Paratubal or Paraovarian Cysts

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Paratubal or Paraovarian Cysts

Synonyms/Description

Adnexal cyst, mesothelial or paramesonephric cyst

Etiology

Paratubal and paraovarian cysts arise from the broad ligament. They constitute 10% of adnexal masses. They are usually benign but may rarely (reportedly 2%) contain malignant or borderline elements.
Etiologies for paratubal cysts include mesosalpingeal cysts, hydatid cysts of Morgagni, and paratubal subserosal cysts arising from Müllerian duct remnants, as opposed to paraovarian cysts, which arise from mesonephric tubules (Wolffian duct) and are mesothelial in origin.

Ultrasound Findings

Paratubal and paraovarian cysts are typically unilocular thin-walled adnexal cysts that are separate from the ovaries. Paratubal cysts are usually farther removed from the ovaries than paraovarian cysts, which are usually adjacent to the ovary. These cysts can (rarely) cause tubal or adnexal torsion or undergo hemorrhage or rupture, resulting in severe pelvic pain. Occasionally paratubal or paraovarian cysts can have septations, nodularities, and excrescences, suggesting a malignancy (occurs in 2% of such cysts).

Differential Diagnosis

The presence of a thin-walled, clear adnexal cyst separate from the ovary is considered to be a paratubal or paraovarian cyst. The differential diagnosis may include a hydrosalpinx (although the tubal wall is thicker than that of a cyst) or a peritoneal inclusion cyst (usually contains multiple septations and takes on the shape of the adjacent peritoneal surface). It is important to identify the ovary separately; otherwise, an ovarian etiology is possible, especially if the cyst is not simple and unilocular.

Clinical Aspects and Recommendations

Most paratubal or paraovarian cysts are incidental findings and asymptomatic. When patients present with pelvic pain, the cysts may have undergone hemorrhage, torsion, or rupture. If the cyst has thick septations, an irregular wall, or nodularity, a neoplasm (cystadenoma, cystadenocarcinoma, or borderline tumor) should be considered.

Figures

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Figure P1-1 A and B, Two views of a simple paraovarian cyst

 

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Figure P1-2 Typical unilocular paratubal cyst. Note that there is no ovarian tissue visible. The ovary was totally separate from the cyst.

 

Suggested Reading

Barloon T.J., Brown B.P., Abu-Yousef M.M., Warnock N.G. Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography. J Clin Ultrasound. 1996;24:117–122.

Kim J.S., Woo S.K., Suh S.J., Morettin L.B. Sonographic diagnosis of paraovarian cysts: value of detecting a separate ipsilateral ovary. Am J Roentgenol. 1995;164:1441–1444.

Kiseli M., Caglar G.S., Cengiz S.D., Karadag D., Yilmaz M.B. Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations. Arch Gynecol Obstet. 2012;285:1563–1569.

Stein A.L., Koonings P.P., Schlaerth J.B., Grimes D.A., d’Ablaing 3rd. G. Relative frequency of malignant parovarian tumors: should parovarian tumors be aspirated? Obstet Gynecol. 1990;75:1029–1031.

Terek M.C., Sahin C., Yeniel A.O., Ergenoglu M., Zekioglu O. Paratubal borderline tumor diagnosed in the adolescent period: a case report and review of the literature. J Pediatr Adolesc Gynecol. 2011;24:e115–e116.

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