Avatar universal

diagnosed with dermoid, but laproscopy surgery found nothing?

A few weeks back I went to Dr. For severe pain in my left lower quadrant. after an ultrasound tech completed an ultrasound I was taken back to my dr who reviewed the multiple ultrasound images, and confirmed I had two large ovarian cysts on my left ovary. One was a follicular cyst, which she was not concerned with operating on at this time, because follicular cysts can come and go, However the dermoid cyst measuring 103 cm3, would need to be removed. I was scheduled two weeks later to have it removed. Ca125 was the only follow up test completed after US, which came back normal. I went to preop a few days prior to procedure, however she was unable to review images with me at this time because the computer system was down. She discussed how she would try to save my ovary but that she may have to take it with cyst.

Before surgery I met with her again and she reviewed the procedures and risks. I came out of the surgery to be told by the nurse and my parents that the doctor said that they couldn't find any cysts, and she appeared baffled. The doctor stated that there were some spots that appeared to be Endometriosis but nothing else. She did not stay to talk to me, and my father was left to explain it to me instead. My op nurse told me to call and schedule follow up in two weeks. I was not happy that she did not stay to talk to me, so I called her office and then she called me back. She explained the same thing that she told my parents, and seemed confused about the ultrasound saying she had another dr at the practice look at images to and confirmed her diagnosis of a dermoid that day.

Does this happen often? Doesn't the doctor usually stay to talk to you after surgery. Is there something that often appears to be a dermoid on the ultrasound, but it is in fact something else? Should my doctor have ordered an MRI, CT scan, more ultrasounds prior to operating? If she saw spots of endometriosis during the laparoscopic procedures should she have removed lesion then? Is this a malpractice situation?

ANOTHER odd thing to note:
when she came out to speak to my parents she had my menstrual cup "soft cup" in during the procedure (due to the spotting I was having I had completely forgot to take this out prior to surgery)  and she found it during surgery.
She was perplexed as to what it was.... she came out showed my parents, explained I had it in my vagina and didn't know what it was and asked them if they knew! She then said, "my assistant surgeon thought it might be a menstrual cup (but acted like she didn't know what it was). The dr goes on to say... "I don't know if maybe she had this in during the ultra sound and that's what was causing the images???"

- first off, she did a pelvic exam on me right before my ultrasound was preformed.... I didn't have it in then and I know I didn't because (sorry for the tmi) I distinctly remembering I hid my pad from the underwear I had just taken off for the exam so I know I wasn't wearing one then.

-second-Why doesn't my gyno know what the most common menstural cup looks like or what it is-it is literally the only type that is sold at walmart. also, I think the menstral cup would look much different then a suspected dermoid cyst.

-third-What was she doing in my vagina? I wouldn't normally ask this, but I ask because I had asked at my pre op if there was any way she could take out my IUD while she was in there and I was under (I had a lot of pain getting it put in and I am afraid of the pain to get it taken out) She told me that she could not do it at the same time because its general surgical protocol if their is one entry point during surgery to ensure no cross contamination to decrease chance of infection.

I'm nervous about many things.
1.That there is something in there and she missed it, or maybe it is in the uterus or somewhere she couldn't see.
2. they have to perform the surgery again.

and  I am angry because I want my vacation time and money back!
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Avatar universal
This all sounds very odd...the fact that the cyst was gone and she was confused about the menstrual cup (are you sure she's an ob/gyn?!).

My best guess is that the cyst was not a dermoid and it went away on its own. Most cysts do go away on their own in 2 to 3 cycles but dermoids do not. Complex ones tend not to go away but they can. As you mentioned, simple / follicular cysts (if they hang around longer than normal) almost always  resolve on their own. Cysts that aren't too large (under 7cm or so...yours was under 5cm) that may go away on their own are best monitored versus jumping to surgery since surgery has risks. Of course, if the cyst is the type that will not go away or it looks suspicious, then surgery would be required.  

The type of cyst is not always clear on imaging whether it be u/s, CT, or MRI). I thought CT gave a better visual but then read that u/s is usually better for viewing ovarian cysts. I don't know about MRI's for viewing cysts. Keep in mind that you do not want CT scans unnecessarily since they emit a bit of radiation.

Your surgery took place shortly after the cysts were discovered so it would not seem that another ultrasound would have been needed. However, maybe some cysts shrink quickly. There was a woman who posted awhile back on this forum who was all ready to go into surgery and insisted on another u/s. Her doctor did not want to do one but she said she would not go into surgery without another u/s. And lo and behold, her cyst was gone.

Since the cyst was gone, you may have been saved your ovary. Far too many women lose an ovary or ovaries when all that needs to be removed is a cyst(s). Our ovaries are essential our whole lives for the hormones they continue to produce long after menopause. Removal of even one ovary can impair fertility and even cause the other ovary to completely shut down (although I suspect this is fairly unusual). This explains ovarian cysts - http://ovaryresearch.com/ovarian_cysts.htm.

As far as the endometriosis, most doctors are not skilled at removing endo lesions. You would want to have an endometriosis excision specialist do that if you are having symptoms that warrant removal.

Regarding removal of your IUD at the same time - I do not understand why that could not have been done. Maybe she just wanted to be able to charge for another procedure? It certainly sounds like it is time for a new doctor.

You can request a copy of your medical records from the doctor and hospital. This should include the ultrasound report. Filing a complaint with the hospital and your state's medical board may be worth looking into. Sometimes, bills are written off / forgiven if one receives poor medical care and "pushes the envelope."
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Avatar universal
yes i am absolutely positive she is an obgyn. Giving her the benefit of the doubt about the menstrual cup, is maybe she had never seen that type??? Trust me I will be asking her next week at my follow up. and I will probably be demanding she performs another ultra sound-with her in the room this time (I will be going to the second opinion the following week anyways to make sure whatever she says is true.) I still don't understand as I have seen the images- very clearly a simple cyst, but there does appear to be a large mass to the side of that. I also have RESEARCHED this to the death and looked at many other US of dermoids and it does look like that is what it is. My thing is, where did it go?

I agree on being happy two still have two ovaries, and didn't have anything unnecessarily removed. I really expressed my desire to keep both ovaries, although she wasn't sure she could, she asked for another obgyn to be in with her (she told me that this doctor had a slightly different technique to separating the ovary from the cyst and has more success than herself- which I appreciated her honesty about her ability to do that.)

as to the money- luckily I have good insurance and I only had to pay about 300 for the procedure (day of surgery). I would think it would be incredibly difficult to get that reimbursed, especially since it was completed by an outside dr. at their facility.

If the next doctor looks at my images and says that she shouldn't have operated or should have known better, I will probably proceed with malpractice claim. Maybe that doctor will tell me she made an honest mistake that could have happened to any treating ob. I would actually feel better about that. I like this dr on a personal level. still unsure to why she left without speaking to me first though-I don't feel like this was planned- I had asked her to take pictures of the cyst because I am a weirdo and wanted to see it, and she had discussed showing them to me after surgery . ... my thought is that she left because she thought I was going to be annoyed or mad, ask a lot of questions that she felt she may need more  time to prepare for.  

Thank you so much for your thorough and thoughtful response. I have my ultra sound images and documents and I do have a second opinion scheduled and requested for my records to be sent over today.

I am having lower left pain again- not terrible but I do feel like something is still there.

I am looking forward to having more definitive answers.

also, good for that woman who begged for another US. I wish I had done the same thing myself. looking back now, I really think that when I went in that day and was in excruciating pain, that the follicular cyst was rupturing. on my ultra sound I had some small free fluid next to that ovary. She didn't mention that- and I only saw it on my ultrasound after the fact. I asked her at my pre op if that could have been what the free fluid was from- she said that was unlikely and that most people have different amount of free fluid depending where they are in their cycle.

another thing to mention is that I went to the office a month prior to this experience for pelvic pain, spotting after sex (never have I bled in between cycles). I didn't get to see my doctor on this day but saw a midwife who performed a pelvic exam and found nothing. I also track my pain and period in an app, and I can create common tags. I was having lower left quad pain on and off, so much so, that I made a tag for it. I looked back when it started and it was back in april.
I have my images from my us and it reads
"dermoid" mass is L-7.32cm H-4.26 cm, W-6.23 cm

as to the Follicular cyst:
left OV cyst L- 4.81, H-4.21, W- 4.8, VOL-

left ovary: l 6.10cm, H-4.45, W-5.98, VOL-84.90 cm3

thank you again!
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