New Dx. of Complex cystic lesion with thick septations w/focal echogenic area

[stace258]

I am very much wanting some sort of medical advice... I had an abnormal pelvic exam Thurs. (pain on Right side with palpation) during exam & was sent for pelvic & TV U/S.  The results show:
2.1 x 1.9 x 2.4cm complex cystic lesion IN right ovary with thick septations with a focal echogenic area.  No abnormal fluid around R ovary.  Ovary measuring 4 x 2.6 x 4cm.
Left ovary showed "multiple" follicular cysts.
We did not even think we were finished having children & this is very heart-wrenching, thinking I could be infertile.  
Also, to think this R ovary could possibly be cancerous?????  The impression stated that the differential diagnosis includes dermoid cyst, cystadenoma, or even cystadenocarcinoma.  Radiologist also recomm. laparoscopy.  
Sounds like I am going to lose my ovaries? or can they take a cyst from INSIDE the overy without damaging it?  Is this possibly life-threatening or in need of chemo?  Very worried.  We just moved & have no family here & 5 & 7 yr. olds to care for.
Anxiously awaiting some sort of info.
P.S.  Brand new OB for me as we just moved here 4 mos. ago & she never even called me back when I paged her yesterday afternoon.
Info?  Please...thank you

[Annekathryn Goodman, M.D.]

Hi Stace,

It sounds like you have a good new doctor. Her suggestions are sound.
An elevated DHEA-S can be associated with PCOS (polycystic ovarian syndrome). This is a very complicated syndrome. The ovarian issues are just part of a bigger metabolic picture. Women with PCOS are at high risk for diabetes and other issues like obesity and cardiovascular disease.

It is important to make sure that a women with PCOS has regular periods. Cycling with the pill or reducing the metabolic issues with metformin helps protect your uterus from overstimulation and the development of cancers or precancer issues.

I suspect that she feels you have a cyst of ovulation or from PCOS. It must be that your US is reassuring. I defer to her as she can directly look at those reports.

best wishes

[Annekathryn Goodman, M.D.]

Hi There,
thank you so much for your excellent information. To summarize,
you have a strong family history of breast cancer.
You have had changing symptoms for the past two years.
Your ultrasound shows a small but complex cyst

I would probably lean towards taking a look at your ovaries by laparoscopy. I would repeat the ultrasound before surgery to make sure it is still there.

You should also start breast cancer screening given the young age of your mother at diagnosis.

as far as me. I have a pretty intense day job. I try to catch up on this forum on weekends and occasional moments during the week.
best wsihes

[Liz181]

A related discussion, should I be worried was started.

[stace258]

That is crazy you just wrote!!!  I just got in here because I REALLY need to run something past you as I feel like you are my doctor  (minus the liabililty :)

I have just found out that my DHEA-S was infact ABNORMAL at 170 & my ovarian tumor/cyst? was potentially hemorrhagic in nature.  I have been told this morning I have PCOS (I knew already that I have just about every symptom).  She is concerned with my adrenal function but doesn't want me to get a renal U/S yet until the recheck on the DHEA-S comes back (rechecked today at lab).  I did tell her that my GRANDFATHER had Addison's disease & he was always fine when the VA Hosp. docs left him on Prednisone & felt horrible when he was off of it.  She thought that family hx. was interesting given this situation.  My mother is also in process of finding out if she has that.  I have a nutrition book about PCOS but want to know what my next step should be.

M.D. is discussing putting me on oral contraceptive for a few months to "calm the ovary down" & possibly Metformin for the adrenal function.  
She states the only reason she is following this cyst is because the anxiety it caused in me when I first saw her??????  I feel like it should be followed as it is still presenting with a focal echogenic area.
AM I MISSING ANYTHING HERE?  WHAT SHOULD I DO -
THANK YOU SO MUCH

[Annekathryn Goodman, M.D.]

Hi Stace
thank you for the follow up. Sounds awesome.
Good luck in your new home
take care

[stace258]

YOU ARE SOOOOO RIGHT!!!
I had a second opinion & repeat U/S & transvaginal U/S at a large Women's Hospital in Pittsburgh.  THAT RADIOLOGIST thinks it is benign, has shrunk & could even be a corpus luteum!  Could that be???  How could one person be sure of taking my R ovary OUT & another think (6 days later in my cycle) that it is nothing.  There was another place on the screen that the sonographer said may be just a darker mark on my ovary???  Anyway, I am awaiting my CA-125 results, aFP, LDH, free t4, TSH & blood glucose results.  I still have had these blessed symptoms for 2 years & they do wreak havoc on my days.  I pray for all of these women & pray that mine is a fluke.  Could that be?  Hard to believe after someone just said my R ovary HAS to come out.  My DHEAS, testosterone & hCG levels were WNL.  Thank you so much for taking your time to do this.  I just moved here 4 mos. ago & was desperate to talk to someone informative about this.  FYI:  I did get a mammogram when I was 30 & need another this year.  That one had showed extra breast tissue or thickening on the L - which I can attest to after nursing two children w/ huge lump under my L arm for months at a time with both.
stace258

[stace258]

I just found this site yesterday... I was wondering what are the times of day you are available to answer questions?

Thanks so much,
stace258

[stace258]

Thank you SO much for your response!  
I have definitely noticed that the next step can range from A - Z for sure!!!

I am 34 years old & have a 7 year old & a 5 1/2 year old - both were breast-fed for atleast 11months.
My mother was diagnosed with breast cancer around the age of 58 years old.  Fast growing type of Ca - treated with Adriamycin.  She in turn developed Congestive HEart Failure - stable at the time.
My paternal grandmother also had breast cancer but I do not know the age upon diagnosis.  Atleast 50's somewhere I think.
My medical history:
chronic sinusitis
environmental allergies
Headaches on & off x 18 years...stress headaches/sinus headaches
lower back is not strong at all
bladder incontinence slightly after my 5 y/o was born (she weighed 9# 4 1/2 oz.)  HOWEVER, my bladder problems have worsened over the past 2 years.  I am having incomplete emptying almost everytime I go to the bathroom.  I have to stand & bend over a few minutes later to finish emptying my bladder.  I do have some stress incontinence
Hemmorhoids started about 2 years ago & I did not even have them while pregnant or after birth.  They have subsided alot but the OB-Gyn said that what I have blocking/protruding when I go to the bathroom IS my rectum??? Rectocele.  
I have fullness in my lower abdomen a lot - an unusual full/solid feeling in the lower part of my abdomen - hard to explain.
20 - 25 pound weight gain in the past 5 months
Fatigue has worsened SO much over the past 2 years.

Endometrial thickness measured 8mm (WNL i believe)
menstrual cycle is regular but I was just telling this OB this week that my pre-menstrual fatigue, moodiness, EXTREME uncontrolled HA x 24 hours has worsened & extended out before my periods every month.  Very manageable bleeding.  Not as much sharp pain at all as when I was, say a teen.  However, the BLOATING is so bad that I am having to take off my wedding ring sometimes now for the whole week or two.  Cycle only lasts about 5 - 6 days.  I experience aching in my abdomen, full cramping(?) in entire lower 1/2 of abdomen like early stages of labor & complete aching of abd., back & upper legs.
I had ONE abnormal pap around 1990 & had cryosurgery in an OB office then.
This U/S & transvaginal U/S was done about 8 days after the FIRST day of my period.
I am completely unclear why some people say they have been found to have "complex" cysts & then were told to wait & even some have shrunk & other have actually had very rare form of fast-growing CA with total hysterectomy.  Very concerned & complex cyst showed "slightly thick septations with a focal echogenic area" - measured 2.1 x 1.9 x2.4cm
Sounds small to me (in comparison to others I have read) to already have septations with focal echogenic area...does that mean it is strongly suggestive of a faster growing Carcinoma possibly?
I will definitely be in touch with the MD's office tomorrow - it has just been awful though not know ing what to hink

Please respond to all of this if you could
I am so appreciative!
Stace258

[Annekathryn Goodman, M.D.]

Hi There,

How old are you and what other medical history do you have?
have you had surgery?
endometriosis?
what is the pattern of your menstrual cycles?
when was this US taken in relation to your period?
what are your symptoms?
any family history of cancer?

these are crucial questions to put a cyst seen on ultrasound in context.

I would recommend that you set up an appointment to discuss the ultrasound findings with your doctor. There are times when just repeating the ultrasound in a few months makes sense and there are times when looking with a laparoscopy is reasonable.

Most cysts are benign but a report like that can be nerve wracking.
best wishes