Ovary
Other nonneoplastic
Follicular cysts
Author: Mohiedean Ghofrani, M.D.
Topic Completed: 1 August 2011
Minor changes: 12 February 2021
Copyright: 2002-2021, PathologyOutlines.com, Inc.
PubMed Search: Ovarian follicular cysts [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Etiology | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Additional referencesCite this page: Ghofrani M. Follicular cysts. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorfollicularcysts.html. Accessed March 3rd, 2021.
Definition / general
- Benign, ovarian cyst measuring at least 3 cm and lined by granulosa and theca interna cells
Terminology
- If < 3 cm, termed a cystic follicle; if > 3 cm, termed a follicular cyst
Epidemiology
- Follicular cyst is common in reproductive years
Etiology
- Ovarian follicle matures during proliferative phase of menstrual cycle, then LH surge causes release of mature oocyte at midcycle, 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
- 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
- Associated with tamoxifen (Gynecol Obstet Invest 1993;35:62)
Treatment
- Excision if symptomatic; LHRH agonists, watchful waiting (Arch Pediatr 1994;1:903)
Gross description
- Rarely greater than 8 cm
- Glistening membrane
- Thin walled
- Unilocular or multilocular
- Clear or serous fluid contents
- No solid component
Gross images
AFIP images
A unilocular cyst has a smooth lining
Images hosted on other servers:
Follicular cyst
Large follicular cysts
Follicular cysts and corpus luteum
Microscopic (histologic) description
- Outer layer of theca interna cells, usually luteinized and may be surrounded by reticulum
- Variable inner layer of granulosa cells, luteinized after puberty
Microscopic (histologic) images
AFIP images
Cyst is lined by luteinized granulosa cells overlying luteinized theca cells
Images hosted on other servers:
Epithelial lining
Theca lutein cyst
Inhibin stain
Cytology description
- 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)
