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Exophytic ovarian cyst
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lionbaby73 posted:
How are exophytic ovarian cysts removed? and, Are they dangerous if not treated?
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Jane Harrison Hohner, RN, RNP responded:
Dear lionbaby: Exophytic just means growing out of the surface of the organ. One can have an exophytic cyst of the kidney, or ovary. One can have an exophytic fibroid growing out of the external wall of the uterus.

More essential to know would the the characteristics of the actual cyst. For example, an ovarian cyst which is just filled with fluid is less likely to worrisome while a cyst with mixed solid and fluid attributes (or all solid) is more concerning and needs additional work up. Here is the best citation I could find at the National Library of Medicine site on ovarian cysts with exophytic growths:

Clin Radiol. 2009 Apr;64(4):430-8. Epub 2008 Dec 20.
MRI appearances of borderline ovarian tumours.
Bent CL, Sahdev A, Rockall AG, Singh N, Sohaib SA, Reznek RH.
Source

Department of Diagnostic Imaging, St Bartholomew's Hospital, West Smithfield, London, UK. clare.bent@bartsandthelondon.nhs.uk
Abstract

This review was performed to describe the range of magnetic resonance imaging (MRI) appearances of borderline ovarian tumours. The MRI findings in 26 patients with 31 borderline ovarian tumours (mean age: 40.1 years, range: 14-85 years) were retrospectively reviewed. For each tumour, site, size, MRI characteristics, and enhancement following gadolinium administration were recorded. There were 20 serous and 11 mucinous borderline ovarian subtypes. Nine of 26 patients demonstrated bilateral disease on MRI; synchronous contralateral ovarian disease included three benign, five serous borderline, and one serous invasive tumour. A history of a metachronous mucinous borderline tumour was identified in one patient. MRI appearances were classified into four morphological categories: group 1 (6/31, 19%), unilocular cysts; group 2 (6/31, 19%), minimally septate cysts with papillary projections; group 3 (14/31, 45%), markedly septate lesions with plaque-like excrescences; and group 4 (5/31, 16%), predominantly solid with exophytic papillary projections, all of serous subtype. There was a significant difference in mean volume between serous (841.5 cm(3)) and mucinous (6358.2 cm(3)) subtypes (p=0.009). All tumours demonstrated at least one MRI feature suggestive of malignancy. The present review demonstrates the variable MRI appearances of borderline ovarian tumours along with imaging features suggestive of tumour subtype. In patients in whom the clinical features are suggestive of a borderline ovarian tumour (young age and normal or minimally elevated CA125), the ability to predict a borderline disease using morphological features observed on MRI would be extremely helpful in surgical planning, with the potential to offer fertility or ovary-preserving surgery. Future studies are required to further this aim.

lionbaby, you deserve the most accurate answer from the GYN that ordered your scan. They should be able to tell you about the actual qualities of your cyst.

Yours,
Jane
 
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Anon_6061 responded:
You can read all about ovarian cysts here -
http://www.ovaryresearch.com/ovarian_cysts.htm .

Most ovarian cysts are benign and will resolve on their own so monitoring may be all that's needed. When surgical removal is necessary, it seems fairly common to remove the ovary versus just the cyst (cystectomy) but according to the excerpt below, cystectomy is possible in most cases. I suspect though that it requires more skill and time but no higher (insurance) reimbursement than ovary removal so that may explain the common practice of ovary removal. Removing the ovary may disrupt hormone production.

"Removing a cyst, called a cystectomy, is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device. The cyst now looks like a deflated balloon and can easily be removed through the small laparoscopy incision. Rarely, if a cyst has destroyed all the normal ovarian tissue, it may be necessary to remove the entire ovary and it is possible to do this, as well, with the laparoscope."


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