Filly's 14th Law
If we were only smart enough to realize that we are looking at a hemorrhagic ovarian cyst, we would be in a powerful position. Not only would we know it is benign, but we would be nearly certain that it will disappear.
When we observe a mass in the patient’s ovary, our first question should NEVER be, “Is this cancer?” Our first question should always be, “Is this mass even a neoplasm at all?” (i.e., is it a non-neoplastic cyst). If it is, then it will almost certainly disappear. Importantly, this is where size counts. If the lesion is less than 6 cm. then such ovarian lesions are overwhelmingly non-neoplastic. To a moderate extent this is even true amongst postmenopausal women.
I am the first to admit that hemorrhage into an ovarian cyst can create a confusing appearance. Diffuse echoes may cause you to consider that the mass is solid. Adherent clot may masquerade as a mural nodule. Fibrin strands may appear to be septations.
Hemorrhagic cysts are overwhelmingly follicular or corpus luteum cysts. One does occasionally see hemorrhage into a serous cystadenoma. Therefore, such lesions are nearly universally benign and self-limiting. Therefore, if the thought even passes through your mind, “Could these features be the result of hemorrhage into a cyst,” then absolutely apply “tincture-of-time” and ask for a follow-up examination. I recommend six weeks. However, if you are nervous, recommend a shorter interval, BUT GET A FOLLOW-UP EXAM! (And review my lecture on ovarian masses.)