YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==OVARIAN CYSTS== 20 AUTHOR Vessey M AUTHOR Metcalfe A AUTHOR Wells C AUTHOR McPherson K AUTHOR Westhoff C AUTHOR Yeates D TITLE Ovarian neoplasms, functional ovarian cysts, and oral contraceptives. SOURCE Br Med J (Clin Res Ed); VOL 294, ISS 6586, 1987, P1518-20 ABSTRACT The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year. 3 AUTHOR Ganjei P TITLE Fine-needle aspiration cytology of the ovary. SOURCE Clin Lab Med; VOL 15, ISS 3, 1995, P705-26 (REF: 19) ABSTRACT FNA cytology has been shown to be highly accurate in diagnosing malignant tumors. In gynecology, an overall accuracy of 94.5% in the differentiation between benign and malignant tumors has been reported. Despite many controversial views regarding its safety, aspiration cytology has been accepted as an innocuous procedure that can be accomplished with minimal discomfort or complications and, in association with laparoscopy, assist in the management of ovarian cysts and masses. Although FNA cannot be considered the first-hand diagnostic procedure for ovarian cancer in postmenopausal patients, it may be extremely helpful in young women, even during pregnancy, to safely differentiate functional and other benign ovarian cysts from malignant ones. In postmenopausal women, especially those in the high risk group for surgical procedures and those undergoing a "second look" intervention following radiation or chemotherapy, aspiration cytology may provide sufficient information to warrant abandoning unnecessary surgery. During laparotomy for suspected unilateral disease, FNA may provide sufficient data about the opposite ovary to allow that organ to remain in place, thus preserving its function in a young patient. The pathologist must be familiar with the cytology of normal pelvic structures and the diagnostic criteria used to differentiate benign from malignant lesions, as well as potential diagnostic pitfalls, such as interpretation based on very few cells or the absence of appropriate clinical information. Although proper classification of ovarian masses can be achieved through FNA, the pathologist should be aware of its limitations, such as difficulties in differentiating adenomas from non-neoplastic cysts, and tumors of low malignant potential from well-differentiated carcinomas. Descriptive histologic terminology should be applied, and terms such as "suspicious" or "atypical" avoided. The aspirated material may not only be used for the diagnosis and classification of ovarian neoplasms, it may also be used for DNA analysis, detection of estrogen receptors and other prognostic markers, thus providing information regarding biologic behavior of the tumors. Finally, it is hoped that aspiration of ovarian lesions routinely detected by sonography, in elderly women or those with a strong family history of ovarian cancer, will allow the physician to accomplish detection of early ovarian cancer. 23 AUTHOR Grimes DA AUTHOR Hughes JM TITLE Use of multiphasic oral contraceptives and hospitalizations of women with functional ovarian cysts in the United States. SOURCE Obstet Gynecol; VOL 73, ISS 6, 1989, P1037-9 ABSTRACT A case-series report of seven women who developed functional ovarian cysts while taking multiphasic oral contraceptives has raised the possibility of an association between these two events. To address this question, we calculated the nationwide rates of hospitalization of women diagnosed with such cysts and examined the use of multiphasic oral contraceptives from 1979-1986. Whereas the use of multiphasic oral contraceptives grew from zero to three million users during the study interval, the hospitalization rate for functional ovarian cysts fluctuated between 472-522 per 100,000 women aged 15-44 years. Thus, there was no discernible association between taking these contraceptives and being hospitalized for functional ovarian cysts. Although this indirect assessment can neither confirm nor refute the postulated association, it suggests that if such an association does exist, its net public health impact has not been great. 2 AUTHOR Ganjei P AUTHOR Dickinson B AUTHOR Harrison T AUTHOR Nassiri M AUTHOR Lu Y TITLE Aspiration cytology of neoplastic and non-neoplastic ovarian cysts: is it accurate? SOURCE Int J Gynecol Pathol; VOL 15, ISS 2, 1996, P94-101 ABSTRACT To evaluate the role of aspiration cytology in the distinction between neoplastic and non-neoplastic ovarian cysts, we examined the cytology of 81 aspirates from 80 women 14-67 years of age. We then correlated results with subsequent histology or the clinical follow-up. Aspiration were performed during laparoscopy (32 cases) or immediately after surgical removal of the tumors (49 cases). The cysts ranged in size from 1.0 to 43.0 cm. Papanicolaou-stained cytospin preparations of samples were evaluated, and the lesions were classified into non-neoplastic (68 cases), benign neoplasms (four cases), and malignant neoplasms (nine cases). Cytologic impressions were correlated with histologic findings in 74 cases and with the clinical follow-up in the remaining seven. Nine of the 12 (75%) cystadenocarcinomas, including two serous neoplasms of low malignant potential (LMP), were correctly diagnosed as malignant by cytology. There were no false-positive results. On the other hand, of the 26 benign neoplasms (19 cystadenomas and seven mature cystic teratomas), only four teratomas (15%) could be subclassified specifically. The remaining 68 aspirates were classified as non-neoplastic. Seventy-seven percent of all proven non-neoplastic cysts measured < 8.0 cm, whereas 77% of all benign and malignant neoplastic cysts were > 8.0 cm. The overall diagnostic accuracy was improved from 63% to 69% when cyst size was taken into consideration. In malignant cysts the diagnostic sensitivity was 75%, specificity 100%, and overall accuracy 96%. We arrived at the following conclusions: Aspiration cytology is an accurate predictor of malignancy in ovarian cystic lesions, but because the sensitivity of the technique is not high enough, one should not rely on aspiration cytology alone; The differential diagnosis between cystadenocarcinomas and tumors of low malignant potential cannot be made by cytology; Although it is difficult to distinguish between benign neoplasms and non-neoplastic benign cysts, diagnostic accuracy will improve when the size of the lesion is considered; Aspiration cytology can provide particularly useful information in young women with functional cysts of the ovary to avoid an unnecessary operation; Acellular cyst fluids should not be considered nondiagnostic because they represent benign cysts in the majority of cases; false-negative results of fine-needle aspiration of cystic ovarian lesions is usually due to low cellularity of the sample and secondary degenerative changes; negative fine-needle aspiration results should be followed clinically. 6 AUTHOR Gerber B AUTHOR Gustmann G AUTHOR Kulz T AUTHOR Rohde E AUTHOR Beust M AUTHOR Sudik R TITLE [Histology and cytology of laparoscopically operated "simple ovarian cysts"] SOURCE Geburtshilfe Frauenheilkd; VOL 55, ISS 7, 1995, P369-73 ABSTRACT In a retrospective study the histopathological findings of 127 laparoscopically operated unilocular anechoic smooth-walled ovarian cysts have been correlated with clinical characteristics (age, duration of observation, complaints, hormonal treatment), size by ultrasound, kind and colour of cysts content as well as cytological findings. The age of patients differed from 16-61 years (mean +/- s: 36 +/- 16). The histopathologic findings yielded 15 (11.8%) functional cysts, 30 (23.6%) persistent corpus luteum cysts, 9 (7.1%) endometriomas, 7 (5.5%) cystic teratomas, 9 (7.1%) undifferenciated cysts and 57 (44.9%) cystadenomas. There were no differences between histopathologic diagnosis groups according to age and cysts size by ultrasound. Functional cysts with complaints (n = 6) may explain that the observation time in 60% of all functional cysts was smaller than 6 weeks, whereas persistent corpus luteum cysts, endometriomas, cystic teratoma and cystadenomas had been observed for longer than 6 weeks in more than two thirds. Intraoperative evaluation of cysts content as "chocolate"-like was suspicious of endometriomas, but was also present in cysts of other histopathological findings. By means of cytology, endometrioma (siderophages) was suspected in 44.4% and a cystadenoma in 42.1% of all histopathologically verified cases. In all, the cytologic findings were useful for correct histopathological diagnosis in only 33.9% of all 127 cases. It is concluded that differential diagnosis of simple ovarian cysts is not possible by clinical characteristics, neither by ultrasound nor by cytological evaluation. Ovarian cysts should be observed for at least two hormonal cycles. A hormonal treatment by combination preparations containing high doses of oestrogen is also recommended. In cases of persisting ovarian cysts laparoscopic removal is necessary.