OVARIAN CYSTS - A CLINICAL DILEMMA

The rapid development of ultrasound technology and its routine applica tion during gynecological examinations has led to the more frequent de tection of ovarian cysts. Such cysts can be diagnosed at any age or st age of a woman's life, and detected as early as the fetal stage or as late as the postmenopause. Ovarian cysts in female fetuses are usually detected during screening in pregnancy and followed after delivery as neonates. A few months are usually sufficient for spontaneous regress ion, although symptomatic cysts should be promptly operated. Infertile women, most cases present benign functional cysts which disappear aft er menstruation or can be managed easily with the combined oral contra ceptive pill. When pregnancy is complicated with an adnexal mass, the second trimester is the preferable time of action in cases when operat ion is demanded. Transvaginal sonography plays an important role, not only in the detection of ovarian cysts but also in the diagnosis of ma lignancy. Large cysts, multiloculi, septa, papillae and increased bloo d flow are all suspected signs of neoplasia. The incidence of ovarian cancer increases with age and is predominant a disease of peri- and po stmenopausal women with an average patient age of 50-59 years. Vaginal sonography has been established as the examination of choice in scree ning and follow-up of patients, with complementary color Doppler studi es and determination of serial serum levels of CA-125. If a malignant cysts is suspected, at any age, explorative laparotomy should be perfo rmed promptly. Sonographic or computerized tomographic scanner aspirat ion procedures, as well as laparoscopic surgery, should be reserved fo r diagnostic or therapeutic purposes in low-risk cancer patients. Earl y detection of ovarian cysts might enable the identification of high-r isk patients for ovarian malignancy, but prediction or detection of ov arian cancer at a premalignant stage is unlikely. If ovarian cancer is a genetic disease, the identification of the responsible gene might b e applied as routinely as the Pap smear, and this would change our cli nical approach to the management of ovarian cysts.