Discussions By Condition: Female sexual conditions

Persistant Septated Cyst (1+yr) + Hemorraghic Cyst

Posted In: Female sexual conditions 1 Replies
  • Posted By: Anonymous
  • September 15, 2008
  • 00:09 PM

28 y/o Hashimoto's Thryoiditis Patient with Multiple Lab Abnormalities and Persistant Septated Cyst-- Background:

--TPOab 3001
--TSH 12.688
--% Bioavailable Testosterone = 26.5%
--WBC = 11 (3+ years)
--Swollen lymph nodes in armpits, base of skull and neck (3+ years)
--Neutrophils (7.9)
--Hemoglobin (15.6)
--Hematocrit (46.0)
--Absolute CD3 (2326)
--%CD 4 Pos. Lymphs (61.5%)
--HCG <2. Never pregnant.

Visited gyn last year for extreme pelvic pain, back pain, urinary, and mentrual irregularities (losing period, worsening cystic acne). When the sonagram came back, doctor wanted me to go for immediate laparoscopy to "see what it was." I declined laparoscopy b/c I felt rushed, doctor did not explain what his suspicions were or why laparoscopy was indicated over MRI. I was uncomfortable with the facility with which he was affiliated-- hospital lost my chart on both previous visits, and I was left for HOURS in the ER meanwhile nobody knew I was there waiting for treatment.

One year later, went for annual exam and presented old sonagram report to new gyn. Did a follow-up sonagram, and doctor seemed very concerned about what he saw. Sent me for an in-house blood test immediately after consultation. Images looked bad, doppler evaluation shows poor vascularity. Sent me for an MRI.

Follow up MRI:
--3.2 x 1.9 x 1.7 cm septated cyst in the left ovary, similar to that seen on ultrasound from a year ago.
--1cm Hemorraghic cyst in left ovary.
--Both ovaries demonstrate small follicles.
--No septal enhancement; no osseous abnormality evident.
--Free fluid in pelvis, likely physiologic.

Sounds like they were attempting to rule out ectopic pregnancy, dermoid cyst, and teratoma. Sounds like it also rules out standard functional cyst given septations and persistence of 1 year. Thickness of septations was not noted; but clearly does not contain the type of enhancing calcifications expected of ectop or benign tumor. This sounds really bad considering that all my blood work just came back elevated and my endo wants me to see a hemotologist.

My understanding is that MRI can't make the distinction between benign and malignant septated cysts. Is that correct or a misunderstanding?

Would an MRI report ever directly list the dx / impression as "ovarian cancer"? What language would you expect to find in a report for a patient who has not been previously diagnosed with cancer via biopsy?

Given the history of symptoms, lab abnormalities, urgency of an immediate blood test, and attempts to rule out a variety of normally benign conditions, I'm very scared that this MRI points to ovarian cancer. Can you offer an opinion as to the degree of my risk at this point?

What do I do next? Where do I go?

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