A 51-year-old woman presents to her primary care physician for her annual physical examination. She reports decreased menopausal vasomotor symptoms over the last few months, with only a few episodes of irregular spotting. Her medical history is significant for menarche at age 16 and initiation of menopause at age 50. Physical examination reveals a right-sided adnexal mass. A pelvic ultrasound reveals a hypoechoic lesion on the right ovary.
Which of the following additional features, if present, would be most reassuring that the ovarian lesion is benign?
The correct answer is:
C) Smooth and simple wall
A cyst with smooth and simple walls can be present in normal ovaries and typically results from delayed involution of a follicle or corpus luteum. These cysts fit into category 1 (normal ovary) of the Ovarian-Adnexal Reporting and Data System (O-RADS).
Answer choice A: Increased vascularity, is incorrect. Malignant lesions often release excess vascular endothelial growth factor (VEGF) to stimulate angiogenesis and support tumor growth. Increased vascularity is a more concerning finding than a smooth and simple wall.
Answer choice B: Size > 10 cm, is incorrect. Although this finding alone does not necessarily indicate malignancy, it is unusual for a benign cyst to reach this size, especially in a woman undergoing menopause. Depending on additional findings, lesions > 10 cm may warrant further surveillance and/or intervention.
Answer choice D: Solid components, is incorrect. Solid components can reflect disorganized, uncontrolled growth and may represent papillary projections into a cystic cavity. Patients with this finding may warrant further evaluation.
Answer choice E: Thick septations, is incorrect. This characteristic is associated with malignancy in 1-10% of instances and fits into O-RADS category 3 (low risk). Depending on additional features, patients with thickly septated cysts may need follow-up surveillance.
Key Learning Point
Features associated with malignancy in ovarian lesions include thick septations, increased vascularity, solid components, and size > 10 cm. A smooth and simple wall is more consistent with a benign lesion.
