Cytology of nonneoplastic cysts of the ovary

From March 1986 through September 1988, cytologic material from 13 nonneoplastic ovarian cysts collected at the time of surgical removal of the ovary was compared with the histologic follow-up of these lesions in an attempt to characterize the cytologic features of benign ovarian cysts. In 22 additional nonneoplastic cysts, cellular material was obtained by the clinician with fine-needle aspiration. The 32 patients ranged in age from 18 to 64 yr (mean, 36.8; median, 35.5); of these, 24 were premenopausal, 6 were perimenopausal, and 2 were postmenopausal. Cytologically, follicular cysts (two cases) showed clusters of granulosa cells, some containing mitotic figures. Luteinized follicular cysts (11 cases) were composed of granulosa cells admixed with luteinized granulosa cells. Hemorrhagic corpora lutei (five cases) were characterized by fresh blood containing hemosiderin-laden macrophages and luteinized granulosa cells. Hemorrhagic corpus luteal cysts (10 cases) showed the presence of luteinized granulosa cells, fibroblasts, hemosiderin-laden macrophages, fresh blood, and abundant fibrin. In addition to these findings, regressing corpora lutei (two cases) contained macrophages with yellow hematoidin pigment. Endometriotic cysts (three cases) were composed of fresh blood, hemosiderin-laden macrophages, and scattered endometrial cells. In two cysts, subclassification was not possible due to scanty cellularity. An understanding of the cytologic features of nonneoplastic ovarian cysts may encourage aspiration as opposed to surgical ovarian removal. This has important implications, particularly in women of child-bearing age who wish to preserve their fertility.