How to distinguish between benign and malignant ovarian cysts

The distinction between benign and malignant ovarian cysts is mainly based on imaging features, tumor marker detection, and pathological examination. Benign cysts usually present with smooth cyst walls and no solid components, while malignant cysts may present with mixed cystic and solid structures and abundant blood flow signals.

1. Imaging examination

Ultrasound examination is the main means of preliminary screening for the nature of ovarian cysts. Benign cysts often appear as single chamber, thin-walled, without papillary protrusions, and have uniform internal echoes; Malignant cysts are commonly characterized by multilocular septa, thick walls, solid nodules or papillary structures, and may be accompanied by ascites. Enhanced CT or MRI can further evaluate the relationship between cysts and surrounding tissues, and malignant lesions often show invasive growth or lymph node metastasis.

2. Tumor marker

CA125 is the most commonly used ovarian tumor marker. When its level exceeds 35U/mL, one should be alert to the possibility of malignancy, but benign diseases such as endometriosis may also lead to elevated levels. The combination of HE4 and ROMA index can improve specificity, and patients with malignant cysts often experience synchronous elevation of both. An abnormal increase in AFP and HCG suggests the possibility of germ cell tumors.

3. Clinical Symptoms

Patients with benign cysts often have no obvious symptoms or only present with a feeling of lower abdominal heaviness, and may experience sudden severe abdominal pain when the cyst twists. Malignant cysts may be accompanied by systemic symptoms such as weight loss and fatigue, and in the late stage, ascites such as abdominal distension and poor appetite may appear. Postmenopausal women with newly developed ovarian cysts or rapid enlargement of cysts should be highly alert to malignancy.

4. Pathological examination

Obtaining tissue specimens through laparoscopic or open surgery for pathological examination is the gold standard for diagnosis. Benign cysts commonly include serous cystadenoma, mucinous cystadenoma, etc., with regular cell morphology; Malignant cysts such as serous cystadenocarcinoma may exhibit cellular atypia, increased mitosis, and interstitial infiltration. Frozen sections can quickly and preliminarily determine the nature during surgery.

5. Growth characteristics

Benign cysts grow slowly, with diameters mostly ranging from 5-10 centimeters, and long-term follow-up changes are not significant. Malignant cysts can rapidly enlarge in the short term, possibly accompanied by irregular thickening of the cyst wall or neovascularization. physiological cysts should not appear in the ovaries after menopause, as the risk of malignancy for such cysts is significantly increased.

It is recommended to regularly monitor changes with ultrasound after discovering ovarian cysts, and avoid vigorous exercise to prevent cyst rupture or torsion. The diet should be light, supplemented with high-quality protein and vitamins in moderation, and the intake of high estrogen foods should be restricted. If symptoms such as persistent abdominal pain and abnormal vaginal bleeding occur, seek medical attention promptly and have a gynecologist evaluate whether surgical treatment or further examination is necessary.