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Complex solid heterogeneous mass ovary

Hello. I was having post menopausal bleeding and a TV sonogram showed complex solid heterogeneous mass on left ovary. A follow up MRI showed same thing. The impression was “solid left ovarian mass. Hetererogeneous enhancement noted. Malignant and benign neoplasm should be considered”. I am scared out of my mind! My Gyn wants to take ovary out. Should I have total hyst, or just ovary. Second opinion? Anyone else had findings similar to this and it turned out benign? Im 54 went through early menopause. Help!
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Avatar universal
Hi - first of all, I'm so sorry you're going through this!!  I know how scary this all is!  I had a tennis ball sized cyst along with my left ovary and tube removed 7 weeks ago.  I had all sorts of blood work done beforehand, which all came back negative (so that was great) but my doctor still said it "could" be malignant (but probably not).  I think the doctors always consider that a cyst could be malignant, it would be non-professional not to consider that.  So the wording that "malignant and benign neoplasm should be considered" isn't anything I would worry about - I think they always say that.  I wouldn't have a total hyst unless you really need one.  My doctor was so useless in giving advice that I ignorantly told her to go ahead and take out both ovaries (I'm 53 and post-menopausal) while she was in there just so I didn't have to worry about getting another cyst (and scare). That's your first impulse - to take it all out just so you never have to have a scare like this again!  So my gyno  said, "sure- okay! We'll take out both ovaries".  Well, I called my primary care doctor (who is great and specializes in women's concerns) and she said NO!  Keep as much as you can - keep that other ovary!  From everything I read, that is spot-on advice.  The ovaries still produce vital hormones even after menopause.  So I kept my right ovary.  Funny, when I called my gyno to tell her my primary doc said I should keep my right ovary she said - "YES!  That's great advice - we'll leave it in!"   WHAT?!  Why didn't she just tell me that in the first place?  Anyway, to the surgery -- since they weren't sure that my cyst  wasn't cancer, they had a cancer surgeon on-hand during my laproscopic surgery.  They did the lab work on the cyst while I was still under and determined my cyst was benign.  But if it had been cancer, the cancer surgeon would have stepped in and would have done a complete hyst - that's what they do when it's cancer. (that's what my doc said, anyway).  Oh, I should say my cyst was complex - I had blood flow through it so that's why it was more worrisome even though my bloodwork all came back good.  I'm not sure what name she called my cyst (she did have a long name to it) but I know it was tennis-ball sized and complex (with blood flow through it).  And mine, thankfully, was benign.  But I know how you  feel - it's so incredibly scary to go through this and nobody really know how scary unless they've also been through it.  That's why these forums are so great!  Hang in there and don't assume the worst (I did - and I put myself and poor husband through 2 weeks of crying and misery for nothing).  Keep positive! (though I know how very very hard that is...)  Hopefully that helps you?
See my comment below to “old before my time”. It was meant for both of you
Avatar universal
I'm sorry you're going through this! Our minds do tend to think worst case scenario. But the odds are very much in your favor since the large majority of ovarian cysts are benign. And most actually resolve on their own within a few months. Post-menopausal cysts are more common than many doctors realize and are almost always benign. If they do need surgical removal, surgeons with good cystectomy skills can usually remove just the cyst and leave the ovary or enough of it to continue producing hormones. This is a good resource - http://ovaryresearch.com/ovarian_cysts.htm.

Hemorrhagic (blood filled) cysts appear solid on imaging so can be confused with cysts that can be malignant. Hemorrhagic cysts resolve on their own. I wonder if yours could be hemorrhagic. I'm curious too how large it is.

Removal of ovary(ies) and/or the uterus is rarely necessary but commonly done. Only about 10% are done for a cancer diagnosis. And gynecologists are not upfront (and oftentimes deceptive) about the many after effects.

Numerous medical studies have shown that women's "reproductive" organs are essential their whole lives. Removal of even one ovary is associated with increased health problems, specifically cognitive impairment, dementia and Parkinsonism. Removal of both ovaries, even after menopause, increases risk for many chronic health problems. This site is a great resource and links to a long list of medical studies - http://www.overy.org/.

Hysterectomy has its own set of permanent and progressive adverse effects. The uterus anchors and separates the bladder and bowel so many women experience problems such as incontinence and incomplete emptying after hysterectomy especially in the long-term. Ovaries typically don't function properly once the uterus is removed. The entire uterus (including the cervix) is key to sexual function as well as breast sensation. And last but not least, hysterectomy destroys pelvic integrity since the uterine ligaments are the pelvis' support structures. That's why women's figures change after hysterectomy. The spine compresses and the hips widen causing a shortened and thickened midsection and loss of the curve in the lower back (since the rib cage now sits on the hip bones). These skeletal changes are a recipe for chronic back, hip and leg problems.

My organs were needlessly removed 12 years ago at the age of 49. I never could have imagined the nightmare that ensued. I aged incredibly fast for one. The biggest mistake I made was trusting my gynecologist of 20 years and not listening to the barely audible voice in my head that something just didn't seem right. I was also told that if the cyst / tumor was malignant that there would be an oncologist standing by to assist. I'm not sure I believe that would have been the case. I was also told I needed surgery quickly and although my gyn wanted me to see an oncologist, there wouldn't be time. Looking back, I think this was another scare tactic.

I hope this helps! Let us know what more you find out.
Thank you both so much for your replies! Im a bit reassured, and yes, I have been crying off and on for days, have myself dead and buried already. They never called this a cyst though, in either the US or MRI. They are calling it a “neoplasm” which is a scary word for me. The size is 4.2 x 3.5 x 4.5. My GYN said she would rather have seen the word “homogeneous” than “heterogeneous”. The only symptoms Ihave is post menopause bleeding and bloated abdoman. Is this bad? She did an endometrial biopsy that eas negative and neg pap smear also. My CA 125 was 18, so that was normal but she said that wasnt a definitive test. Any more thoughts? Thank you so much
Oh sweetie - I know how you’re feeling - it’s so damn scary!!!! Actually my Gynocologist called my cyst a neoplasm as well! I don’t recall her saying it was either homogenous or heterogenous - she just never said. I had a d&c done at the same time as my laparoscopy because my uterine lining was very thick (she said probably because of the cyst). I had a polyp in my uterus as well which she removed. My polyp didn’t cause any bleeding, but my best friend had bleeding after menopause and her bleeding was from a polyp (which was benign) so that’s always a possibility for the bleeding. I didn’t have a bloated abdomen so not sure on that symptom... I actually didn’t even have pain from my huge cyst though.  Oh and the radiologist at my intravaginal ultrasound also called mine a “mass” not a cyst so I’m not sure they always call a cyst a cyst, if that makes sense? I wish I could give you a hug cuz I know how scared you are!!! I also had myself dead and buried so I know how you feel!
I know how you feel! The fear can overwhelm us. But it can also make for misguided decisions. Neoplasm is a scary word but it just means abnormal tissue / growth (benign or malignant). Ditto for tumor.

Ovarian cysts can cause hormonal changes which can cause irregular bleeding, postmenopausal or not. And it is not all that unusual to have bleeding in the early post-meno years since the ovaries can have hormonal spikes since they never completely shut down. I would not think this is a concern since your biopsy was negative. Your cyst / mass is still on the small side. But some bloating is normal. Mine was 9.5cm and made me gain about 3 lbs.

I hope this eases your mind a bit.
Avatar universal
Thank you all so much I am so glad I found this forum! You are all making ne feel so much better that maybe this isnt what Im thinking (the worst). I will keep you all posted. Thank you!
Hey there!  Yes, please do keep us posted and hang in there!  Wishing the very best for you!!!  :o)  (and hugs)
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