(Ultrasound Review) Adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women should be managed conservatively, according to researchers. Gynecologists at Malmo University Hospital in Sweden scanned women with asymptomatic benign adnexal cysts at regular intervals in order to determine the natural history. The results of this prospective study were published in Ultrasound in Obstetrics and Gynecology.
Ultrasound examinations were performed using either an Acuson XP with a 5 or 7 MHz transvaginal transducer or a Sequoia 512 with a 5-8 MHz transvaginal transducer. Sonography demonstrated 160 cysts in 134 women. Ultrasound classification of cysts included unilocular cyst, multilocular cyst, unilocular solid cyst, multilocular solid tumor or solid tumor. Seventy-six percent of cysts were unilocular and the remaining 24% were complicated.
"Seventy-two cysts (45%) had a largest diameter of 3-19 mm and 88 (55%) had a largest diameter of 20-80 mm," they reported. Surgical intervention was considered necessary in 12 women in whom there was a change in cyst morphology or change in size. All 14 cysts in 12 women were benign. Cysts remained unchanged in 49%, resolved in 29% of women, and 13% of women developed new cysts. Patients under 60 years showed a higher rate of cyst regression (54%) compared with those over 60 years (8%).
Although a few women underwent surgery, according to the authors, "the clinical course in the remaining women strongly suggests that none of the cysts that were left in situ were malignant at inclusion or became malignant during follow-up." Their study included both simple cysts and more complicated cysts that were obviously benign in appearance.
"The results of our study support conservative management, because all 160 cysts followed a benign course, 95% of those that did not disappear remained essentially unchanged in size and morphology and only two (1%) might have caused symptoms during follow-up," they concluded.
The natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women.
Valentin, L and Akrawi, DDepartment of obstetrics and gynecology, Malmo University Hospital, Malmo, Sweden
Ultrasound Obstet Gynecol 2002 August; 20:174-180
By Ultrasound Review
November 5, 2002
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
