Case history
Case history #1
A 27-year-old woman (gravida 2, para 2) presents to her family practitioner with a chief complaint of pelvic pain. The pain began about 3 weeks previously and is characterized 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 gynecologic and medical histories are unremarkable. Previous surgeries include one cesarean delivery and an appendectomy. Review of symptoms reveals some increased frequency of urination but no other notable menstrual, hematologic, gastrointestinal, or genitourinary symptoms. Physical exam 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 exam, palpation of the right adnexa elicits moderate tenderness.
Case history #2
A 58-year-old obese postmenopausal woman (gravida 4, para 3) presents to her annual gynecologic visit without initial complaint. During the interview, she denies postmenopausal 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 exam is nondiagnostic due to her body habitus, and pelvic exam is limited. There is concern for a vague fullness that is appreciated on rectovaginal exam.
Other presentations
There are a myriad of presentations for ovarian cysts, from childhood to the last decades of life. Adolescent women may present with nonspecific complaints such as menstrual irregularities, abdominal distention, 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 gonadotropin lab value may be elevated due to hormonal production by these tumors. Patients presenting with the acute onset of abdominal pain and vomiting with hemodynamic instability may represent a cohort in whom ovarian cysts have ruptured or undergone torsion. Pregnant women often exhibit increased fundal height or abdominal distention that precludes the diagnosis of an ovarian cyst prior to ultrasound confirmation.
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