transvaginal ultrasound

Dr. B, this is in response to your answer on my transvaginal ultrasound and question posted previously..
Thank you for your answer. I also have sought out 4 other doctor's opinions. One dr. told me that i need to have my left ovary removed because of the dermoid.  The other three seemed to be not very concerned about it and said to follow up with another sonogram in 6 mos. - 1 year.  I am very scared and not sure what to think. I have my first sonogram in November and my second one in February with no change in the dermoid..  However, I do worry, could it be cancer..? Can these types of cysts turn into cancerous cysts?  since I am 45 years of age, is there an increased risk involved?
Also I have been having very peculiar thick white vaginal discharge for 5-6 mos. I have been tested for everything under the sun and everything comes back "negative"- cultures, hpv and have been tested for all types of infections. Although the tests come back negative, I have itching/burning off and on.  Could the cyst or the polyp in my uterus be causing this??  One dr. told me I must have alot of estrogen.. Should I get a biopsy of the vulvar area? (my drs do not seem to want to do this.)    I am fed up with getting no where on these issues. Can you help with any input?

[Elaine Brown, MD]

Hi!
Dermoid cysts almost never become cancerous.  It's a funny thing that a dermoid is actually more likely to be positive in a very young woman (18 or so) than in older ladies.
Yours may have been there for years.  IF there are going to be any problems, ultrasound will almost certainly detect them -- usually cancer grows and there would definitely be a change in a 6 month time frame.
A polyp would not cause whitish discharge in most instances.  A biopsy would be warranted if there are any discreet lesions on the vulva.  If random biopsies are done, they are likely going to show chronic inflammation
As far as the discharge goes, I would probably treat with diflucan on the off chance that it might help, but it may just be physiologic discharge.  One way to know if it is physiologic is if it changes with your cycle. Physiologic discharge usually becomes more prominent at midcycle and lasts until the period.
Hope this is helpful!
Dr B