A 25-year-old woman has a left ovarian cyst on ultrasound with the following features: unilocular, thin-walled, no internal echoes, no septae, no papillary projections, 6 cm diameter. CA-125 is 18 U/mL. What is the most appropriate management?
- A Immediate laparoscopic oophorectomy
- B CT pelvis to further characterize
- C Conservative management with repeat USS at 4–6 months ✓
- D MRI pelvis and tumour marker panel including AFP and hCG
Correct answer: C. Conservative management with repeat USS at 4–6 months
Explanation
A simple unilocular thin-walled cyst <7 cm with normal CA-125 in a premenopausal woman is almost certainly benign (likely functional or serous cystadenoma). RCOG/ISUOG guidelines recommend conservative management with follow-up ultrasound at 4–6 months. Surgery is not indicated for asymptomatic simple cysts in reproductive-age women. CT and MRI are not first-line for such a clearly benign morphological pattern.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.