Abnormal Transvaginal us

I had a US done and it showed Complex fluid surrounding both ovaries with thick septations and fluid in my left ovary, They also said that my left ovary was poorly identified... Not sure how they seen fluid if it was poorly identified. The Impression was endometriois or the malignancy were in the differential. Why would they put the malignacy if it has not been confirmed via biopsy?? Can the U/S detect that it is cancer for sure? I have no symptoms of endometriosis and was already checked for PID.. I would like for someone to help clarify this since my dr seems un concerend and I can't get to my gyn until July. Thank You!!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Based on the ultrasound findings an opinion about the possible nature of the lesion can be given but the final diagnosis of cancer can only be confirmed or ruled out with a tissue examination.  
At this point you need to undergo a complete physical and gynaecological examination and further investigations to ascertain the nature of the ovarian lesion. An abdominal CT scan and a CA125 may be helpful.
All the best, and God Bless!

[Trainwreck84]

Thank you for your reply since I have posted I did see my gyn he looked at the ultrasound and said it does not look good and that I need to have surgery, He didn't say what kind or go into detail but he had me do a ca 125 and wanted to see me in a week. Should I get a second opinion? If so should it be with a oncologist?

[Trainwreck84]

Got the labs back my Hcg was 3 and my ca125 is 22

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
These numbers are OK, but still do not rule out the need to operate. What is your age, and is your family complete?
A gyn onc surgeon would be the ideal person to evaluate you. Seek an early appointment.
Good Luck!

[Trainwreck84]

Would I have to have my gyn refer me to a gyn onc or would my history be enough to warrant a visit? I'm still young 25 and my family is complete with 2 children. Could my numbers be fine and cancer still be a concern?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Please discuss with your gyn the approach he / she is planning. An oncology reference would be wise at this stage.
Non-epithelial ovarian lesions do not show high CA125 numbers.
All the best, and God Bless!

[Trainwreck84]

I went to my gyn and he is sending me to a oncologist I go monday.. He also mentioned that what ever is going on might require some resection of my small intestine and also has some connection to my bladder. He did mention that it had to do with the fluid and septations. He is not saying 100% that it is not cancer due to positive tumor markers.. what should I ask the oncologist at the first visit?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Was a CT scan done? Or is this discussion taking place only on the basis of the USG report?
Good luck with the oncology consult tomorrow. Your oncologist will need to review all your reports, and perform a physical exam.
You need to discuss with the oncologist the differential diagnosis, the tests that need to be done to confirm the diagnosis, and the treatment options.
Please keep me posted.

[Trainwreck84]

Hello thanks for the quick response, A Ct was not done and he is basing everything on the TV US and blood work which he said were positive markers.. Should I ask for a ct scan with gadolinium-based contrast??

[Trainwreck84]

I went to the gyn onco, He did not do a internal pelvic exam due to the severe tenderness during palpitation of pelvis. He explained that he thinks the cysts are peritoneal inclusion cysts.. However he made that assumption before even looking at my ultrasound pics.. Then when I asked him if he had seen them he had not I showed them to him then he said well I still can't make a diagnosis and you should have a mri. I was not happy that he was going to push me away so to speak before even looking at the pics.. He then said he wants to see if my ovaries are enlarged. How ever in 6 months my right ovary has gone from 2.2cm x 2.2 x 2.4 they were never bigger than this for over 3 years now  The ovary now measures  5.3cm x 6.5cm x 4.2cm   Why did that not alarm him?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
I think an imaging is indicated. MRI may have a few benefits compared to CT, but either is acceptable.
Please get one quickly, and re-visit the gyn onc.
Good Luck!

[Trainwreck84]

Thanks again!! My question to you is since the size of my ovary where the pain is has increased should that be of concern? Or is a ovary of that size considered normal?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The ovary (with surrounding complex mass) seems to be increased in size.
A better imaging modality (CT, MRI) will better define this mass.
Good Luck!

[Trainwreck84]

My mri report :  findings suggest Endometriosis with a focal endometriomas and bilateral complex hydro/hematosalpinx. Not sure that this means this is not cancer.

[Trainwreck84]

I messed up the impression sorry...  

      There is no papillary enhancement... Thin endometriotic plaques are suspected along the peritoneal reflection demonstrating low signal on T1 and T2 weighted images.. Lower abdomen demonstrates pericolic gutter fluid probable hepatic enlargement without hydronephrosis.. Endometriosis and complex hemato/hydrosalpinx

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The MRI has indeed been useful in clarifying the diagnosis. Your pelvic lesion does not have any classic radiological features suggestive of cancer. Rather, there appears to be a spot of endometriosis (benign enlargement of uterine tissue), which has compressed one Fallopian tube, causing blood and fluid to collect within it.
Please consult your gynecologist. Surgery may be needed, followed by a histopathological examination of the tissues removed.
All the very best!

[abigela]

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