Need help understanding lab diagnosis

[lillmisstn]

Here is a copy of my lab diagnosis that I received two weeks ago. The pathologist here in Japan (we are a military family in Okinawa) sent it to Walter Reed for an expert to look at it, however we have yet to hear anything back. Two weeks seems like a lng time for something like this to get a result. PLEASE any information is GREATLY appreciated. My stress level is thru the roof and I am just very concerned at this point. I initially went into the ER b/c my abdomen was severly swollen and my groin area was as well. the dr said in my surgery, he saw some "lumpy, bumpy stuff" on my ovaries but just moved on b/c he was looking for something ruptured. See below:

Final Diagnosis:
BODY CAVITY FLUID
-Satisfactory for evaluation, highly cellular
-Features suggestive of a granulosa cell tumor of ovary (see comment)
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COMMENT: THis highly cellular aspirate is composed of individually dispersed uniform tumor cells and small loosely cohesive clusters. Within the cohesive aggregates, structures consistent with Call-Exner bodies are evident. The nuclei have smooth outlines, extremely finely reticulated, and finely dispresed chromatin, and a lack of prominent nucleli. Longitudinal grooves are evident in several of the homogenous neoplastic cells. Although the features are highly suggestive for a granulosa cell tumor of the ovary, other diagnoses must also be considered in the cytologic differential diagnosis. these include but are not limited to small cell carcinoma, endometrial stromal sarcoma, and carcinoid tumor. Because of the cohesive tendency of the tumor cells, a diagnosis of lymphoma is not favored. Tissue confirmation is recommended.
CLINICAL DIAGNOSIS & HISTORY
31 year old female with abdominal pain, abdominal wall swelling and turbid ascitic fluid on diagnostic laparoscopy

[Annekathryn Goodman, M.D.]

Hi there,
I think you should get a consultation with a gyn oncologist. It sounds to me from the report from Water Reed that you have a granulosa cell tumor. It is not normal to see Call Exner bodies in a benign ovarian cyst. You need to have that ovary removed!

You should keep notes. You should also make a fuss about being sent to a gyn oncologists. Do not take no for an answer.
please let us know what happens
take care

[Annekathryn Goodman, M.D.]

Hi There
It sounds like you have a kind of malignant tumor called a granulosa cell tumor. This is a tumor from the cells of the ovary that make estrogen. these are highly curable with surgery. Sometimes it is not possible to completely understand what the tumor is until it is removed. that should be the next step. please let us know what happens
best wishes

[lillmisstn]

I should be receiving my slides back from Walter Reed next week .. I am going to send them to a wones center in NC to have abother pathologist look at them .... But now I have had my period twice in the last two weeks .... Its definitely not normal for me to have that. I go back to the gyn in Jan ... Is it best to keep notes of all this to take in with me?
I know these are alot of questions, and I apologize but being in another country slims my choices down a bit for going to someone for advice ...
you are a blessing

[lillmisstn]

Dr Goodman,

I also had another question. Could this 'assessment' be correct if what the pathologist examined was fluid versus something that was biopsied? the dr had also told me that they only sent 3 cc to Walter Reed which wasnt a whole lot after it was spun down. Just wondering :)

Thank you again for taking the time to look over these questions and reply!!

[lillmisstn]

THank you for your reply. I went aabck to the dr yesterday & he said that the pathologist @ WR felt that with my medical history (I rarely complain of anything or go to the dr) it was in her opinion that the cells she examined were benign? She also said that it "could have been a cyst that ruptured". If that were the case, why would I still have the pain with my ovary? And would a cyst make me gain almost 10 lbs of fluid? Also, I have severe in digestion everytime that I eat. It feels like I have a rock in my stomach. I can go with her expert opinion but I have had several people tell me that something just doesnt sound right & that a tissue confirmation is really the only way to know exactly what it is. Should I get a second opinion?

Best Regards.