Invasive serous cystadenocarcinoma is now thought to primarily originate from solid precursors in the fallopian tube and serous tubal intraepithelial carcinoma, further supporting the benignity of simple ovarian cysts [50]. A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects these findings with higher threshold for follow-up of simple cysts [42]. Namely, in premenopausal women, simple cysts, including paraovarian and paratubal cysts <5 cm, do not need to be followed. The rationale of follow- up for simple cysts >5 cm (and 7 cm for exceptionally well seen cysts) is based on a potential risk of mischaracterization of larger cysts and potential clinical value of size monitoring growth rates of larger cysts, which may reflect benign neoplasms and warrant clinical follow-up along with a very small predisposition for torsion or rupture [51]. Classic benign lesions include endometriomas, hemorrhagic cysts, and dermoids as well as benign extraovarian lesions such as paraovarian cysts, hydrosalpinx, and peritoneal inclusion cysts have characteristic appearances on US [23,34]. Hemorrhagic functional cysts will decrease or resolve on sonographic follow-up in 8 to 12 weeks versus nonfunctional cysts, which will persist. Endometriomas may change in appearance with age, losing the classic unilocular ground glass appearance with multilocular appearance and presence of nonvascular papillary or other solid components more common in older premenopausal women [52]. These changes can overlap with malignancy and endometriomas and require yearly follow-up due to a small risk of malignant transformation [53]. Sonographically diagnosed dermoids, if not excised, can be safely followed with yearly US with the risk of missing malignant degeneration quite low [54].
Clinically Suspected Adnexal Mass No Acute Symptoms. Invasive serous cystadenocarcinoma is now thought to primarily originate from solid precursors in the fallopian tube and serous tubal intraepithelial carcinoma, further supporting the benignity of simple ovarian cysts [50]. A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects these findings with higher threshold for follow-up of simple cysts [42]. Namely, in premenopausal women, simple cysts, including paraovarian and paratubal cysts <5 cm, do not need to be followed. The rationale of follow- up for simple cysts >5 cm (and 7 cm for exceptionally well seen cysts) is based on a potential risk of mischaracterization of larger cysts and potential clinical value of size monitoring growth rates of larger cysts, which may reflect benign neoplasms and warrant clinical follow-up along with a very small predisposition for torsion or rupture [51]. Classic benign lesions include endometriomas, hemorrhagic cysts, and dermoids as well as benign extraovarian lesions such as paraovarian cysts, hydrosalpinx, and peritoneal inclusion cysts have characteristic appearances on US [23,34]. Hemorrhagic functional cysts will decrease or resolve on sonographic follow-up in 8 to 12 weeks versus nonfunctional cysts, which will persist. Endometriomas may change in appearance with age, losing the classic unilocular ground glass appearance with multilocular appearance and presence of nonvascular papillary or other solid components more common in older premenopausal women [52]. These changes can overlap with malignancy and endometriomas and require yearly follow-up due to a small risk of malignant transformation [53]. Sonographically diagnosed dermoids, if not excised, can be safely followed with yearly US with the risk of missing malignant degeneration quite low [54].