A cystic follicle and a follicle cyst are noncancerous (benign) fluid-filled spaces in the ovary. Both develop from a follicle, which is a normal structure in the ovary that holds a developing egg. A follicle is not a tumor and not an abnormality. A follicle is surrounded by two layers of cells: granulosa cells on the inside and theca cells on the outside. Each month, a group of follicles grows, and one normally opens to release its egg.
When a follicle does not release its egg, it keeps filling with fluid and enlarges. The result is a cyst, a closed space filled with fluid. Because these cysts arise from the normal working of the ovary, they are called functional cysts. They are among the most common ovarian findings in women of reproductive age.
Neither a cystic follicle nor a follicle cyst is a tumor, and neither is cancer. They do not turn into cancer over time. This article will help you understand what these terms mean on your pathology report, what each one means, and why they matter for your care.
What is the difference between a cystic follicle and a follicle cyst?
The difference between a cystic follicle and a follicle cyst is size, and nothing else. Pathologists use a cutoff of 3 cm.
- Cystic follicle — A fluid-filled follicle measuring 3 cm or less. These are very common and are usually seen as an incidental finding in an ovary removed for another reason.
- Follicle cyst — The same change measuring more than 3 cm. Because of its size, this is the one most likely to cause symptoms or be seen on imaging.
The 3 cm cutoff is a convention agreed on by pathologists, not a point at which the biology changes. A cystic follicle and a follicle cyst form the same way, look the same under the microscope, and mean the same thing for your health. Your report may also use the older term follicular cyst, which means the same as follicle cyst.
What causes a cystic follicle or a follicle cyst?
A cystic follicle or follicle cyst forms when a follicle fails to release its egg and continues to fill with fluid. In a normal cycle, a surge of a hormone called luteinizing hormone causes the follicle wall to thin and open. When that surge does not happen, or does not have its usual effect, the follicle stays closed and keeps growing.
This is a normal variation in how the ovary works, not a disease. These cysts are most common during the reproductive years. They also occur in newborn babies, whose ovaries are exposed to hormones from the mother before birth, and around the time of puberty and menopause, when hormone levels fluctuate. Functional cysts are uncommon after menopause, because ovulation has stopped. For that reason, a cyst found in the ovary after menopause is usually investigated more carefully.
What are the symptoms?
Most cystic follicles and follicle cysts cause no symptoms. Small ones are usually found by chance, and many come and go without ever being noticed. When symptoms do occur, they usually relate to the cyst’s size or a complication.
- Pelvic pain or pressure — A dull ache or feeling of fullness on one side of the lower abdomen.
- Sudden, sharp pain — A cyst can burst, which is called rupture. This causes sudden one-sided pain and sometimes bleeding into the abdomen. Severe or persistent pain needs urgent medical attention.
- Sudden, severe pain with nausea — A large cyst can cause the ovary to twist on its blood supply, a problem called torsion. This is an emergency and requires prompt surgery.
- Changes in menstrual bleeding — Some of these cysts keep producing estrogen, which can delay a period or cause irregular bleeding.
These symptoms have many possible causes, and none of them is specific to a follicle cyst.
How is the diagnosis made?
Most cystic follicles and follicle cysts are identified on an imaging test rather than by a pathologist. On ultrasound, a follicle cyst appears as a thin-walled, single-chambered space filled with clear fluid, which is reassuring. Most of these cysts go away on their own within two or three menstrual cycles. The usual next step is therefore a repeat ultrasound several weeks later, to confirm that the cyst has shrunk or disappeared.
A cystic follicle or follicle cyst appears on a pathology report in one of two situations. The first, and by far the most common, is as an incidental finding. The ovary was removed for some other reason, and the pathologist noticed the cyst while examining the tissue. The second is when a cyst persisted, grew, caused symptoms, or looked unusual on imaging, and was removed surgically for that reason.
When the tissue reaches the laboratory, the pathologist describes the cyst’s size and appearance, then examines the lining under the microscope. Recognizing the two normal cell layers of a follicle is what confirms the diagnosis.
What do these cysts look like under the microscope?
A cystic follicle and a follicle cyst are fluid-filled spaces lined by the same cells that line a normal follicle. To the naked eye, the cyst is thin-walled, usually forms a single space rather than several, and contains clear or slightly blood-tinged fluid. Under the microscope, the pathologist looks for the following features.
- An inner layer of granulosa cells — These are the cells that surround a developing egg in a normal follicle. They form a thin, even layer on the inside of the cyst.
- An outer layer of theca cells — These rounded cells sit just outside the granulosa cells. Together, these two layers identify the cyst as a follicle.
- Thinning or loss of the lining — In larger cysts, fluid pressure can flatten the cell layers or wear them away in places. This is expected and does not change the diagnosis.
- Luteinized cells — The lining cells sometimes take on a bright pink appearance and enlarge, a change called luteinization. This reflects hormone activity and is a normal finding in these cysts.
- Bleeding into the wall — The wall may contain red blood cells or brown pigment left behind by older bleeding. This is common and is not a sign of cancer.
- Dividing cells — Cells caught in the act of dividing, called mitotic figures, can be seen in the lining of these cysts. Their presence here is normal and does not suggest a tumor.
What other findings may be described in the report?
Along with a cystic follicle or follicle cyst, your pathology report may describe several other features of the ovary and the tissue around it.
- Cyst size — The report gives the greatest dimension in centimeters. This measurement determines which of the two terms is used.
- Intact or ruptured — The report may note whether the cyst was whole when removed or had already burst. Rupture of a functional cyst carries none of the significance it would for a tumor.
- More than one cyst — Several cystic follicles are often present in the same ovary at once. This is a normal finding and does not by itself mean polycystic ovary syndrome, which is diagnosed on clinical and hormonal grounds rather than from a pathology report.
- Other normal structures — The report may mention a corpus luteum, a corpus albicans, or primordial follicles. All are normal parts of an ovary at different stages of the menstrual cycle.
- Other findings in the same ovary — The report describes anything else present, such as endometriosis or a separate tumor. Each is reported separately.
How are these different from other ovarian cysts?
The ovary can produce several kinds of cysts, and the pathologist tells them apart by what lines the inside. Your report may mention one of the following.
- Corpus luteum cyst — Forms after an egg has been released rather than because it was not released. A corpus luteum cyst is also a functional cyst, is also noncancerous, and often contains old blood.
- Endometriotic cyst — Lined by tissue like that of the lining of the uterus and filled with old blood. This is a feature of endometriosis and is managed differently.
- Serous cystadenoma — A benign tumor rather than a functional cyst, lined by cells resembling those of the fallopian tube. A serous cystadenoma does not resolve on its own.
- Cystic granulosa cell tumor — A low-grade cancer that can form a cyst. It is usually much larger, and the lining cells are disorganized and grow into the cyst wall. Distinguishing this from a large follicular cyst is one reason the pathologist examines the lining so carefully.
What happens after this diagnosis?
A cystic follicle or follicle cyst is a normal, noncancerous finding in the ovary. It does not require treatment in its own right, and it does not turn into cancer. If the cyst was found incidentally in tissue removed for another reason, your care will be guided by that other diagnosis rather than by the cyst. Points your doctor may raise include:
- No follow-up for the cyst itself — Once a cyst has been removed and confirmed as a functional cyst, no further monitoring is needed for it.
- New cysts can form — If you still have ovaries and are still ovulating, new functional cysts will continue to form and resolve. This is normal and is not a recurrence.
- Hormonal contraception — Birth control that prevents ovulation reduces how often new functional cysts form. It does not make an existing cyst disappear any faster.
- Fertility — Functional cysts do not damage fertility. If one ovary was removed, the other usually continues to work normally.
- When to seek care — Sudden severe pelvic pain, especially with nausea or vomiting, should be assessed promptly, since rupture and torsion both need urgent attention.
Questions to ask your doctor
- Was the cyst found by chance, or was it the reason for my surgery?
- How large was the cyst?
- Was the diagnosis a cystic follicle or a follicle cyst, and does the difference matter for me?
- Was the cyst intact, or had it ruptured?
- Was more than one cyst found?
- Was any part of the ovary removed, or only the cyst?
- Was there any concern that this could be a tumor rather than a functional cyst?
- Were any other findings described in the ovary or fallopian tube?
- Am I likely to develop cysts like this again?
- Could this affect my periods or my fertility?
- Do I need any follow-up imaging or appointments?
- What symptoms should prompt me to contact you?
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