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This video shows a Large ovarian cyst with internal septations, uterine mass, and Cholelithiasis. The presence of solid components, papillary projections, intralesional vascularity, or nodular septa in a cyst is a high concern for malignancy. In premenopausal women, cysts with uniform internal echoes, reticulations, or septations may represent hemorrhagic functional cysts or an endometrioma. Once thought a risk for malignancy, septated ovarian cystic tumors are actually mostly benign. Having a cyst on an ovary does not usually affect one's chances of becoming pregnant, which is why doctors will typically only investigate further if a couple has been trying to conceive naturally through regular intercourse for a year, but have not yet been successful in falling pregnant. Large or persistent ovarian cysts, or cysts that are causing symptoms, usually need to be surgically removed. Surgery is also normally recommended if there are concerns that the cyst could be cancerous or could become cancerous. Pathologic cysts sometimes develop tissue partitions ( called septations) so that on ultrasound one can see many different fluid compartments. Also, pathologic cysts may develop tissue growths into the cyst, so the wall is not smooth, and these are called "excrescences". Complex ovarian cysts are those that contain either blood or a solid substance. Simple cysts are relatively common and usually clear on their own. Complex cysts are more likely to need treatment. Most ovarian cysts are benign, meaning that they are noncancerous. An ovarian cyst may need to be removed if it is: Suspected of being cancerous —the chances are more likely in older women. Large—more than 2.5 inches in diameter. Solid—rather than containing just fluid.