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Ovary-nontumor

Non-neoplastic cysts / other

Follicular cysts


Reviewer: Mohiedean Ghofrani, M.D. (see Reviewers page)
Revised: 3 November 2014, last major update August 2011
Copyright: (c) 2002-2014, PathologyOutlines.com, Inc.

Definition
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● A benign, ovarian cyst measuring at least 3 cm and lined by granulosa and theca interna cells

Terminology
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● If < 3 cm, termed a cystic follicle; if > 3 cm, termed a follicular cyst

Epidemiology
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● Follicular cyst is common in reproductive years

Etiology
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● Ovarian follicle matures during proliferative phase of menstrual cycle, then LH surge causes release of mature oocyte at mid-cycle, then follicle transforms to a corpus luteum
● If no fertilization, corpus luteum typically atrophies, eventually forming a corpus albicans
● If no LH surge or no ovulation, follicle grows and becomes a cyst, which usually disappears within 2-3 menstrual cycles but may persist

Clinical features
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● Usually asymptomatic or forms an adnexal mass
● Pedicle may twist and cause hemorrhagic infarction
● Associated with precocious puberty in children
● May be multiple when a component of McCune-Albright syndrome (polyostotic fibrous dysplasia, cutaneous melanin pigmentation and endocrine organ hyperactivity)

Case reports
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● Associated with tamoxifen (Gynecol Obstet Invest 1993;35:62)

Treatment
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● Excision if symptomatic; LHRH agonists, watchful waiting (Arch Pediatr 1994;1:903)

Gross description
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● Rarely greater than 8 cm
● Glistening membrane
● Thin-walled
● Unilocular or multilocular
● Clear or serous fluid contents
● No solid component

Gross images
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Follicular cyst

       
Large follicular cysts


A unilocular cyst has a smooth lining


Follicular cysts and corpus luteum

Micro description
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● Outer layer of theca interna cells, usually luteinized, and may be surrounded by reticulum
● Variable inner layer of granulosa cells, luteinized after puberty

Micro images
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Epithelial lining


Theca lutein cyst

Inhibin stain

AFIP images:

Cyst is lined by luteinized granulosa cells overlying luteinized theca cells

Cytology description
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● May be highly cellular with granulosa cells, resembling granulosa cell tumor (Acta Cytol 2003;47:1059)
● May have atypical cells (Diagn Cytopathol 1991;7:48)

Additional references
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● See also hyperreactio luteinalis, large solitary luteinized follicular cyst of pregnancy and puerperium
eMedicine

End of Ovary-nontumor > Non-neoplastic cysts / other > Follicular cysts


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