Paraovarian Cyst

What is a paraovarian cyst?

Paraovarian cysts are sacs filled with fluid or semisolid material that form near your ovaries. Unlike ovarian cysts, they don’t form directly on or inside your ovaries. Instead, they’re nearby. The name provides clues about where they’re located and what they’re made of:

• Para means near or alongside.
• Ovarian has to do with your ovaries.
• Cysts are mostly fluid-filled sacs, but they sometimes contain a mix of fluid and solid parts.

They’re also called paratubal cysts when they’re close to your fallopian tubes (para = near, and tubal = fallopian tubes). Hydatid cysts of Morgagni are a specific type of paraovarian cyst that forms on the fallopian tube fimbriae. Fimbriae are finger-like projections at the end of your fallopian tubes that sweep an egg from your ovary into your fallopian tubes during ovulation.

Paraovarian cysts are mostly harmless and don’t usually cause symptoms.

How common are paraovarian cysts?

These cysts account for 5% to 20% of masses near your uterus. It’s difficult to know just how common they are since they don’t usually cause symptoms. Some people likely don’t get diagnosed because they don’t have a reason to visit their healthcare provider.

People of all ages can get them, but most people who get a diagnosis are in their reproductive years, from ages 20 to 40.

What are the symptoms of a paraovarian cyst?

Paraovarian cysts don’t usually cause symptoms. When they do, it’s often because they’ve grown so big that they create pressure within your abdomen. The pressure may feel like a dull ache or a sharp pain.

Do paraovarian cysts cause pain?

They can if they get too big and put pressure on your abdominal organs. Sometimes, they don’t cause pain, but they cause an unpleasant feeling of pressure or fullness. This usually happens when a cyst grows especially large.

What causes paraovarian cysts?

You get paraovarian cysts when parts of your broad ligament grow into a sac and fluid collects there. The broad ligament is a protective tissue layer that covers your reproductive organs, including your ovaries and fallopian tubes. Most paraovarian cysts form in your broad ligament’s middle layer.

These cysts likely arise from leftover pieces of your Müllerian ducts — from before you were born. Müllerian ducts are paired ducts that develop inside an embryo. They eventually mature into parts of your reproductive system, including your fallopian tubes, uterus, cervix and the top of your vagina. Leftover bits of these ducts can form cysts within your broad ligament as these organs develop.

What are the complications of this condition?

Paraovarian cysts don’t cause symptoms or require treatment unless you have a complication or the risk of one. Complications include:

• Enlargement. Most paraovarian cysts are 1 to 8 centimeters (from .5 to over 3 inches) in diameter. When they’re small, they don’t usually cause symptoms. But they can grow up to 20 centimeters (nearly 8 inches) in rare instances. An enlarged cyst can put pressure on your abdominal organs and create symptoms like pelvic pain, constipation or frequent urination. Large cysts can increase your risk of other complications, like twisting (torsion) or breaking and bleeding.
• Torsion. Large cysts are at risk of twisting, or torsion. Torsion causes symptoms like abdominal pain, low back pain, fever and vomiting. Depending on the cyst’s location, torsion can also cause your fallopian tubes to twist. The twisting cuts off the supply of blood and oxygen. It can cause long-term tissue damage. It’s essential to get emergency treatment if you experience torsion.
• Rupture. Cysts can break open and cause internal bleeding.
• Cancer. Although it’s extremely rare, these cysts can become malignant or cancerous. Still, it’s much more likely that a cyst with solid components (tumor) is benign, or noncancerous.

How are paraovarian cysts diagnosed?

Many people learn they have a paraovarian cyst when their healthcare provider finds one during a pelvic exam or ultrasound. An ultrasound uses sound waves to create pictures of your abdominal cavity, including your reproductive organs and masses like cysts. An MRI (magnetic resonance imaging) can also detect them.

If you’re experiencing symptoms of an enlarged cyst, like pelvic pain, your provider may perform a transvaginal ultrasound to see what’s causing the issue. A transvaginal ultrasound uses the same technology as a traditional ultrasound. It involves inserting a wand-like instrument called a transducer inside your vagina to check for growths like cysts.

Your healthcare provider may need to remove the cyst and examine the material inside to see if it’s a simple cyst (fluid-filled) or has solid parts, like a tumor. Your provider will determine whether this is necessary. Usually, it isn’t.

How are paraovarian cysts treated?

Most paraovarian cysts are harmless and don’t require treatment. In rare cases — when a cyst puts you at risk of complications, or there’s any risk that it could become cancerous — your provider can remove it. Management and treatment options include:

• Expectant management. This means you don’t need follow-up care for your cyst. When this happens, your cyst is harmless, isn’t causing symptoms and there’s no risk of complications. This is the most common response to paraovarian cysts.
• Surveillance. Your cyst is likely harmless, but there’s a potential risk of complications, like enlargement or cancer. In that case, you may need ultrasounds or blood tests so your provider can learn more about the cyst.
• Surgery. Removal is an option if your cyst is causing symptoms or puts you at risk of complications.

Surgical procedures used

The most common surgery for removing paraovarian cysts is called a laparoscopic cystectomy. Your healthcare provider removes the cyst through tiny cuts in your abdomen.

Can paraovarian cysts be prevented?

They’re not preventable. The good news is that they’re low-risk growths that you probably shouldn’t worry about.

What can I expect if I have a paraovarian cyst?

Chances are, you’ll learn about the cyst during an appointment with your provider for an unrelated issue. They’ll let you know if you need monitoring or if they’d like to run tests. Mostly, paraovarian cysts are harmless growths that don’t interfere with your life.

Do paraovarian cysts go away?

They often go away on their own without causing any issues. In rare cases, they may do the opposite and enlarge or twist. In this case, your provider can remove them.

When should I see my healthcare provider?

Don’t skip annual visits with your gynecologist once you’re 15 or become sexually active. You should report any new symptoms to your provider at your annual exam. While a paraovarian cyst isn’t usually concerning, your provider can ensure it’s not putting you at risk of complications.

When should I go to the ER?

A twisted cyst (torsion) is a medical emergency. You should get help right away. Signs include:

• Sudden, sharp pain in your abdomen.
• Pain radiating from your low back.
• Intense pain that makes you feel sick to your stomach or causes you to vomit.

What is the difference between an ovarian cyst and a paraovarian cyst?

Paraovarian cysts form near the ovary, not on it or inside it. Still, these cysts resemble each other on imaging and often cause similar symptoms. They can cause similar complications and a provider may need to remove them using the same surgical techniques.

But there are key differences. Ovarian cysts often form in response to hormonal changes in your body. Paraovarian cysts don’t respond to hormones. Some research suggests that paraovarian cysts are more likely to twist than ovarian cysts.

Are paraovarian cysts cancerous?

It’s possible but extremely rare. There are very few reported cases of these cysts becoming cancerous.

A note from Cleveland Clinic

Don’t be alarmed if your healthcare provider finds a paraovarian cyst during an ultrasound. It’s likely just the leftover material from when your reproductive system was forming before you were born. It’s most likely harmless. Your provider will let you know if they need to remove it.