Ovarian cyst

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Ovarian cyst



Ovarian cyst


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Ovarian cyst

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USMLE® Step 1 style questions USMLE

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A 35-year-old woman comes to the emergency department due to abdominal pain that started suddenly several hours ago. Two hours ago, the patient felt a sudden, sharp pain in the lower abdomen during a routine workout at the gym. Since then, she has felt nauseated and vomited twice. Medical history is unremarkable. She denies any trauma or history of similar symptoms, vaginal bleeding, unprotected sexual intercourse, or history of sexually transmitted diseases. Temperature is 37°C (98.6°F), pulse is 98/min, respirations are 16/min and blood pressure is 127/74 mmHg. On physical examination, there is no guarding, but severe, right adnexal tenderness is noted. Urine pregnancy test is negative. Doppler ultrasound confirms the diagnosis of ovarian torsion and a thin-walled, unilocular cystic mass filled with anechoic fluid is visualized. The patient subsequently undergoes ovarian cystectomy and detorsion. The results of the histopathological examination are shown below:  

Reproduced from: Wikimedia Commons

Which of the following is the most likely diagnosis?

External References

First Aid









endometriomas p. 670

Dyspareunia p. 590

endometriomas p. 670

Endometriomas p. 670

Endometriosis p. 665

endometriomas and p. 670

Ovarian cysts p. 670


Content Reviewers


“Cyst” comes from kustis, which means “pouch”, so ovarian cysts are fluid-filled sacs on or in the ovaries. They are very common in females of reproductive age, but can affect females of any age.

The ovaries are a pair of white-ish organs about the size of walnuts. They’re held in place, slightly above and on either side of the uterus and fallopian tubes by ligaments.

Specifically, there’s the broad ligament, the ovarian ligament, and the suspensory ligament. And the suspensory ligament is particularly important because the ovarian artery, ovarian vein, and ovarian nerve plexus pass through it to reach the ovary.

If you slice the ovary open and look at it (don’t try this at home) there’s an inner layer called the medulla, which contains most of the blood vessels and nerves and an outer layer called the cortex, which has ovarian follicles scattered throughout it.

Each follicle is initially made up of an immature sex cell, or primary oocyte, which is the female sex cell, and layers of theca and granulosa cells surrounding the oocyte.

Now, there’s actually loads going on with the ovaries throughout the menstrual cycle, which is controlled by the hypothalamus and the pituitary up in the brain.

The hypothalamus secretes gonadotropin-releasing hormone, or GnRH, which makes the nearby anterior pituitary gland release follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH.

In the first two weeks of an average 28-day cycle, the ovaries go through the follicular phase, meaning that out of the many follicles scattered throughout the ovaries, a couple of them enter a race to become the dominant follicle, that will be released at ovulation, while the rest regress and die off.


An ovarian cyst is any fluid-filled sac that develops in the ovary. Common ovarian cyst types are corpus luteum cysts, theca-lutein cysts, dermoid cysts, endometrioid cysts, etc. Most ovarian cysts do not cause any symptoms unless they either break open or cause the ovary to twist and become ischemic (ovarian torsion). This can result in lower abdominal and back pain, vomiting and feeling faint, bloating, and loss of the affected ovary.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Diagnosis and management of ovarian cyst accidents" Best Practice & Research Clinical Obstetrics & Gynaecology (2009)
  6. "Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation" Women's Health (2018)

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