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Ultrasound report:Comparison: CT pelvis of 9/7/04
Findings: The uterus is top normal in size. However, there are multiple intramural masses identified, with at least four measurable masses in the myometrium. There is a mass within the lower left uterine segment anteriorly, measuring 2.1 x 1.5 x 1.3 cm. There is a hyperechoic mass within the anterior mid body in the midline, measuring 1.9 x 1.6 x 1.6 cm. There is a slightly hyperechoic mass along the right side near the fundus measuring 1.9 x 1.4 x 1.5 cm. There is an 2.0 x 1.6 x 1.2 cm. hypoechoic mass in the posterior lower uterine segment. Endometrial stripe appears normal.
Both ovaries are enlarged. Within the right ovary, there is a complex cyst, containing low-level internal echoes and a 13 mm intramural nodule. This complex cyst measures 4.6 x 3.0 x 4.7 cm. Previous ct showed a right adnexal cyst measuring 3.6 x 2.6 cm.
The left ovary also contains a complex cyst, with low-level internal echoes, irregular shape, and possible small mural nodule, measuring 2.5 x 1.9 x 1.9 cm. Previous CT showed a left adnexal cyst, measuring 1.8 x 1.6 cm. There is a second small complex cyst on the left, with diffuse internal echoes, measuring 0.9 x 0.9 x 0.8 cm No other adnexal masses are seen, and ther is no evidence of free fluid.
1. Myomatous uterus. Several of the myomas are hyperechoic, which suggests the possibility of degeneration, possibly lipomatous degeneration.
2. Complex ovarian cyst bilaterally. These were present previously, but may have enlarged slightly, especially on the right. Possible etiologies include endometriomas or ovarian neoplasm, either benign or malignant. MRI may be useful to evaluate the possibility that these represent endometriomas.
Thank you again for the complete information. I agree in general with doctor # 2. The cysts are small (less than 5 cm) and by MRI are most likely endometriomas. The uterus looks to be just a fibroid uterus.
In the absence of other symptoms, it seems reasonable to do a smaller procedure with laparoscopy.
I do have to say that without doing a physical exam and seeing you - I base my thoughts on your good information. But I do think that there is an additional "feel' to one's opinion that comes from seeing and examining. So I would say that there are no wrong answers. Doctor #1 and #2 are giving you their thoughts and telling you what their respective comfort levels are in how to take care of you.
THANK YOU for your response yesterday, Dr, Goodman. I rec'd ultrasound report, below. What does it mean? Do you think they could be removed with laproscopy? Do you think a hysterectomy is necessary even if cysts are not cancerous?
1. Multiple small fibroids in the uterus. No suggesion of adenomyosis.
2. 4.7 cm oval cyst in the right adnexa, containing a small irregular nodular focus along the inferior wall, which shows mild enhancement. This may represent an hemorrhagic cyst, less likley a dermoid. I cannot entirely exclude a cystdenoma ot cystadenocarcinoma.
3. 3.4 cm. oval cystic-appearing mass in the left adnexa, which shows slightly heterogenous contents, which are suggestive of probable endometrioma. please correlate clincially.
Went to second doctor for another opinion. (Recall doctor #1 said I needed a complete hysterectomy due to size of cysts even if only benign. Also said cysts were too big to remove by laproscopy) Dr #2 advised only right ovary looked suspicious, and ordered CA-125. He is going to do laproscopy, and try to remove right cyst without harming right ovary. If he can't safely remove cyst, he will remove right ovary. He advised one ovary can supply sufficient horomones to body. He is going to look at the left cyst, but he advised MRI is very good at identifying endrometriomoas. He says he has a pathologist in the operating room to biopsy cyst on the spot.
Dr #2 seemed better informed. Do you think he have good advice? My last question: I have read on these boards you shoudl have a gyno-oncologist do the surgery. Should I seek a third opinion? thank you
PS. I have the best health insurance in the world. Thank goodness.
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