ovarian cyst with septation

[lacpuppydog]

Hello:
I am 45 years old, no children, no family history of ovarian cancer, however my aunt on mother's side had breast cancer post menopause.  

I've been dealing with heavy and prolonged bleeding for approximately 7 years.  On and off bc's, progesterone only pills, and now currently on provera to stop the bleeding.  Provera at 10 mg. for 10 days out of the month seems to work. Could not tolerate bc's due to raised blood pressure and  both the bc's and micronor gave me migrain headaches, so I went on the provera instead which seems to be ok.

I've had several tests done: 3 uterine biopsies, several ultrasounds of pelvis, hystosonogram, CT of abdomen and pelvis, and blood tests to check hormones. All were normal, except there was a time before a got on the hormones that my uterine lining was thicker than normal, one small fibroid, and evidence of not ovulating normally.

Recently my bloodtests showed an abnormal LH level, suggesting that I'm not ovulating.  I recently had a TVUS which showed  2 fibroids, one was 2 cm, the other was 1 cm. Endometrium was normal with a double-wall thickness of 5mm. Otherwise normal uterus.

The right ovary contained two, less than 2cm "simple" cysts, which are thought to be physiologic.  The left ovary contains a dominant 2.7cm x 2cm elliptical cyst with one thin septation.  Both ovaries are normal in size with normal volumn of 12cc on the right and 8cc on the left.  Normal Dopplar is seen on each side.  No soft tissue mass seen.  No free fluid. Follow-up US recommended in 8 weeks for left overy cyst.

Can you please tell me what the risks are for the septation on the ovary and what it means in relationship to cysts that are malignant.  Do malignant cysts usually have septations?  Is my cyst more likely to either be or turn into cancer because of this septation?  Can non-malignant cysts have septations? Also, does the cyst being elliptical verses round mean anything?

Thank you for your time,
LAC

[shazz70]

i need some good advice can anyone help i have a 12.6cm cyst with at least 5 septums and a tumor on my left overy what are the chances of it being cancer ?  the doctors are not giving me any answers as i work with them as their receptionist

[got2mary]

Dear Doctor Goodman,
    
     I am 40 years old, 3 children, and no family history of ovarian cancer.  Last week after holding back a need to urinate while in route, I returned home to relieve myself.  At that point I had severe abdominal pain.  This pain did not let up - it felt as if I was in labor.  A few hours later the severity diminished.  Now it feels as if the baby (which I am not pregnant) dropped.  This with intermittent stabbing, cramp like pain continues.  My abdomen is distended.  It hurts to have a full bladder, laugh, cough, or push (as with a bm or flatulence).  I also have pain in my peri area.
     I have seen my family doc whom took a urine sample to r/o pregnancy and UTI.  He preformed an abdominal and vaginal exam which I was extremely tender.  He sent me for a STAT US.  My left ovary is 2X larger than my right and contains a 2.8 cm cystic lesion which contains diffusely low echoes, thin septations, one focal wall thickening measuring 0.5 cm.  Flow is demonstrated within the left ovary w/o evidence of torsion.  There is no free fluid present within the cul-de-sac.  Impressions are:  left ovarian cystic structure that could represent a hemorrhagic corpus leteum cyst or endometrioma.  L ovarian neoplasm or ovarian malignancy could not be excluded.  Follow up US in 6 wks recommended.  
     My doc told me that he believed that the cyst had ruptured causing this pain - wouldn’t that be evident in the US?  Where would the fluid go?  US didn't show it?  I stated my concerns re cancer so he sent me for a CA 125 - no results yet.
     What does diffusely low echoes, thin septations, one focal wall thickening measuring 0.5 cm mean?  Aren't low echoes and the wall thickening a concern?  How thick is a corpus leteum cyst wall normally?
     If it is a ruptured cyst are my symptoms and US normal for this diagnosis?  Why would my ovary be enlarged?  How long does it take for the pain to go away?  It's been a week now.

     Thank you for your time,

     Waiting in Pain

[simcha701]

I am 37 years old, two children.  I suffered from endometreosis prior to having my kids.  Had two laparoscopies in my early twenties, endured cysts, etc.  But thankfully, had two successful pregnancies.  With my youngest three years old, I now suddenly have a 6cm complex cyst on my left ovary, with internal septations and intermediate echoes.  Symptoms are bloating, pressure, back pain and indigestion/constipation.  No heavy bleading, and no sharp "endo"pain (as I recall it), rather a constant dull ache.  The ultrasound read "most likely endometrioma or hemmoragic cyst" with minimal free fluid and recommended follow up to exclude functional etiology.  My gyn says I can do the CA 125, but it could come back high so she recommends another US in 4 weeks.  Should I do the CA-125 (i.e. is a low result more reliable than a high one)? Should I wait four weeks or go for the laparoscoy immediatelly to not take a chance?  I still want to have more children and do not want to lose an ovary.

Thank you so much,

Confused and Scared.

[Annekathryn Goodman, M.D.]

Dear LAC,
It sounds like you are having excellent care. You are right at that age of heavy periods. this can last for years before menopause. You have had just the right workup and treatment. Those cysts on your ovaries sound pretty normal. You are probably not ovulating every month which is why your LH is off (perimenopause.) those cysts happen from the times you are ovulating. The standard thing to do is repeat an ultrasound in 2-3 months. A septation just means a thin boundary between two collections of fluid.
best wishes