Paraovarian / Paratubal Cyst

Definition

Paraovarian / paratubal cysts are epithelium-lined fluid-filled cysts in the adnexa adjacent to the fallopian tube and ovary. The terms are used interchangeably depending on the location of the cyst.

Epidemiology

Although their exact incidence cannot be known due to their typically asymptomatic nature, paraovarian cysts may account for 5-20% of all adnexal masses and are found in about 15% of laparoscopies.

Aetiopathogenesis

Paraovarian cysts develop either from the mesothelium of the broad ligament (68%) or from paramesonephric (30%) or mesonephric remnants (2%).

Clinical Image

Typically asymptomatic. Complications may include:

Cyst enlargement (common, yet gigantic cysts with pressure symptoms e.g. hydronephrosis are rare)
Torsion (not uncommon, especially in younger patients)
Rupture (uncommon)
Haemorrhage (uncommon)
Neoplasm (extremely rare)

parovarian paratubal cyst — Parovarian cyst. Above: the cyst is measured in two perpendicular planes. Below the same images, where the paraovarian cyst has been colored to emphasize. A little free peritoneal fluid is seen.

Diagnostics

Ultrasound is the top diagnostic tool to identify a paraovarian cyst. The following finding is pathognomonic:

Anechoic, unilateral, thin-walled, mobile cyst which can be separated from the ovary (and tube, if visible) on palpation.

Management

If found on ultrasound and small in size, control examination is suggested.
If found during surgical intervention (laparoscopy, cesarean section etc.) careful surgical removal is suggested – the ovarian and tubal blood supply must not be disrupted.
In case of symptoms, surgical removal is indicated.
In case of suspected malignancy, surgical removal in one piece is important.

A large parovarian cyst mimicking an ovarian cyst.

Bibliography

Durairaj, A., & Gandhiraman, K. (2019). Complications and Management of Paraovarian Cyst: A Retrospective Analysis. Journal of obstetrics and gynaecology of India, 69(2), 180–184. https://doi.org/10.1007/s13224-018-1152-2
Alaoui, F. Z., El Fatemi, H., Chaara, H., Melhouf, M. A., & Amarti, A. (2012). Borderline paratubal cyst: a case report. The Pan African medical journal, 13, 53.
Leanza, V., Coco, L., Genovese, F., Pafumi, C., Ciotta, L., Leanza, G., Zanghì, G., Intagliata, E., & Vecchio, R. (2013). Laparoscopic removal of a giant paratubal cyst complicated by hydronephrosis. Il Giornale di chirurgia, 34(11-12), 323–325.