Complex ovarian mass

[LisaMeador]

Hi, I'm 23 years old and I've just been diagnosed with a midline mixed cystic and solid mass on my right ovary. I had both an ultrasound and an MRI but in not sure what either of them mean.

Ultrasound:
Findings:  The uterus was normal in size and contour.  It measured 7.3 x 2.89 x 3.89 cm.  The endometrial thickness was 0.81 cm which is within normal limits. The myometrial echotexture was   uniform.  Right ovary measures 13.47 x 8.48 x 6.46 cm. A complex mass involving the entire right ovary. The solid component of this mass measures 8.2 x 4.5 x 6.3 cm. There is marked posterior shadowing noted from the solid area of the mass. Possibility of a dermoid cannot be excluded in this mass. The left ovary measures 3.0 x 2.0 x 2.8 cm an content a cyst measuring 2.0 x 1.6 x 2.4 cm. Both ovaries demonstrated  normal perfusion on color Doppler imaging .  No free fluid noted .

MRI:
Findings: There is a large midline mixed cystic and solid mass, which measures 14.6 x 13.1 x 7.4 cm and appears to arise from the right ovary. The solid component of this mass measures 8.9 x 9.2 x 6.6 cm and demonstrates heterogeneous signal characteristics.  Within the superior most aspect of the central solid mass, there is subtle T1 hyperintensity, which may represent hemorrhage given that no corresponding signal loss is seen in this region on the out of phase images (series 7 image 4). This mass causes mass effect on the superior aspect of the bladder and posteriorly displaces the uterus.

A simple appearing cyst is noted in the left ovary and measures 3.5 cm in maximal dimension. A small amount of free fluid is noted in the pelvis.

No pathologic by size criteria lymphadenopathy is demonstrated within the visualized field-of-view. No peritoneal implants are visualized to suggest peritoneal carcinomatosis.

Impression: 1. Large mixed solid and cystic right ovarian mass measuring 14.6 x 13.1 x 7.4 cm.  Differential considerations include mucinous cystadenoma, serous cystadenoma, and less likely a teratoma given lack of visualized fat. Ovarian carcinoma is not entirely excludable.  Recommend GYN consultation for consideration of surgical removal. 2. No suspicious pelvic or peritoneal lymphadenopathy. 3. Left ovarian simple cyst.  If the right ovarian mass is removed and found to represent a serous cystadenoma, consider followup MRI of the pelvis in 12 months given that serous cystadenomas have a propensity for bilaterality and can mimic simple cysts. 4. Mildly limited exam secondary to lack of intravenous contrast.


I'm so worried about cancer  as everything online seems to be pointing in that direction. I have a GYN appt set up but it's not for two more weeks.  Any info on this would be greatly appreciated. I'm trying not to google, but it's really hard.

[HVAC]

The cancer would show up on ultra sound or MRI. I think you doctor is right. If you don't have the BRCA mutation your chance of ovarian cancer at your age is less than 1%. My cancer was clear on the ultra sound.

Alex

[LisaMeador]

Thank you, you've been so kind and responsive to me during this whole thing. I really appreciate it. I guess I will be moving forward with surgery and hope I can put all of this behind me.

[LisaMeador]

So, unfortunately, the receptionist I talked to gave me the wrong information on my cyst. I'm extremely upset over it.. Wednesday I went back to the GYN and my cyst hasn't changed in size at all and the hormone therapy didn't dissolve it. I'm back to having surgery this month and back to a million questions. The GYN believes it's a dermoid, the original diagnosis.. Which doesn't make sense considering my MRI results showed no fat within the mass. That's when ovarian carcinoma popped up as possibilities. I asked my GYN about cancer and he told me "I'm too young". He also said my ultrasound didn't show classic signs of malignancy (fluid around the mass or fluid in the abdomen) and basically crossed it off all together. I wish I could get a second opinion, but unfortunately tricare won't let me. I'm so confused and this has been such a long drawn out process. I'm feeling pretty defeated...

[HVAC]

I think you can cross cancer off the list. Good news.

[LisaMeador]

Hi! I'm sorry I have been MIA from this site. I did find out some news today. Between the first ultrasound and the second my cyst shrunk 3 inches and went from complex to a simple cyst. That was before the progesterone treatment. I'm hoping that means I can definitely cross cancer off the list of worries. I go back to the GYN Wednesday and I hope to hear it's gone all together.

[HVAC]

I guess you have Tricare? It is very bureuacratic. My dad was a Navy Chaplain. I grew up with Military medicine. They did send me to the Mayo when I was a baby due to my neurological problems and later to Duke. No one thought children got MS back then. Now they know better.When I was 5  years lodI got mauled by a German shepherd dog. An army surgeon just got back from Vietnam. He did a great job reconstructing my face. I never had to have plastic surgery. I know there is alot of red tape for referrals. In the civilin world it took me over 4 years to be diagnosed with cancer. I kept going in with issues which is not likely. My oncologist complains I do not call when I should. I worked years for veterinarians so I know when things are bad and when things can turn around on their own. But if your gut pushes you for answers listen to your gut. I should have pushed for myself harder. I had all the symptoms of Ovarian Cancer. After I was diagnosed my doctors asked themselves how they had missed the obvious. In my case I have the bad genetics. MY grand mother and aunt died of ovarian cancer. My brother and father had bad prostate cancer in their 50's. I think they would have had the BRCA mutation like me. My body makes cancer pure and simple.

I am really hoping your thing turns around for you. The day you email that your cyst has resolved will be a day I am very happy. I had someone tell me they had surgery and it was not cancer. I was so happy. Keep the faith.

Alex

[HVAC]

You can always get a second opinion. It is normal to still be worried. You will not relax until the cyst shrinks. I have learned that worry is trying to control the future and I can't. What I worry about does not come to pass. Other things I did not think of happen but things do not turn out exactly like I imagine them. I live with the BRCA mutation. I have a 90% of breast cancer plus my ovarian is terminal. I have learned to not wait for the other shoe to drop. I live a happy normal life. I have learned people are not statistics. Each case of cancer is different. I should be dead and I am not. I do not want to waste the time I have left worrying or playing what if. They can tell by the US if it is cancerous. I say let the doctor do the worrying. If you have a good doctor trust him.

Even if the worst happens I have learned that you just deal with it. I have been in chemo for four years. I thought I would not live 4 years. I went to the Lion King last night. I am going to Charleston soon. I went to Europe last year. I swim, I walk my dogs, and ride horses. I do not own a horse. A nice lady lets me ride hers. I have chemo once a week but I live my life otherwise. I even adopted a deaf dalmatian puppy two years ago. I love my pup. Life goes on and you live it.

Hopefully this cyst will just be a hiccup in your life.

Alex

[LisaMeador]

You live exactly as you should and I hope nothing but the best for you. I'm sorry about everything life has thrown at you, but you seem so strong. You are extraordinary. That's so great you don't let anything define you, you're just yourself.

I'm going to try to follow the GYN's advice. My issue is this was my first visit with him so I'm not sure if I trust him or not. My husband is military, so anything out of primary care has to be referred and the GYN was their pick. Unfortunately, I won't be able to get another referral. I hope he's right and this thing goes away with the medicine. I'm ready to feel 100% again and just feel 23 again. Too much worrying going on.

All of you ladies are amazing and I'm so glad I found this site. It gives new perspective and it's comforting to see people beating statistics. Keep fighting!

[LisaMeador]

So, I just left the GYN. He performed a transvaginal US again. He came back in the room to tell me it was a large cyst and that 90% of them go away on their own. He told me nothing about the cyst looked cancerous and he was 100% certain with hormone therapy, the cyst would go away. He has 50 years of experience, but somehow I can't have that sigh of relief. Maybe it's just my anxiety..

[LisaMeador]

I got my GYN appt pushed up to today. I go in at 130 (15 min from now) my mind seems to be blank as to what to ask. I'm also hoping I can get my referral to the GYN/ONC today. I will keep updates posted.

[old_before_my_time]

I echo HVAC's comments. The comment "they have to cover their butts" can needlessly instill a lot of fear in us. That is what it did to me and it made for cloudy thinking and ultimately being over-treated. I was rushed into surgery for a complex mass similar to yours (it ended up being a mucinous cystadenoma). Even though the mass was benign per the frozen section done in the operating room, my long-time gynecologist removed all my organs anyway (both ovaries, tubes, and uterus). All he should have removed was the cyst and then sewn me back up when it was benign. Unfortunately, far too many women lose organs unnecessarily. And we need all of our "reproductive" organs our whole lives for their hormonal, anatomical, skeletal, and sexual functions.

The types of cysts mentioned in the radiology reports were dermoid, hemorrhagic, mucinous cystadenoma, and serous cystadenoma. All of these types are benign and should not require removal of your ovary or any other parts but only the cyst itself. Of course, as HVAC stated, the biopsy done once the cyst is removed will tell if it is benign or malignant. That should dictate whether or not anything else is removed. But keep in mind that not all surgeons have good cystectomy (cyst removal) skills. And removing an ovary is easier. But the loss of even one ovary can have negative effects on your endocrine system since the ovary has both reproductive (exocrine) and post-reproductive / menopausal (endocrine) functions which are vital to every aspect of our health. So you don't want to lose one or both unnecessarily. The uterus and its supporting ligaments and blood vessels also have non-reproductive functions (anatomical, skeletal, and sexual).

These sites are helpful in understanding ovarian cysts and the functions of the ovaries:
http://ovaryresearch.com/ovarian_cysts.htm
http://www.overy.org/  

[HVAC]

I am not in the medical field. I do know that unless you have the BRCA gene you have a 1.4% chance of Ovarian Cancer in  a lifetime so it is rare. 98% of ovarian cysts are benign. It is even more rare to have ovarian cancer in both ovaries at the same time. Your lymph nodes are normal. There is no cancer in your peritoneal cavity which you would see if it were cancer. I was full of cancer in my peritoneal cavity. They can't completely rule out cancer with out doing pathology of tissue. You have cysts in both ovaries. You have no free fluid that also points away from cancer. They have to cover their butts and not exclude cancer all together. You can ask for a CA125 blood test. Try not to worry too much.

Alex