Please Help Me Understand CT Results

[StaceyCee]

Hi Everyone,

This is going to be very long, so I apologize ahead of time.  I am hoping someone can help me understand all, or some of my CT results.  I'll give you all the background story first.  In the beginning of February, I went to the Gynecologist for my yearly pap smear.  I told her about the history of ovarian cancer on my mothers side of the family.  I also told her that I had spotted on and off for three days the previous week.  I even explained to her that when I was a teenager, I was diagnosed with PCOS.  At that time, I hadn't gotten my period in months.  I had some blood work that apparently showed I had PCOS (elevated testosterone).  So I've been on the pill ever since to help control my periods.

The doctor asked me to come back the following week for an ultrasound.  She also ordered blood work.  The thyroid, LSH/FH, etc. came back normal.  The testosterone was elevated at 58.  The CA-125 was 9.3 (I do realize that the CA-125 should not be used as a diagnostic tool).  The first ultrasound showed that my right ovary and uterus were normal and that the left ovary was enlarged.  She said to come back in a month.  That ultrasound also showed a normal right ovary and uterus, but the left ovary was still enlarged.  Both ultrasounds showed that there was no fluid in the cul de sac.  The doctor said that the second ultrasound showed a possible dermoid.  She ordered a CT scan of the pelvis and abdomen with and without contrast.

I went to the doctor today to discuss the CT scan results.  I really felt that she didn't provide any real answers or insight.  The CT scan does suggest a teratoma/dermoid.  However, the CT scan seems to have picked up on a complex cystic structure in the right adnexal area measuring 3 cm in the uterus.  Nothing at all was picked up on either ultrasound.  Also, when I met with the doctor, she never even mentioned the complex cystic structure in the uterus.  I noticed this after reading the report when I got home.  Also, the report states that there are small retroperitoneal lymph nodes.  I asked the doctor what those meant, and she said she really didn't know.  I asked her if she thought I should get the dermoid removed.  She couldn't give me a straight answer.  I know I should get it removed though.  So I asked her if she could recommend anyone.  She had no answers.  I don't even know where to start to look for someone to do this.  Should I have a gynecologic oncologist do this surgery (even though all signs are pointing to this being benign)?

Here are the results of the CT scan verbatim:

FINDINGS:  Inferior heart and pericardium unremarkable.  Gallbladder is present.  Precontrast imaging demonstrates no abnormal soft tissue calcification.  There is a 4 mm bone island in the anterior aspect of the left iliac medial iliac bone slice 63.

There are small retroperitoneal lymph nodes.

There is a lesion that measures fat density averaging -142 in the left adnexal region, measures 3.2x3.43x4.73 cm and is of low attenuation measuring fat centrally.  There is minimal wall irregularity and there is minimal debris within the structure.  This may represent teratoma/dermoid.

Uterus is deviated to the right of the midline.  There is a complex cystic structure in the right adnexal area measuring 3 cm.  There is a prominent central canal.  There is no evidence of free fluid.

IMPRESSION:  Approximately 3.2x3.43x4.7 cm fatty mass with debris in the left adnexal region.

There is no definite associated lymphadenopathy or free pelvic fluid.

There is prominence of the central canal and a complex cystic structure in the contralateral right adnexal region probably physiologic ovary.

Recommend:  Clinical GYN correlation, ultrasound pelvis, consider MRI pre and post intravenous gadolinium.

END REPORT

Thanks for reading all of this if you've made it this far.  If anyone can offer any insight, it would be greatly appreciated.

Thanks! .

[aussiepixie]

That's great news.    I'm glad you followed it through.    P

[StaceyCee]

Thank you for your reply! As a matter of fact, I did find a new Ob/Gyn who did another ultrasound. I was then referred to a Gynecologic Oncologist. I had the Da Vinci robotic surgery a month ago exactly. My left ovary was removed as it contained a large dermoid. Fortunately, I recovered very well.

[aussiepixie]

I am only a lay person but.........   I hope by now you've followed up the recommendations of both the Dr and the radiologist who originally reported your scan.   Preferably with a new Ob/Gyn.    best wishes.

[StaceyCee]

Thank you for your reply. The report states that the lymph nodes are small though. It also states that there is no definite associated lymphadenopathy. If the lymph nodes are small, is that a good thing since there's no mention of enlargement? Also, since there is no definite associated lymphadenopathy, isn't this also a good thing? If you can answer these questions, this will be a big help. Thank you.

[Dr. Kokil Mathur]

Hi!
Like in case of any other lymph nodes, multiple swollen retroperitoneal lymph nodes should be viewed with suspicion. They could be due to tuberculosis or sarcoidosis. They could also be due to malignancy. Further tests like MRI should be done. Most of complex cystic lesions are benign and result from fibrous and cystic tissue mixing together. However, since you have a family history of ovarian cancer and presence of retroperitoneal lymphadenopathy, you must get this further investigated even if the CA 125 is normal. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.