Dr Abri de Bruin

Welcome! Please see this website as an educational reference for patients. My practice strives to offer comprehensive and individualized care in minimal access surgery, endometriosis and infertility.

Ovarian Cysts

There are different ovarian cysts

  • Clear ovarian cysts

How big are they?

  • They vary in size depending on when they are diagnosed, and is usually between 20 and 40mm

What do they look like?

  • on ultasound they are black and have a thin border

Why do they form?

  • can be due to the women not ovulating

What is the treatment

  • usually treated with progesterone tablets for 5 days and then a follow up ultrasound 2 weeks later or during your period to make sure they have cleared

What is the chance that I will need surgery?

  • Very small.  If the cyst does not clear up, use of the oral contraceptive pill for a month is the next option.
  • If that does not work, the cyst can be aspirated by draining the fluid from the cyst - this is done in the rooms
  • If all else has failed, then a laparoscopy will be done to remove the cyst
massive-ovarian-cyst.jpg

Corpus luteum cyst

How big are they?

  • They vary in size depending on when they are diagnosed and is usually between 20 and 40mm

What do they look like?

  • The cyst is not clear, but no clear signs of blood in the cyst is seen

Why do they form?

  • usually when the women does not ovulate and the follicle persists, or is there is a progesterone problem in the second half of her cycle

What is the treatment

  • most of them will clear up using progesterone treatment and only if that does not help, or the pain is too severe, surgery is an option

Haemorraghic cyst

How big are they?

  • They vary in size depending on when they are diagnosed

What do they look like?

  • usually mostly black with white elements inside the black cysts

Why do they form?

  • this is when bleeding occurs within a cyst

What is the treatment

  • most of them will clear up using progesterone treatment and only if that does not help, or the pain is too severe, surgery is an option

Complex cyst

How big are they?

  • varies

What do they look like?

  • usually a combination of clear elements (black on sonar) and solid components (white on sonar)

Why do they form?

  • depends on the diagnosis

What is the treatment

  • here surgery is most often indicated to make a diagnosis and to treat at the same time

Endometrioma

How big are they?

  • They vary in size depending on when they are diagnosed and can reach 10cm!

What do they look like?

  • They have a ground glass appearance - very typical of endometriosis

Why do they form?

  • Because endometriosis grows inside the ovary

What is the treatment

  • Surgical treatment where the cyst wall is removed and the ovary protected as much as possible.  An oophorectomy - where the ovary is removed - is not indicated, unless a cancer is suspected

Dermoid cyst / Terratoma

How big are they?

  • They vary in size depending on when they are diagnosed

What do they look like?

  • Very much like an endometrioma, but most of the time they will have an irregular appearance or solid areas in the cyst

What is the treatment

  • Surgery to remove the cyst and to keep the ovary.  The cyst should be removed inide a special bag to make sure that the content does not spill into the pelvis
teratoom-in-sakkie-opereer.jpg

Borderline malignant tumour

How big are they?

  • It varies

What do they look like?

  • usually they are solid cysts that contain cystic components as well - complex cysts

Why do they form?

  • they are pre-cancerous, so it depends on the underlying borderline tumour

What is the treatment

  • Surgery with most probably removal of the ovary and possibly the other one as well.

Cysts in postmenopausal women

Here the possibilities range from simple clear cysts to malignant cysts

It is important to look at the following characteristics of the cyst:

  1. The cyst wall
  2. The content
  3. Blood flow in the wall of the cyst
  4. Free fluid in the pelvis
  5. The contra-lateral ovary
  6. Size of the cyst

It is important to remember that all cysts are sent away for hystologic examination to confirm the diagnosis and to exclude malignancy

In nearly all cases especially in young patients, every effort should be made to retain the ovary and not to remove the ovary, unless there is a very high suspicion of a cancer in the cyst

This will depend on various ultraound findings, blood tests and age of the patient.

PROPERTY OF DR ABRI DE BRUIN 2015