Adnexal Mass

I am 45 yrs old & had a TAH 11 yrs ago for pelvic pain/adhesions. My ovaries and tubes were left. I recently saw my gyn for rt & left sided pelvic pain. I had a vag. u/s. The results are:
The right ovary measures 1.9x1.2x1.3 cm. Immediately adjacent to the rt ovary is a cystic tubular structure that measures 3.9x1.7x1.5 cm. The cyst walls are smooth & there is no hypervascularity noted. This has the appearance of a hydrosalpinx.
There is a cystic appearing mass in the lt adnexa that measures 4.3x2.1x1.9 cm. There are no excrescences or papillae noted and the walls are smooth. There is at least one septation and possibly a second. Complete characteristics of this mass is difficult due to multiple loops of bowel. The visualized septation is 1.3 mm thick and has a small calcification noted and some minimal blood flow through it.No fluid is seen in the cul-de-sac.
I am scheduled for a f/u u/s next week and have surgery scheduled in a few weeks. I had tumor markers doen which were nl. Does the septation make this more suspicious? Also, is the calcification and blood flow significant? Does this most likely represent a complex cyst? Could the cyst resolve on it's own? Although I continue to have pain and actually feel like the pain has increased.
I am trying to decide if I should have the ovaries removed although with adhesions most likely present from the TAH, I know it may have to be done anyway. My dr mentioned that they would probably try to do this laparscopically although it may not be possible.
I am hoping on the repeat u/s, the mass can be more fully visualized and loops of bowel won't interefere. Why would loops of bowel be present?
Thanks so much for your input. I am anxious to get this resolved.

[Elaine Brown, MD]

Hi!'

If you were my patient, I would strongly suspect that a lot of what is seen on ultrasound is the result of adhesions.  Adhesions may be holding the loops of bowel adjacent to the ovaries.  Also, adhesions can form little pockets of fluid that look like cysts.

I would be EXTREMELY careful with a laparoscope, as I would not want a bowel injury.

I would not be terribly concerned about cancer, as your ultrasound is not very consistent with that.  I would discuss with you that each time a surgery is performed, more adhesions are going to form, so that would be in favor of removing the ovaries this time around.  However since you are so young, I would also be in favor of leaving one ovary so that hormone replacement could  be avoided for the present time.


I would probably leave the decision up to you!  ;)

I hope all goes well!
Dr B