Dermoid cyst

I am a 52 year old woman with a history of atypical ductal hyperplasia for which I underwent four years of tamoxifen therapy (2002-2006).  I still have regular periods.  Due to an episode of spotting, I recently had a pelvic ultrasound which indicated an endometrial thickness of 10 mm and a 4 mm dermoid cyst on my left ovary (a new finding compared with a previous ultrasound in 2008).  What further evaluation and/or treatment do you recommend?  Is it necessary for the dermoid cyst to be removed?  I have a very strong family history of premenopausal breast cancer (mother, sister, maternal great aunt) but no family history of ovarian cancer; my sister and I are negative for the BRCA genes.

[Annekathryn Goodman, M.D.]

Hi there
you at very least need a D&C (dilation and curettage) and hysteroscopy to rule out cancer of the lining of the uterus. tamoxifen is associated with a small increase risk of uterine cancer.

if you have a cancer or precancer of the uterus, you need a hysterectomy and then your ovaries should be removed because you ar higher risk for ovarian cancer.

if the D&C is normal, you can choose to follow the ovarian cyst or take out that one ovary. If you have a cyst in an ovary that is changing, that may be a good reason to have it removed

good luck
best wishes