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complex cystic mass on right ovary, most likely neoplastic.
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complex cystic mass on right ovary, most likely neoplastic.

Hi there.  My name is Amy (37 yrs) and I was just wondering if anyone can help me interpret my results I got when I had terrible lower abdominal pains about 17 days ago.  After, abdominal x-ray, CT scan, and pelvic ultrasound.... I was told I had a large cyst on my ovary approx. 6cm diameter.  CT results stated: cystic right ovarian lesion with septation and questionable upper wal thickening.  GYN consult recommended.  I then had a pelvic ultrasound several days later and those results were:  complex cystic mass, right ovary, most likely neoplastic. and also recommending GYN consult.  More of the report stated:  ovary measures 7.1 x 4.5 x 6.6cm with volume of 111ml.  There is a complex avascular cystic mass within this ovary, which measures 6.3 x 6.0 x 3.5cm.  At least 2/3 of this has a solid component.  The remainder has a complex cystic component containing debris.  No flow on doppler. The radiologist immediately told my primary doctor's nurse that this was "very concerning".  She called me right away and helped set-up the GYN visit.  This GYN seemed very confident that it is likely a hemorrhagic cyst and will likely resolve itself over the next couple months.  I'm getting mixed messages and very confused.  I'm likely going for a 2nd opinion next week and maybe a follow-up ultrasound.  If it hasn't shrunk at all, is that going to necessarily mean cancer??  Wondering if anyone else has had similar results and what the outcome was.  Any info. will be helpful.  Thanks you very much.  Amy
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Hi Amy, its wise that you should go for a second opinion, but no this does not mean cancer. Most complex cysts are benign, and it can be a number of benign masses.  Hemmoraghic cyst do resolve on their own, and are not cancer.  However if its still there in the next couple of weeks, then its likely to be a non-functional mass that will need to be removed,  a number of cystic masses that are benign can show solid components- Endometriomas, Dermoids & hemmoraghic cysts can mimic each other on ultrasound and they are all benign and contain debris (apart from 2% of dermoids can turn cancerous).  I was diagnosed with 10cm complex mass they thought was a hemmorghic cyst or an endometrioma, turns out its neither, they now think its a dermoid, and it will be removed on 11th January.  Asvascular means it doesnt have blood flow, which is a good sign. Unfortunately CT or ultrasound is not 100% diagnostic and a mass cannot be determined benign or malignant until its removed and tested in pathology.  However 95% are benign, please keep that in mind.  Its hard not to worry and the waiting is the hard part, not knowing what it is, I am going through this myself! Best Wishes.  Yvonne
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Also, just to add, not sure where you are in the world, but if you are anxious and worried please push the specialists to act quicker, I had to do that in the UK on the NHS system,and they did react quickly.  Unfortunately we dont have the option to have a Gynologist/Oncologist to do the surgies, you are only referred to a Oncologist if the mass is proved malignant, and then have to go through more surgery.  There are lots of great people on this forum that give good advice and have very similar experiences, which I have found comforting to read.
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I am sorry you have to go threw this it is very stressfull to have this hanging over your head. Keep in mind most cysts are benign!!  
My wife was recently Dx with granulosa Cell cancer( GCT) Jan 2010 and I know what it feels like to not know what the next step is. Here is a quick overview.

Tests like sonograms, Cat scans and MRI's along with blood tests like CA125, Inhibin A&B, MIS and CEA are just used as a guides for the Dr's to help assist in making a diagnoses(Dx).
The blood test CA-125 is a test used by Dr's as a guide to determine if you have the most common form of ovarian cancer, approximately 80% of all ovarian cancers are epitheal ovarian cancer which is cancer of the cells on the surface of your ovary. Please keep in mind that CA-125 can be elevated if your menstruating and some other causes of inflamation (inflammation)..
There are other types of ovarian cancer that are hormone driven and depending which form a person has there will be excess symptoms of that specific hormone. This is the type my wife was Dx with granulosa cell ca. These group type are called sex cord -stromal tumors. These type of tumors have specific markes that the Dr's use just like ca-125 to aide in their dx of epitheal ovarian ca. They are Inhibin A&B and MIS. Please keep in mind if and only if you have a dx of these form of tumors there is a missconception that these tumors are always benign, which is completely false> They are just slow growing tumors as opposed to epitheal.
Unfortunately with any type of suspected ovarian mass/tumor/ suspicious cyst(s) surgery will be the only way for the Dr's too make a definitive Dx.
*****It is NOT recommended to biopsy any ovarian mass/tumor/suspicious cyst as it can rupture and seed the pelvis with cancer cells if that what it turns out to be. **********
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Since there is some suspicion  I would immediately find a good GYN/Oncologist surgeon. I am not suggesting what you have is cancer but studies have shown that treatment of ovarian cancer by nongynecologic oncologists and by low volume surgeons is associated with suboptimal surgical management. I would reccomend going to a large tiertiary hopsital where they see large volumes of patients.  This is not to make you worry even more but to make sure that the Dr who treats you has vast experience with diagnosing and treating various types of GYN / Onc issues if that is what it turns out to be. If the Dr wants to remove the cyst/mass via laprascopic procedure #####PLEASE make sure they have much experience with removing these INTACT! All too often I read posts from patients who say their Dr thought it was a cyst and removed it haphazardly causing a rupture and seeding of the pelvis with cancer cells, only to be found on pathology post removal. ######
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Next: From experience I would be asking for an MRI of the abdomen/pelvis ,MRI's are very precise when read by a **Radiologist that specializes in GYN/ONC**, My wife went to a radiology practice that does all types of MRI's and the Radiologist read her MRI as a fibroid. I then took her to Sloan Kettering in NYC(specializes in cancer only) to see a GYN/ONC surgeon who had the MRI repeated by a GYN/ONC Radiologist who called her DX to the tee which was confirmed after surgery.
The best advice you see all over these posts is you have to be your own advocate, be aggresive (aggressive) and stay on top of your phycicians. Get copies of all your tests/results as you are entitled to them. Post with any other questions you have this site has some very knowledgeable people on it. I wish you all the best.
Kevin
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Everything Kevin said is right on the mark.....the only point I would reinforce is the absolute need to find a gyn/oncologist for your surgical procedure.  I had a renown gyn/oncologist( from here in the Midwest in the US) perform my surgery.  Even with all his experience my tumor ruptured spilling malignant cells throughout my peritoneal cavity.......that meant I was staged IC rather than IA and ended up needing 6 chemo treatments.
It is imperative you have the most experienced specialist at your side.
Hang in there, and push until you get a referral to a gyn/oncologist.
Peace.
dian
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