complex mass cannot r/o neoplasm

[medsec76]

I recently went to the hospital for acute pain in the right lower quadrant where they found a lesion. I am 34 years old, and I had a hysterectomy 3 years ago, but still have my ovaries. I had the hysterectomy due to HGSIL and they said it was a level 0 cancer where the cells were on my cervix, but had not invaded. I also had extensive endometreosis. I have had pain for the past 2 years especially with intercourse or extreme activity. Over the past year I had cramping, almost like a period on a daily basis, i stay very tired and it hurts in my ovary area when i use the bathroom. I will have intermittant sharp pains alot and I have to stop till it passes. They did a ct and a transvaginal ultrasound. The findings were as follows: ct- a 3 x 3 cm soft tissue density in the right adnexa which shows a 2mm thick enhancing capsule with a low attenuation center. the impression was as follows a 3cm lesion in the anterior hemipelvis which incorporates a soft tissue margin within which there is a 2mm thick enhancing capsule. Inside the capsule is a region of fluid attenuation. It could relate to atypical ovarian cyst or mass. Then they did a US as a followup which stated:that the right ovary could not be seen. There is a moderate amount of fluid in the cul de sac and a complex appearing lesion measuring 3 x 3 cm of the right adnexa. The impression says complex semisolid, semi cystic mass of the right adnexa possiably a abcess or hemorrhagic right ovarian cyst in association with moderate amount of fluid in the cul de sac. Unable to definitely rule out neoplasm. My questions are what does the enhancing capsule with a low attenuation center mean.? Is this a cyst or a mass? Is it on my ovary or inside the ovary or just in the region where my ovaries are? If it is just a hemmoragic cyst then why are they saying cannot rule out neoplasm? Last question will they have to do surgery or can they treat this with medicine? Hope someone can help me, my appt with the specialist is May 11,, but I'm gonna drive myself crazy till then. Thanks to all advice in advance.

[LibraOne]

A related discussion, Ovarian Cancer was started.

[kcd86]

Hi, I am an RN and my wife was recently Dx with granulosa Cell cancer( GCT) Jan 2010. 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). Based on your TV-sonogram report, and symptoms unfortunately with any type of suspected ovarian mass surgery will be the only way for the Dr's too make a definitive Dx. It is NOT recommended to biopsy any ovarian mass as it will rupture and seed the pelvis with cancer cells if that what it turns out to be.  Please make sure they drew your blood for the following blood tests,Inhibin A&B, CA125 and CEA so at the very least you have baseline blood work.
Since there is some suspicion based on your TV-sonogram I would immediately find a good GYN/Oncologist surgeon. 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.
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. Post with any other questions you have this site has some very knowledgeable people on it. I wish you all the best
Kevin