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Ovarian Mass--What do these results mean?

I am 30 years old. I've been in alot of pain for awhile, the majority of that being while on my period. I've had urinary incontinence for years to the point that if I have to go I will wet myself and do so often. A couple of weeks ago after a wellness exam, the doctor discovered that I had abnormal cells on my cervix / HPV 18/45. She referred me to get a transvaginal and transabdominal ultrasound to check to see if I had a cyst or anything causing pressure on my bladder. The ultrasound discovered a solid mass on my right ovary. She immediately referred me to get an mri. After the MRI, I'm still waiting for someone to explain the results to me and meanwhile I'm in a lot of pain that over the counter painkillers just aren't helping. Is there anyone that could help interperet these results for me? Or that could at least give advice on what I could do? I'm taking the bar exam (attorney licensing exam) in a few weeks and the stress from being in pain / not knowing what's happening is alot. Thank you to anyone who can help!



EXAM: MRI PELVIS WITHOUT AND WITH CONTRAST

HISTORY: Mass in the right ovary.

TECHNIQUE: A multiplanar multiecho pelvic MRI examination was performed. Axial, coronal, and sagittal fast spin echo T2 weighted imaging with 4 mm slice thickness, fast spin echo small field-of-view T2 weighted imaging with 3 mm slice thickness and 1 mm skip obtained in long and short axis of the uterus, axial in and out of phase gradient echo T1, axial T1 and fat saturated spoiled gradient sequences are performed utilizing a 3T magnet. After intravenous administration of contrast material, postcontrast fat saturated spoiled gradient sequences are obtained in axial and sagittal plane. 16 mL of gadoterate meglumine contrast material from a 20 mL vial is intravenously administered. Diffusion weighted imaging with multiple values and ADC map imaging is also provided. Subtraction views are provided.

COMPARISON: None

FINDINGS: The uterus is anteverted. The uterus measures 7.3 x 4.0 x 4.3 cm. The endometrial stripe measures 0.6 cm. The endometrial cavity is grossly normal.

The junctional zone is normal.

There is no evidence for lymphadenopathy in the pelvis.

There is a 5.9 x 5.0 x 5.4 cm lobulated lesion in the right anterior pelvis abutting the right ovary and the uterus which is intermediate signal on T1-weighted sequence and dark signal on T2-weighted sequence. There is diffuse enhancement following administration of intravenous gadolinium.The right ovary appears to be displaced anteriorly with appearance of a claw sign related to the above-described lobulated lesion suggesting that this is a tumor arising from the right ovary. Considering dark signal on T2-weighted signal, this finding most likely represents ovarian fibroma or fibrothecoma. Differential diagnosis includes a pedunculated fibroid extending into the right ovary.

The left ovary is mildly enlarged and a follicles as well as a 2.8 cm corpus luteal cyst.

Urinary bladder is unremarkable.

Great vessels demonstrate normal course and caliber. No evidence of aneurysm.

There is no significant free fluid in cul-de-sac.

The osseous structures are intact.

IMPRESSION:

Lobulated enhancing lesion measuring up to 5.9 cm in the right anterior pelvis most likely arising from the right ovary. Considering the dark signal on T2-weighted sequence, this finding probably represents ovarian fibroma or fibrothecoma. Less likely possibility includes pedunculated fibroid extending into the right ovary.

Corpus luteal cyst measuring 2.8 cm in the left ovary.
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134578 tn?1642048000
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Your doctor can tell you what the results suggest, and should. I would call in if you haven't heard anything. You could also call in and tell them you're in a lot of pain. You could even hint that you're concerned about possible ovarian torsion, just to get them to move on seeing you about the pain.

The good news is that every possibility they have named is benign. Basically, you've got a benign tumor attached to or near your right ovary. It needs to be removed. (The corpus luteus cyst on the left ovary will probably go away by itself in your next cycle.) You might be unexcited about the timing given your upcoming bar exam, but it's a simple surgery, minimally problematic (they used to call it "Bandaid surgery" because the scar that is left below your navel is so small it can be covered with a Bandaid.) They'll use viewing tubes and microscopes, find the tumor, and pop it out. You'll be back on your feet the next day, and probably feeling tons better in lots of ways. (That's the good part about doing this before the bar exam. You don't want to sit for hours taking a test with an aching ovary.)

They said the tumor looks like it came from your ovary, though it might be on a stem from your uterus. If it came from your ovary, your doc might caution that there's a chance they will find they need to remove the ovary. This is not a given -- tumors can be removed from ovaries and the ovary left intact -- but if the tumor is totally involved with it or because the tumor causes torsion in the meantime, you might lose the right ovary. Please don't worry, the other ovary will take over the job and ovulate for it. My sister lost an ovary to torsion and never had a problem, had a baby and everything. The other ovary simply ovulates every month instead of every other month. Of course encourage your doctor and the surgeon to understand you want to preserve your ovary if you can. What you REALLY don't want to be left with is a scar on the ovary, though. Ovaries swell when they ovulate, and a scar there can hurt like hell. So, follow the doctor's advice.
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Thank you so much for this! I've called the doctor and left messages but noone has returned my calls! This is super helpful and makes me feel alot better!
Doctors are super busy right now because people are coming back in for things they let go during the worst of the pandemic, but there is no excuse for them leaving you hanging.

Do look up torsion, because if the little tumor *is* attached to the ovary and not just near it, it's possible it could cause it to twist. When someone gets torsion it hurts noticeably. You said the pain you are having now is more than o.t.c. meds will touch, so stay alert to the possibility that it could be torsion, and get in to the ER if you suspect it.

Take care and good luck. The world needs more good lawyers who have faced their own challenges and have empathy. :-)
Here's a good article on ovarian torsion. https://www.medicalnewstoday.com/articles/322666

You are such a delight! Thank you so much for your kind advice! Doctor called me back and let me know they are still unsure what makes up the tumor but everything is looking benign! Wants me to wait until after the exam to have surgery b/c of the chance they may need to go deeper in my abdomen than planned. She did prescribe some meds that won't mess with my studying. Thank you so much for your help yesterday! I was going crazy!
I'm glad your doctor called you back. It didn't sound from the MRI report like they would know what kind of tumor it was until they had it out and biopsied, but the possibilities the report named were all definitely benign.

That doesn't mean waiting to remove it is a great idea, though. You're in pain, and it could get worse, the tumor could grow. It seems a bit surprising that the doctor would have you wait weeks to get it out, even in the face of your bar-exam prep. It sounds like she's saying it's OK to be on painkillers for a long time. (Or is the pain from this only occasional, and much of the time you won't need to take any pain meds? I could see a longer timeline then, but would still worry.) A few weeks would be a long time to be on painkillers, plus they might mask your symptoms. If you get the tumor removed right away, you could study while convalescing, and neither be in pain from the tumor nor constantly on painkillers.

Anyway, call your doc if you get fever or vomiting, or if the painkillers suddenly stop working. Also, if taking painkillers for several weeks is really what's being proposed, run that by the pharmacist when you pick up your prescription, and make sure there are not any known problems with long-term use.

Good luck!

Thanks! You really have been a Godsend for my crazy anxiety! I think she just prescribed a non-narcotic painkiller so as to not interfere with my studies for sparingly use. Post of the unbearable pain occurs during my cycle and that's almost over (YAY)! I shouldn't need it every day or even every other day for the next couple of days. She was also concerned that I wouldn't be able to study or take the test if we tried to do surgery beforehand with it being about 2 weeks away. Since they're unsure what the tumor is she advised me that depending on what they find it may be a more extensive procedure. I am taking all of your advice and keeping a watch on it. If I end up with extreme pain I will not hesitate to go to the emergency room.
Oh, if the bar exam is only two weeks away and not "a few" weeks away, I wouldn't do the surgery until after it, either. I envisualized you taking painkillers for 8 weeks or something.

Good luck with everything. Write back when the surgery happens and they figure out what the mass was. (It would be cool if it was a dermoid cyst, but probably not or they would be able to see hints on the MRI. Fascinating what can happen in the ovary area.)  In the meantime, take care.  :-)
Thanks! I've read about those...honestly so cool! I'll be sure to let you know!
Thanks so much for your help Annie! I am on day 7 of recovery. The surgery went well and the doctor was in for a surprise herself!  The doctor said she was pretty amazed and I had a super difficult case because the mass was literally of collection of rocks inside my stomach to the point that it dulled several scalpels lmao. She understood why I was in pain because sis (the mass) had taken over. Had to take some ovarian tissue but I still have both! What came out of me is a long stalk of essentially "rocks" connected on either side. It may be borderline and I'll know by my follow-up appointment. I've been walking around and the most pain I'm in is from the significant gas and swelling that I can't seem to get away from. And the pain from that is the worst Other than that I'm okay! So glad this thing is out and I can get diagnosed!
Rocks, hmm? Like maybe calcium? Very odd indeed, but consistent with what I've read about ovarian cysts. (Kidney stones are also a lot like rocks.) I hope you got to keep one of the rocks for your collection! :-)  This is why I usually recommend an abdominal MRI -- there is only so much an ultrasound can see.
(And obviously even the MRI couldn't figure it out as being rocks.)
Yes, I'll def keep you posted on the type of tumor they think it is! So strange!
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