Paraovarian cyst

Paraovarian cysts (POCs) are remnants of Wolffian duct in mesosalpinx that do not arise from the ovary. They account for ~10-20% of adnexal masses 3-4.

Epidemiology

They typically occur in women around the ages of 20-40 years old.

Clinical presentation

Most are asymptomatic, although patients with large lesions can present with pelvic pain.

Pathology

They usually occur around the broad ligament and arise from paramesonephric, mesothelial, or mesonephric remnants. They are usually simple cysts (although some authors include paraovarian cystadenomas under the umbrella of paraovarian cysts).

Radiographic features

A paraovarian cyst is easier to recognise if the ipsilateral ovary is demonstrated to be separate from it. 

Pelvic ultrasound
  • typically thin-walled and smoothly marginated
  • most often appear as unilocular 'simple' cysts (in ~66%) and rarely as multilocular (~4%)
  • a soft tissue nodule in the cyst may indicate development of a neoplasm (rare) 9
Pelvic MRI

Often seen located close to the ipsilateral round ligament and are often of homogenous signal intensity. 

In uncomplicated cases, signal characteristics usually follow that of fluid 12.

  • T1
    • hypointense
    • can be hyperintense if complicated by haemorrhage
  • T2
    • hyperintense

Other features include

Treatment and prognosis

Paraovarian cysts occasionally can be complicated by rupture, torsion, or hemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively. 

For simple paraovarian cysts with no suspicious features on ultrasound, follow-up recommendations are the same as for ovarian cysts. According to a consensus statement by the Society of Radiologists in Ultrasound 13, follow-up is recommended for cysts that are:

  • 5 to 7 cm in a woman of reproductive age
  • 1 to 7 cm in a postmenopausal woman

Irrespective of age, cysts larger than 7 cm warrant further evaluation (with MRI) or surgical review.

History and etymology

Paraovarian cysts are have also sometimes been referred to as paratubal cysts or a hydatid cysts of Morgagni 14,

Differential diagnosis

For an adnexal cystic lesion consider:


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Article Information

rID: 13384
System: Gynaecology
Synonyms or Alternate Spellings:
  • Paratubal cyst
  • Paraovarian cysts
  • Parafimbrial cysts
  • Paratubal cysts
  • Paraovarian cyst (POC)
  • Paraovarian cyst
  • Hydatid cyst of Morgagni
  • Hydatid cysts of Morgagni
  • Parafimbrial cyst
  • Para-ovarian cysts
  • Hydatid of Morgagni
  • Hydatids of Morgagni
  • Paratubal cyst
  • Paraovarian cyst
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