Avatar universal

Dermoid cyst removal better?

I just had a ultrasound and mri of the pelvis. The results are as follows

Ultrasound 2/6/18:
the uterus is normal in size 8.5 cm(longitudinal) X 4.7 cm (anterior - posterior) X 5.2 cm (tranverse). Heterogeneous 1 echogenicity is noted. The endometrial stripe measures 11 mm in thickness. Multiple small uterine fibroids are noted throughout the uterus. Largest fibroid is noted measuring 2.7cm x 2.7 cm.
The right ovary is surgically absent (it was removed in 1993 due to a dermoid cysts)
In the left adnexae a septated cystic mass is noted and measures 5.1 cm (longitudinal) X 4.0 cm (anterior- posterior) X 5.1 cm (transverse).
The left ovary is surgically absent

There is no free fluid noted in cul-de-sac

MRI 3/12/2016

the uterus is enlarged and lobular in morphology. It measures 8x5x5 cm. The uterus is anteverted. The fundus and body of the uterus are tilted to the right. There is a 2.5x2.5 cm and a 1.6x1.5 cm submucosal fibroids in the posterior body of the uterus. These exert mass effect on the endometrial cavity. There is a 0.7 cm fibroid along the lower anterior body of the uterus, intramural/submucosal in location. No other focal uterine lesions visulaized.

There is a small amount of fluid in the endometrial cavity, an endocervical canal, which is most probably physiological in nature. At the level of the lower uterine segment/upper cervix, there are a few subcentimeter polypoid lesions measuring up to 8mm, suspicious for endometrial/endocervical polyps. There are a few small subcentimeter cervical nabothiam cysts.

There is A 3.6x2.6 cm high T2, low T1 signal intensity left adnexal lesion, which is presumably of left ovarian origin, containing a few thin internal septae and no obvious internal nodularity. The right ovary is not visualized. However, no right-sided adnexal lesions are seen.

There is no ascites or loculated fluid collections. No discrete lymphadenopathy is seen.

The urinary bladder is only minimally distended which limits evaluation. No gross abnormalities are seen. No ovvious abnormalities are noted in the vagina or urethra.

The included segments of colon and small intestines are not dilated.
No suspicious osseous lesions are seen.

1. A 3.6x2.6 cm septated multiocular left ovarian cysts, with no evidence of abnormal enhancing soft tissue components, highly in favor of a benign lesion. The right ovary is not visulazied. However there are no right-sided adnexal lesions.

2. A 2.5x1.6 cm submucosal uterine fibroids.

3. Suspect a few suncentimeter endometrial/endocervical polyps

4. No pelvic lymphadenopathy or ascites.

5. Otherwise unremarkable MRI of the perlcis with contrast

My doctor is stating that since the cyst on my ovaries shrank in the momth between the ultrasound and the mri and because of my hystory of dermoid cysts (had surgery in 1993 and 1997 to remove dermoid cysts) it is mostly likely a dermoid and no action is necessary as they are rarely cancerous. He states that if i want him to try and remove, he will do so, but there is a risk of total removal of the ovary which would put me in menopause. I am deeply conflicted with this as i am only 46 years old (dont plan to have any children)and doctor says my bloodwork indicates i am nowhere near menopause. I am very worried about surgical menopause and hrt or et therapy. Sadly he didn't give me any directions, just basically said it was up to me whether i wanted him to try and removemthe cysts. But i am also very nervous to just leave the the cyst inside due to the risk of torsion or possibly even cancer.
Dr also states he needs to burn the inside of my uterus, do a dnc and remove the polyps.
What do u think of this recommended treatment?
1 Responses
Avatar universal
Based on my experience and everything I've learned since being over-treated for a benign ovarian cyst, I'd say just monitor this cyst for now via periodic ultrasounds. Most cysts are benign and resolve on their own although it's my understanding that dermoids do not. But yours doesn't sound like a dermoid cyst as that is one type that I believe they can usually see pretty clearly on u/s (due to the components e.g. hair, teeth). Ovarian cancer is extremely rare. If this cyst does grow and needs to be surgically removed, I'd search for a surgeon with good cystectomy (cyst removal) skills. I've read that doctors who do many cystectomies can almost always save the ovary or enough of it for normal hormone production. Trust me - you do not want to be without ovaries!

I don't understand why your doctor is recommending any treatment for your uterus. Eliminating the lining via burning or other procedure (general term ablation?) can cause problems in the long-term including an increased risk of hysterectomy due to post ablation syndrome which causes chronic pelvic pain. Fibroids are benign and typically do not need any intervention. Polyps are benign too and generally don't need to be treated unless they're causing heavy or irregular bleeding which typically only occurs if they are irritated by intercourse or are not removed properly (at the base). If they are problematic, a polypectomy would be the way to go.

My long-time gynecologist removed my uterus, ovaries and tubes for a benign ovarian cyst. "Surgical menopause" is a misnomer as it is nothing like natural menopause. The ovaries do not shut down at menopause. They produce hormones a woman's whole life especially testosterone that can be converted into estrogen as needed. Since the ovaries are part of the endocrine system, women without ovaries have a "short circuited" endocrine system that is unfixable and puts them at risk for many increased health problems such as heart disease (#1 killer of women), stroke, osteoporosis, hip fracture, lung cancer, colorectal cancer, impaired memory and cognition, dementia, parkinsonism, mood disorders, sexual dysfunction. One study showed that ovary removal does more harm than good in women as old as 75.

It's been 12 years since my surgery and I've connected with so many women who had parts unnecessarily removed and are now suffering the many after effects. 90+% of hysterectomies and oophorectomies are unnecessary. We even need our uterus for its anatomical and sexual functions. But it also has some endocrine functions aside from the ovaries as its removal is associated with a 3x increased risk of heart disease which appears to be due to a uterine substance as well as the uterus' connection with the ovaries.

I wish you the best in getting proper treatment.
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