Normally, several follicles (93) are detectable in the 1st days of the menstrual cycle, seen as 4-6-mm small cycsts in the ovary. After the 10th day of the cycle, one follicle becomes dominant, the so-called graafian follicle, with a diameter of about 10 mm (Fig. 61.2). Thereafter, this follicle shows linear growth, increasing in size by about 2 mm per day until it reaches a size of 18-25 mm just before ovulation. In the meantime the other follicles regress.
It is relevant for fertility therapy and IVF that serial sonographic examinations allow close monitoring of follicular which remains visible for only a few days as a hyperechoic area at the site of the former graafian follicle. In case of fertilization and implantation, the corpus luteum persists and can be identified as a corpus luteum cyst (64) until the 14th gestational week (Fig. 61.3).
Follicular dysfunction includes premature luteinization of the follicle and continued growth without ovulation to a follicle cyst (64) (Fig. 61.4). The diagnosis of a follicle cyst should be considered if the diameter is larger than 3 cm.
Fig. 61.3b maturation, and that the time of the ovulation might be observed by endovaginal sonography. Signs considered to indicate imminent ovulation include a follicular size exceeding 2 cm, the visualization of the small, peripheral, ring-shaped cumulus oophorus, and intrafollicular echos projecting from the wall. Following ovulation, the leading graafian follicle ^disappears** or at least diminishes markedly in size; at the same time a small amount of free fluid can be detected in the cul-de-sac. Through invasion of capillary sprouts, the ruptured follicle becomes the progesterone-producing corpus luteum.
An ovarian cyst with a diameter exceeding 5 cm is suspicious of tumorous growth and, especially if septations, wall thickening, or solid internal echos (\) are present (64) (Fig. 62.1), malignancy must be ruled out. A cyst containing sebum, hair, or other tissue components constitutes a dermoid (Fig. 62.2), which comprises about 15% of the usually unilateral ovarian tumors and can be classified as a primary benign tumor that rarely undergoes malignant transformation. A dermoid has to be distinguished from hemorrhagic or endometrial cysts, which are filled with blood products and can exhibit fluid-fluid interfaces (->) (Fig. 62.3) or a homogeneous echo pattern (50) (Fig. 62.4).
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