🌸 Functional vs Pathologic Ovarian Cyst Simulator

The Adnexal Mass — First Look on Ultrasound

Most ovarian cysts are found by chance during routine pelvic imaging.

• ~10%: Lifetime incidence (women affected)
• >70%: Found incidentally (on routine TVUS)
• <1%: Malignancy risk (simple cyst, premenopausal)
• TVUS: First-line imaging (transvaginal ultrasound)

Why cysts are found by accident

Pelvic pain or routine screening often reveals a silent cyst.

The differential diagnosis question

Is it a normal cycle event, or a true pathologic growth?

Why ultrasound comes first

TVUS is cheap, fast, and radiation-free for first triage.

Sonographic Feature Assessment — Reading the Cyst Wall

Structured criteria turn a fuzzy image into a reproducible risk score.

• 10: IOTA simple rules (B-rules & M-rules)
• 3 mm: Septation cutoff (thin vs thick wall)
• ≥3 mm: Papillary projection (suspicious feature)
• 1–4: Color score (internal vascularity grade)

Septations

Thin, few septa favor benign; thick, many favor pathologic.

Echogenicity pattern

Anechoic, ground-glass, or heterogeneous each point differently.

Wall and vascularity

Smooth thin wall with low flow favors a benign cyst.

Functional Cyst Pattern — Follicular and Luteal Origin

Simple, thin-walled, anechoic cysts almost always resolve on their own.

• <3 cm: Follicular cyst size (normal follicle range)
• 6–8 wk: Resolution time (spontaneous regression)
• <5 cm: Corpus luteum cyst (may bleed internally)
• 6–12 wk: Repeat scan interval (confirms resolution)

Follicular cysts

An unruptured follicle keeps growing past ovulation.

Corpus luteum cysts

The post-ovulation structure fills with fluid or blood.

Expectant management

Watchful waiting with a follow-up scan is usually enough.

Pathologic Cyst Pattern — Endometrioma and Dermoid

Complex internal texture signals a lesion that will not resolve alone.

• Ground-glass: Endometrioma sign (homogeneous low-level echoes)
• Tip of iceberg: Dermoid sign (fat, hair, calcification)
• 17–44%: Endometrioma rate (of endometriosis patients)
• <2%: Dermoid malignant change (rare, older patients)

Endometrioma

Old blood produces a hazy, uniform ground-glass fill.

Dermoid cyst

Fat, hair, and teeth create bright, jumbled echoes.

Why these need intervention

Complex cysts rarely regress and often need surgery.

Torsion Risk Evaluation — Size, Pedicle, and Danger

A large or heavy cyst can rotate the ovary and cut off its blood supply.

• >5 cm: Risk rises sharply (diameter threshold)
• 2.7%: Torsion incidence (of gynecologic emergencies)
• Doppler: Whirlpool sign (twisted vascular pedicle)
• <8 h: Salvage window (to save the ovary)

Size as the driver

Bigger cysts add weight that favors ovarian rotation.

The whirlpool sign

Doppler shows swirling flow around a twisted pedicle.

Time-critical surgery

Fast detorsion preserves ovarian tissue and fertility.