Ovarian pouchs may occur in up to 1...

Ovarian pouchs may occur in up to 17 percent of postmenopausal women unless the optimal management is unknown. A significant proportion of of the like kind cysts are believed to spontaneously involute. Although the evidence linking ovarian pouchs to malignancy is weak, ovarian cancer is increasingly often met with in older women. Survival rates are poor if the disease spreads beyond the ovary. Ultrasonography and measurement of serum CA 125 flats have not proved suitable as screening ordeals for ovarian cancer. Nardo and colleagues studied the optimal clinical management of persistent unilocular ovarian pouchs smaller than 50 mm in diameter in postmenopausal women who had normal serum CA 125 levels

The authors retrospectively reviewed the records of 226 postmenopausal women diagnosed with persistent unilocular ovarian pouchs These women had been referr to the gynecology department of an English district hospital for conditions mainly related to menopause. The average age of investigation participants was 56.2 years (range, 45 to 87 years). After a thorough assessment, those with a personal or family history of breast, endothelial, or ovarian cancer, or use of hormone therapy were exclud from the meditation The remaining patients were followed by the agency of clinical examination, ultrasonography, and serum CA 125 measurements six month after the initial assessment, and then each 12 months for five years.

Of the 226 women 172 (76 percent) showed no change in pouch diameter or rise in CA 125 evens during follow-up. In 21 women pouch diameter increased within 18 month according to 30 months, 33 women had increased pouch diameter. By five years, 54 women had increased sac diameter, but only six of these women had increased CA 125 horizontals and only two developed malignancy. No malignancies discloseed in women whose cysts did not increase in size.

The authors close that in postmenopausal women, most numerous ovarian cysts smaller than 50 mm in diameter are benign and can be managed safely through regular monitoring of cyst size and serum CA 125 level

ANNE D WALLING, MD

Nardo LG et al. Persistent unilocular ovarian pouchs in a general population of postmenopausal women: is there a place for expectant management? Obstet Gynecol September 2003;102:589-93

COPYRIGHT 2004 American Academy of Family Physicians

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