cysts on pelvic and abdominal CT scans

[madcarly]

I am 47 yr.old. post menopauseal woman. I had a partial hysterectomy at 20 yr.old. I only have my ovaries.I had 6 breast biopsies all with "a typical hyperplasia cells" and ended with bilateral mastectomies. DX was fibrocysytic disease and dr. recommended mastectomy 10 years ago because this was a precancerous condition. I have ultrasound done yearly by me breast surgeon. There have been areas of concern found on mamograms since. I took hormones for two years and stopped just over a year ago. For the past 2 years I have had intermittant right flank pain, low right abdominal pain, leg pain fever, nausea, bowel changes, sudden weekly weight loss. All of these symptoms have increased in severity in the last six months. My internist sent me to a general surgeon, who ordered stat ct scans w/ contrast of abdomen and pelvic area. the radiology report was: 2.4 cm AP x 2.0 cm transverse low density lesion within right pelvis suggestive of a right ovarian cyst. Numerous calcifications within the pelvis bilaterally, some appear to overly the uterous. Some suggestive of phleboliths. some calcification within uterine fibroids cannot be excluded. possibility of distal ureteral calculus cannot be excluded.
Why would a radiologist report on a uterous I do not have. and also are these findings normal. I am now scheduled for a transvaginal ultrasound this week. I am confused, I thought a ct scan was better than ultrasound.

[Sumer K Sethi, MD]

well especially for lower abdominal structures like uterus and ovaries TVS gives  better information than CT scan. and lower abdominal calcifications most likely wud be phleboltihs.

[maeholland]

Hi madcarly, I wanted to tell you that I had normal looking cysts on my ovaries followed for 18 months before I was diagnosed with ovarian cancer. Luckily it was stage I-C. I was premenopausal, age 34, CA125 was below 35, and the cysts looked simple. However, my doctor put me on birth control and one of the cysts grew to 9 cm, so he went in surgically. The surgical biopsy only showed "complex hyperplasia with atypia, no evidence for malignancy," but he didn't feel right about it and referred me to a gyn-onc. That saved my life. In addition to the medical tests, my body was VERY vocal that there was a problem. I had so many symptoms I could not ignore them, which is not the case with normal cysts.

An ultrasound is more sensitive than a CT scan when looking at the ovaries, and 3-D doppler is important to look for solid spots. Have you considered seeing a gyn-onc to have an exploratory surgery? No diagnosis can be made until tissue goes to the pathology lab, and even then, a small biopsy is not as good as the whole mass. What's the deal with those pelvic calcifications? Maybe they should be evaluated by a pathologist. Also, getting a baseline CA125 wouldn't hurt. Have you had BRCA2 testing? Like you, I am having colon problems (and now joint problems).

I have just had a colonoscopy with several biopsies taken - to test for Crohn's, etc. I am working with two oncologists, a gastroenterologist, a reproductive endocrinologist, a primary care physician, and I'm being referred now to a rheumatologist. I also have an acupuncturist, naturopath and genetics counselor (M.D.). My cancer behavior and now colon and joint problems continue to be a mystery. I hope that you persist in finding a physician who can help you sort out your situation. My team is incredible. On many occasions the medical tests have failed us, and my body has defied all statistics, but their experience (and my symptoms)led them to a diagnosis. I hope you find a doctor who will help you before you get really sick.

[madcarly]

I posted under Ovarian Cancer last month.I am 47,not overweight.I had a hysterectomy 21 years ago still have ovaries. Was told by gyno.in 99 I was beginning menopause.Went on HRT for 2 years.Stopped when my breast doc.found out. I had a bilateral mastectomie 11 yrs.ago for repeated biopsies for masses always with "atypical hyberplasia cells" and calcifications. I have had intermittant RLQ pain 2 years-radiates to lower back.Over the past 3 mo.pain has gotten severe,with 14+lbs weight loss, nausea, diarhera and loss of energy. PCP doc.ref.me to surg.for abd.& pelvic CTw/contrast to rule out appendicits. results were: patchy infiltrate rt.mid lung field;rt.adrenal gland has slight fullness;numerous calcifications within pelvis bilaterally;
possibility of distal ureteral calculus;atherosclerotic calcification within iliac arteries bilaterally particularly involving the internal iliac arteries bilaterally; 2.4cm AP x 2.0cm transverse low density lesion within right pelvis sugesstive of right ovarian cyst. multiple phleboliths in region of prominent vaginal cuff. Was then ref.to GYN.who ordered TV ultrasound.results: Right ovary has several small follicular type cysts, no free fluid in the cul-de-sac. GYN dr.then ref.to Colon dr.for colonoscopy said these cysts wouldn't present w/pain and symptoms,& because of my hist.w/GI symptoms and the atypical cells from breast biopsies & my mother having colon cancer, he thought I needed this done and we would repeat the TV ultra in 3 months.Had the colonoscopy and the results are: diverticulosis as well as a pedunculated polyp in sigmoid colon; biopsy results that I picked up today; 1.(polyp)lesion shows prominant serrated appearance, a serrated adenoma is considered but with the lesion being 8mm and less than 1cm in diameter and showing surface maturation, the lesion appears most compatible w/a hyperplastic polyp. 2.Random Biopsies; no significant pathologic alterations noted in random biopsies.I have not seen the colon dr.until this fri. The day after my colonoscopy I had severe pain for 3 days and colon dr.wanted me to go to ER to check for problems with procedure. ended up telling me to get a 2nd GYN opinion because the sigmoid colon won't have pain in right side. 2nd GYN now tells me that he needs FSH and CA125 test and then will decide if ovary has a small tear and if I am in menopause or not. this is because he thinks i need laproscopic if tests show I am not in menopause. he also said I need a referral to urologist for things on the CT scan. I am so confused, in so much pain and I would love it if you could help with all this medical mumbo jumbo. What does it all mean in terms I can understand.I thought I was through with female problems long ago. Now I am worried about the colon biopsy because of my mother having had stage III colon cancer and all this other stuff. What would you recommend. I was diagnosed with R.A.6 years ago and I am taking 400mg.plaquenil a day,I take 50 mg.toprol. Please help clarify.

A Forum-M.D.-KP
(19-Mar-04) madcarly A hyperplastic polyp are the most common nonneoplastic (non-cancerous) polyp in the colon. At the present time, there is no clear consensus regarding what recommendations should be given to asymptomatic patients at average risk for CRC who are found to have a distal hyperplastic polyp on a screening sigmoidoscopy. Thus, decisions should be individualized after informing the patient of the uncertainty versus the risks and benefits of a colonoscopy.

There are some GI docs that would repeat the colonoscopy in 5 years to ensure there is no growth in the polyps. These type of polyps are less likely than others to progress to cancer.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Lawrence. Approach to the patient with colonic polyps. UptoDate, 2004.

C2 surgeon
(18-Mar-04)  . a hyperplastic polyp is completely benign, and is not really even a polyp, in the sense that "polyp" implies a tumor. A hyperplastic polyp is really just an enlarged area of the surface lining, and has no significance.

C3 madcarly
(24-Mar-04)  . I had to go to GYN again with severe pain this time it was left side. It was also not what appeared to be cyclic, as the last time I had this pain was March 5 through the 8th. And again on Feb. 3 through 9. Ultrasound was done and now I have nickel size cyst on left ovary as well as the ones on the right. I have been passed from PCP doctor to (2) GYN's, (1) colorectal doctor and now to a urologist because everyone says I should not have this pain with cysts. I simply do not understand. The urologist ordered an IVP although he said my urine was perfect. no blood, no bacteria. I am 47 and since I had my uterous and tubes removed because of endo. in 1982, I have never had any female problems. If anyone has had anything like this please let me know. I am still loosing weight although I haven't changed my eating habits. Possibly, when I have this terrible pain it lasts for several days and I may not eat as much, I get the bowel problems worse at this time also.

If anyone has any suggestions, please let me know.

Thank you.