Fallopian tubes & broad ligament

Broad ligament

Developmental cysts


Author: Lucy Ma, M.D.
Editorial Board Member: Gulisa Turashvili, M.D., Ph.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Lucy Ma, M.D.

Last author update: 1 November 2022
Last staff update: 1 November 2022

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PubMed Search: Paraovarian cyst

Lucy Ma, M.D.
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Cite this page: Ma L. Developmental cysts. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/fallopiantubesdevelopmentalcysts.html. Accessed December 9th, 2022.
Definition / general
  • Benign developmental cysts arising from remnants of Müllerian and Wolffian ducts as well as from mesothelium
Essential features
  • Benign, fluid filled cysts located adjacent to the adnexa (fallopian tube or ovary)
  • Cysts are lined by non-stratified epithelium, which can be ciliated (paramesonephric cyst) or flat, cuboidal (mesothelial and mesonephric cysts)
  • Usually are incidental findings
Terminology
  • Paratubal cysts, paraovarian cysts, mesothelial (or simple) cyst
  • Hydatid cyst of Morgagni (no longer recommended): typically refers to pedunculated cyst located near tubal fimbria (Arch Gynecol Obstet 2012;285:1563)
ICD coding
  • ICD-10:
    • Q50.1 - developmental ovarian cyst
    • Q50.4 - embryonic cyst of fallopian tube
    • Q50.5 - embryonic cyst of broad ligament
Epidemiology
Sites
  • Adjacent to the adnexa, along broad ligament, between the fallopian tube and the ovary
Pathophysiology
  • Müllerian (paramesonephric) and Wolffian (mesonephric) ducts grow mostly in parallel during development
    • Müllerian ducts eventually fuse
    • Fusion of Müllerian ducts creates a transverse fold, which becomes the broad ligament
  • Broad ligament contains Müllerian and Wolffian duct remnants, which can then become cystic
  • Reference: Kurman: Blaustein's Pathology of the Female Genital Tract, 7th Edition, 2019
Etiology
Clinical features
Diagnosis
  • Incidental finding
  • If symptomatic, usually diagnosed by ultrasound
Radiology description
  • Ultrasound findings: majority are unilocular cysts without papillations (Ultrasound Obstet Gynecol 2006;28:330)
    • Presence of papillary projections / solid nodule typically indicates neoplastic cysts
Prognostic factors
Case reports
Treatment
  • Surgical excision if large or symptomatic
Clinical images

Images hosted on other servers:
Torsed paraovarian cyst before detorsion

Torsed paraovarian cyst before detorsion

Torsed paraovarian cyst after detorsion

Torsed paraovarian cyst after detorsion

Large paraovarian cyst

Large paraovarian cyst

Gross description
  • Thin walled, fluid filled cyst(s) located adjacent to fallopian tube or ovary
Microscopic (histologic) description
  • Paramesonephric cysts are lined by single layer of bland ciliated tubal epithelium
  • Mesonephric cysts are lined by single layer of low cuboidal, nonciliated epithelium with occasional clear cells (rare) (Am J Obstet Gynecol 1977;129:873)
  • Mesothelial cysts are lined by single layer of flat or cuboidal, nonciliated cells, which may show transitional cell metaplasia (see Walthard cell nests)
  • Distinction between the types of cyst may be difficult but has no clinical implications
Microscopic (histologic) images

Contributed by Lucy Ma, M.D.
Simple cysts adjacent to Walthard nests Simple cysts adjacent to Walthard nests Simple cysts adjacent to Walthard nests

Simple cysts adjacent to Walthard nests

Paratubal cysts adjacent to fallopian tube

Paratubal cysts adjacent to fallopian tube

Ciliated epithelium

Ciliated epithelium

Sample pathology report
  • Not essential to include in report, particularly if cysts are small and incidental
  • Right fallopian tube, salpingectomy:
    • Fallopian tube with paratubal cysts
Differential diagnosis
  • Serous cystadenoma:
    • Presence of dense collagenized cyst wall
    • Absence of rudimentary plicae
  • Hydrosalpinx:
    • Presence of well developed, smooth muscle wall
    • Presence of occasional branching plicae with columnar epithelium containing histologic normal ciliated and secretory cells
    • Direct communication with nondilated portion of fallopian tube
Board review style question #1

A 45 year old patient underwent total hysterectomy and bilateral salpingo-oophorectomy for a myomatous uterus. The left adnexa showed the finding in the image above. What is the next step in management regarding this finding?

  1. Computed tomography (CT) of the chest
  2. Germline testing
  3. No additional therapy
  4. Serial serum CA-125 levels
  5. Surgical staging
Board review style answer #1
C. No additional therapy

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Reference: Developmental cysts
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