16.0cm cystic Mass right adnexa highly suspicious for cystic ovarian neoplasm

[Kathy W]

Dear Members,

Please help me determine if this is ovarian cancer or not:

Pelvic and Transabodominal ultrasound:

Impression:
16.0cm cystic Mass right adnexa highly suspicious for cystic ovarian neoplasm  

Cancer Antigen 125 = 26

Findings:
There is a large complex predominately cystic mass in the right adnexa, likely ovarian in origin and measuring 16.0 x 10.6 x 10.0 cm.  There are septations and several small cystic areas within the larger cystic components of the mass.  Doppler evaluation shows low resistance vascular flow in the periphery of the mass.  Left ovary is normal in size and appearance.  Uterus is normal and endometrium is normal.

I am having problems with my insurance here in Minnesota, land of HMO's.  Having health insurance, sure does not mean having access to healthcare.  There is ONE Guy Knock in my health care system at which, I am an RN.  He does not like our hospitals.  I cannot see him until October 4th, and then how long before surgery?  A regular OB/GYN (infertility specialist) can do my surgery on Sept 21.  I am seeing an out of network guy on this Friday at 7:30 AM.  If he does the surgery, I'd have to pay 50% of the cost.  I can try to appeal Select Care Wausau Benefits plan, but then it might take 4-6 weeks anyway, and Dr. Savage would be available by then.  

Is this benign or cancer?  I am an RN, for crying out loud and I cannot figure it out.  And, all the regular OB/GYN would say is, "I won't know until I get in there."  Nobody will be honest with me.  Some say, "WAIT FOR A GUY KNOCK".  
HELP:  In St. Paul, MN  Kathy RN

[Quer]

Hi there!

     I read all your messages,im 26yrs. old and 4mos. and 2weeks pregnant.Last Oct. 5,2005 I went to see a sonologist and my result says that, i have a cystic mass measuring 7.4x 7.0cm. that was seen at my right adnexa.This is my 3rd ultrasound,I had a transvaginal ultrasound twice before I had my previous ultrasound now. What was seen before was I had a sabchronic bleeding when i was 2mos. pregnant, but now its gone.But the problem is,there is a cystic mass shown in my latest ultrasound last Oct.5.This problem wasn't shown before.

     I haven't seen my obgyne up to now, though my sonologist said that i need to see her. Im scared and wanted to know from you guys if there's anything that you can share to on what to do? My sonologist said that it can be a physiological cyst. I would appreciate your help, thank you and GOD BLESS!


PHILS,
Quer

[Kathy W]

I saw the Guy Knock.  He said that it was less than 20% chance that was malignant.  He sent me for a CT scan that day.  My insurance approved "out of network coverage", at "in network" rates.  I am scheduled a week from today with my Guy Knock.  

However, my CT scan report scares the poop out of me.  Consider this report in relationship to the Ultrasound.  

Technique:  Oral contrast material and 140 cc Omnipaque IV.  

Lung Bases:  Normal

Abdomen:  Status Post cholecytectomy.  No biliary dialation.  The liver, pancreas, both adrenal glands and both kidneys are normal.  0.8 cm ehnancing lesion in the medial aspect of the spleen on image 13.  No lymphadenopathy.  There are several tiny soft tissue nodules, 0.7 cm and less in diameter, in the lateral right perinephric fat on images 22 to 25.

Pelvis:  12.5 x 10.0 cm complex cystic mass arises fromt he right ovary and compresses the left superior aspect of the bladder.  I am not certain if the bladder wall is involved.  Normal left ovary and uterus.  No free fluid or lymphadenopathy.  

Impression:
1.  12.5 cm complex cystic mass in the right ovary suspicious for cystic neoplasm.  There is a mass-effect, and possibly involvement, on the left superior aspect of the urinary bladder.

2.  Small subcentimeter soft tissue nodules in the right lateral perinephric fat are indeterminate.  Metastases cannot be excluded.

3.  Indeterminate 0.8 cm enhancing lesion in the spleen.  

What does all this mean?

Can perinephric fat nodules be normal?

Can ehancing lesions in the spleen be normal?  

What could be other causes of these?
Thanks
Kathy

[MickeyVicki]

So, did you get in to see 'Guy'?  Are you going in for surgery tomorrow with your regular doc?  Did you get any other answers to  your questions?   Let us know who, how, when, and what!

Best Wishes!

[MickeyVicki]

Yes, in the few weeks leading up to my surgery, I was dismayed at the lack of reliable information on ovarian mass statistics.  Basically, the only way to determine if the mass, be it a solid tumor or a simple cyst, is malignant is to GO IN AND SEE.  Geez, it is 2005, and this is the best that we can do for women in such situations??!!

Actually, complex means that it has septations, and not all complex cysts contain solid components.   Having septations does somewhat increase the chance of malignancy; however, the chance of malignancy in a septated cyst is more closely related to the size (thickness) of the septation walls.  The thicker the walls, the greater the chance of cancer.    Of course, generally speaking, an ovarian cyst of any kind supposedly has only a 1 to 2 percent chance of being malignant, with a 3 to 4 percent chance for women who are menopausal or who have taken some forms of fertility drugs.

My scary cyst at the initial transvaginal ultrasound was some 6 cm by 5 cm.  By the time it was removed several weeks later, it was close to 15 cm.    It was a benign endometrioma.

[Kathy W]

Thanks for the replies so far.  It is helpful to know.  Even as a nurse, I looked at the words highly suspcious for ovarian neoplasm and I thought that neoplasm was synomous with malignancy.  I later realized that is not always the case.  

I think it might be worse for the following reasons:
1.  Low resistance blood flow
2.  Blood flow to the periphery of the mass
3.  Complex means both solid (worse) and fluid
4.  Septations are bad

Good things are:
1.  26 serum CA 125 level
2.  I am premenopausal
3.  I am 36 years old (younger)
4.  It is predominately cystic or fluid filled
5.  It is in one ovary
6.  NO ASCITES (free fluid in the abdomen)

What I cannot figure out is what all these statistics mean for me, as far as statistical chances that this thing is malignant.  

I read conflicting information on size of the mass.  Some articles say greater than 10.0 cm mass is more malignant than benign.  Other articles say that size does not matter, while still others say that the larger they are the less likely they are to be malignant (cancer).  

I cannot believe that in this day and age, that we do not have some statistical information that would lead a person to believe one way or another.  It is amazing.  

Kathy

[Kathy W]

GYNECOLOGY

CASE 13 COMPLEX ADNEXAL MASS

A "complex adnexal mass" refers to an adnexal mass containing tissues of various echogenicity, some of which may be somewhat cystic and others solid. The differential diagnosis includes ovarian tumor, abscess, ectopic pregnancy, endometrioma, or complicated cyst (with hemorrhage or infection).

[MickeyVicki]

OK, I can relate and for what it is worth, here are my thoughts on the matter.  (I had  a super-deluxe cyst removed last year.    Mine was on the left ovary, however, and contained scary solid components.)

I would see 'Dr. Noc' and ask if there is anything that the office can do to word paperwork in a way that might speed the process or get an emergency appeal going now.  My doctor did more or less the same for me last year.  I have insurance with the "Tightwad and Spendless" Company!

However, if 'Guy'  is concerned about cancer and believes the mass should be removed ASAP, then I would have a specialist perform the surgery even if I had to pay for 50% of it myself!  After all, what is money when one compares it to one's health?!

[jenny2]

This is totally your call, but I did have my regular OBGYN do the surgery to remove my right ovary.  She had the pathologist do a frozen section while I was in the operating room and if it was malignant, the hospital had a Oncologist on call who would come in and do the rest (take lymph nodes, ect for staging).  I also signed consent for a total hysterectommy at that time b/c I did not want to wake up and be told i needed another surgery.  So my advise would be to talk to your OBGYN and see what the procedure is and if they can test in the OR, ect.
For me, I did not want to wait any longer than I had to but many will say to definitely see the gyn onc to do the surgery, ect SO basically I think it is just a call for whatever you are comfortable doing.\
Good luck with your decision,
Jen

PS. Mine turned out to be fine, so please try to remember that they do not know for sure until it is out!

[Kathy W]

I am 36 years old with two kids.  I have had pain, bloating, and crampiness in my pelvic within the past 2 - 3 months.  I have also complained in the past 6-8 months of interminttent brief umbilical pain, and superficial abdominal pain and said, "Geez, I feel like I must have a hernia!" to my family members.  

I found out that I had a mass on 9-8-2005.  I had that ultrasound on 9-9-2005.  I saw a regular OB/GYN on 9-12-2005.  

My options:

See the Guy Knock on Friday and get his opinion for sure

1.  Have the regular OB/GYN take it out on Wed Sept 21
2.  Wait until Oct 4 to see Savage and then wait even longer for surgery (1-2 more weeks).
3.  See if this Guy Knock on Friday can get me in ASAP and pay out of pocket 50%.
4.  Attempt an insurance appeal for coverage out of network and hope that works.  

I am already horribley anxiety stricken.  If i have to wait for 4 more weeks or longer to get this watermelon out of me I might start going nuts.  

Kathy and her big right huge ovarian tumor