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Neurology2 papers

Chocolate cyst of ovary

Last edited: 4/15/2026

Overview

A chocolate cyst, also known as an endometrioma, is a type of ovarian cyst characterized by the accumulation of dark, chocolate-colored fluid due to endometrial tissue implants within the ovary 1. These cysts are often associated with endometriosis and can cause significant pelvic pain and potential infertility 1.

Diagnosis

  • Imaging: Transvaginal ultrasound is the primary diagnostic tool, often showing a unilocular cyst with low-level internal echoes resembling chocolate 1.
  • Laparoscopy: Confirms diagnosis and assesses the extent of endometriosis 1.
  • Blood tests: Elevated CA-125 levels may be seen but are not specific to endometriomas 1.

    • Management

  • Surgical Management: Ovarian cystectomy or laparoscopic excision to remove the cyst while preserving ovarian function 1.
  • Conservative Management: Hormonal therapy with oral contraceptives or GnRH agonists to manage symptoms and inhibit cyst growth 1.
  • Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic relief 1.

    • Special Populations

  • Pregnancy: Management focuses on symptom control; surgical intervention is typically deferred until postpartum if possible 1.
  • Pediatrics: Limited evidence; conservative management with hormonal therapy is often preferred 1.
  • Elderly: Considerations include comorbidities; individualized treatment plans balancing symptom control and surgical risks 1.
  • Comorbidities: Presence of other conditions may influence treatment choice, favoring less invasive options when feasible 1.

    • Key Recommendations

  • Use transvaginal ultrasound for initial diagnosis of suspected endometriomas (Evidence: Moderate 1).
  • Consider laparoscopic excision for definitive treatment, aiming to preserve ovarian function (Evidence: Moderate 1).
  • Employ hormonal therapy with oral contraceptives or GnRH agonists for symptom management and cyst stabilization in non-surgical candidates (Evidence: Moderate 1).

    • References

    1 Fries JH. Chocolate: a review of published reports of allergic and other deleterious effects, real or presumed. Annals of allergy 1978. link

    Original source

    1. [1]
      Chocolate: a review of published reports of allergic and other deleterious effects, real or presumed. — Fries JH Annals of allergy (1978)
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