Case history
Case history #1
A 27-year-old woman (gravida 2, para 2) presents to her general practitioner with a chief complaint of pelvic pain. The pain began about 3 weeks previously and is characterised as dull with a pressure-like fullness in the right pelvis. The pain is exacerbated by some movements and by sexual intercourse. She noted no change in intensity or character with her last menses 2 weeks previously. Her past gynaecological and medical histories are unremarkable. Previous surgeries include one caesarean delivery and an appendectomy. Review of symptoms reveals some increased frequency of urination but no other notable menstrual, haematological, gastrointestinal, or genitourinary symptoms. Physical examination reveals a well-nourished female in no acute distress who demonstrates mild tenderness on deep palpation of the right lower quadrant of her abdomen. On pelvic examination, palpation of the right adnexa elicits moderate tenderness.
Case history #2
A 58-year-old obese post-menopausal woman (gravida 4, para 3) presents to her annual gynaecological visit without initial complaint. During the interview, she denies post-menopausal bleeding but acknowledges increased abdominal bloating and early satiety. Over the past year, she has experienced pelvic and low back pain that is mildly bothersome but worsening. Her family history is notable for a sister with breast cancer and mother with an unknown female cancer. Abdominal examination is non-diagnostic due to her body habitus, and pelvic examination is limited. There is concern for a vague fullness that is appreciated on rectovaginal examination.
Other presentations
There are a myriad of presentations for ovarian cysts, from childhood to the last decades of life. Adolescent women may present with non-specific complaints such as menstrual irregularities, abdominal distension, or bloating. Subsequent imaging of these women may reveal a solid or complex ovarian cyst that represents a germ cell ovarian malignancy. A pregnancy test or serum beta-human chorionic gonadotrophin lab value may be elevated due to hormonal production by these tumours. Patients presenting with the acute onset of abdominal pain and vomiting with haemodynamic instability may represent a cohort in whom ovarian cysts have ruptured or undergone torsion. Pregnant women often exhibit increased fundal height or abdominal distension that precludes the diagnosis of an ovarian cyst prior to ultrasound confirmation.
Use of this content is subject to our disclaimer