Giant ovarian follicular cyst

Specialty: Gynecology and breast.

• Giant functional ovarian cyst
• persistent distended follicle
• large volume ovarian cyst

Why it occurs

• Failure to rupture a mature follicle during the normal ovulation process, which continues to accumulate follicular fluid rich in estrogen and grows excessively above 5-10 cm in diameter

Initial workup

Transvaginal and abdominal gynecological ultrasound (a large, unilocular, very thin-walled cystic formation is visualized, with pure anechoic content, without septa, papillae or solid areas inside, and normal peripheral Doppler flow). Determination of serum beta-hCG (to rule out pregnancy). Ca-125 marker (which may be slightly elevated due to peritoneal irritation, and should be interpreted with caution in benign unilocular cysts).

Standard management

• There are no drugs that accelerate the resorption of an already established giant follicular cyst. Ibuprofen 400-600 mg can be prescribed orally every 8 hours to control minor discomfort. Expectant management with relative rest and ultrasound follow-up is advised in 6 to 12 weeks (the vast majority of follicular cysts resolve spontaneously by resorption). The use of combined oral contraceptives prevents the formation of new cysts but does not treat the current cyst. If the cyst is larger than 8-10 cm, persists after 3 months of follow-up, or has suspected torsion, the definitive treatment is laparoscopic cystectomy (note: avoid simple percutaneous aspiration of the cyst due to its high rate of immediate recurrence).