primary causes of infertility. It is associated with diabetes mellitus and cardiovascular disease most of the time. Polycystic ovary syndrome (PCOS) appears as enlarged ovaries with multiple small follicular cysts. The ovaries appear enlarged due to excess androgen hormones in the body, which cause the ovaries to form cysts and increase in size. […] Neoplastic cysts arise from the inappropriate overgrowth of cells within the ovary and may be malignant or benign. They may arise from the surface epithelium, and the benign lesions include serous and mucinous tumors. Other cystic lesions can include stromal or germ cell elements.

• #3 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  Dermoid cysts or mature cystic teratomas contain elements from all three differentiated germ layers (ectodermal, mesodermal, and endodermal) and appear complex but can have a variety of appearances due to the tissue they contain. […] Endometriosis is the presence of endometrial glands and stroma at extrauterine sites, with the ovary being one of the most common sites. Endometriomas (common in endometriosis) arise from ectopic growth of endometrial tissue and are often referred to as chocolate cysts because they contain dark, thick, gelatinous aged blood products.

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