complex ovarian cyst

[1nanah]

I just received the results of my ultrasound.   Below are the results
INTERPRETATION: Transabdominal and transvaginal imaging of the pelvis was performed.  The uterus measured 9.7 x 3.9 x 5.8 cm. Several nabothian cysts are seen within the cervix, the largest measuring 12 mm.  A posterior uterine leiomyoma is present measuring 2.2 cm. A 2.3 cm posterior leiomyoma is present that abuts the endometrial stripe.  There is also a 2.0 cm anterior uterine leiomyoma. The endometrial stripe measured 11 mm.

No free fluid is seen within the cul-de-sac.  The right ovary measured 4.2 x 3.6 x 3.8 cm. The left ovary measured 2.1 x 1.5 x 1.5 cm. A 3.4 cm complex right ovarian cyst is present.  This has a somewhat thick wall and internal echoes.  This could represent a hemorrhagic cyst or endometrioma.  One cannot completely exclude cystic neoplasm.  It does not have any internal blood flow.  Continued follow-up is recommended.  

IMPRESSION:
1. 3.4 cm complex right ovarian cyst.  This could represent a hemorrhagic cyst or endometrioma.  One cannot exclude cystic neoplasm.  Continued follow-up is recommended with repeat examination in 4 to 6 weeks.  
2. Multiple uterine leiomyomas are present.

I am scheduled for a followup ultrasound but  still scared.  I continue to get the symptoms that prompted me to go to the gyn and concerned that maybe I should ask her to do more now?  

I am 44 years old. thank you for your help

[kcd86]

First I would get copies of all the sonograms as well as the CT scan and make sure they are all consistant with stating the correct side of the ovaries in question. If the ovary that was in question can't be visualized the question I would ask is it being occluded from being seen by something else? What about an MRI which is more precise!! I am a little concerened that now you are bing toldOH it's not on the right side now it's on the left. Again push for an MRI of abdomen and pelvis. Abdomen since you had some questionable "cysts" on your liver and splenic swelling

[1nanah]

Kevin,

I had a followup tv ultrasound today.  I dont know all the results of it yet.  Only that the complex cyst that was on my right ovary seems to be gone and one is now on my left ovary.  Pain is still with me.  Should I have a concern?  I just cant seem to be patient.

[kcd86]

The answer to your question is,sure it all could be related but I think at this time without any diagnostic tests having been done it would be pretty far reaching. At this stage it is very anxiety producung with all the potential what if's.
I have seen that TV sono show a complex cyst/mass and sometimes ct scan does not show it. Either way that complex cyst/mass has to be evaluated by a gyn/oncologist, hopefully he/she will have you do an MRI. Just as my other post says DO NOT HAVE A BIOPSY of the Cyst/mass it has to be removed INTACT and viewd by a pathologist for a definitive diagnoses. You need also at the same time an MRI of the abdomen to help define what exactly is going on with your liver and spleen. A complete blood work up to also help your physician see why you have a slightly enlarged spleen.
All the best
Kevin

[1nanah]

thank you for your assistance.   I dont go back in to see my gyn for a couple more weeks.  I have days where I feel perfect....and days when I feel ill.  Can you describe the symptoms that you had?

[1nanah]

Kevin,

I have a few more questions if you dont mind answering.  The results from the TV ultrasound that I posted were from my current GYN.  I had a different one that I left that did a CAT scan.  This scan found the  leiomyomas that are mentioned earlier, but did not find the complex cyst.   However, something that did concern me,   a cyst on my liver was noted as well as my spleen being slightly enlarged.

Something else,  when the TV was done, a mammogram was done as well.  This found a mass on the right side (same side as the ovarian cyst mentioned above)  Dr had me to a diagnostic mam which then led to a breast ultrasound..  Radiologist is 80% certain that the mass was dense tissue and cysts but I am going back in 6 months for another mammogram.  


Could all of this be related?  or just coincidence?

[Ichoosejoy]

I had a complex cyst that my gyn wanted to watch....he said it was probably benign.  I was not comfortable with watching it and wanted it removed.  Mine was similar in size to yours.  In the end, it ended up being cancerous.  You cannot be too careful when considering your own health.  Do not allow a biopsy, because that could rupture the contents, and *if* there is cancer, then it spreads.  

You should get a second opinion from a gyn/onc.

[1nanah]

once again, thank you for your help.   Searching the net can certainly put a scare in a person.  Your reply helps very much.

[kcd86]

They are basically saying is this a cyst or is it cancerous. An MRI will help define this suspicious cyst a little better. Unfortunately having it removed will be the only definitive way for a certain diagnoses.

[1nanah]

Thank you for your support.   I dont understand the terminology in the report.  What is cystic neoplasm?  should I be concerned about anything else in the report?   Thanks again to all for your wisdom.

[kcd86]

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!!  Since your transvaginal sonogram(TV) showed a complex cyst on your ovary warrants a very thourough work up to rule out any other potential issues.
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). A transvaginal ultrasound (TV) is the most valuable diagnostic study in the evaluation of an adnexal or pelvic mass/suspicious cysts.  Cysts, hemorrhagic cysts, endometriomas, and dermoids have a high predictive diagnosis via TV ultrasound.

An MRI is usually the next test that should be given as they are more precise when read by the right radiologist.
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 cuases of inflamation..
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.  Please make sure you have your blood drawn for the following blood tests,Inhibin A&B, CA125 and CEA so at the very least you have baseline blood work.
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Since there is some suspicion based on your TV-sonogram 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 to see a GYN/ONC surgeon Dr Carol Brown 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 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