Transvaginal ultrasound results

[NervousMim]

I am a 39 year old woman who has had irregular brown/pink spotting  through ovulation for the past four months. I have also had rectal pressure on the heaviest days of my period for the past ten months. I had a normal endometrial biopsy that showed I was ovulating normally. Just to be sure I had a transvaginal ultrasound. The results have scared me more than put my mind to rest. The part that really scares me is the "hypoechoic nodule with an echogenic rim." I'm worried about cancer. Can that, rather than the polyp, be what is causing the bleeding?  Would a polyp stop bleeding once I have ovulated? The last round of bleeding contained some clear thin fluid on one day. Is that a bad sign?

Here are my results:

IMPRESSION:
Probably endometrial polyp
Hypoechoic nodule in the right ovary for which followup is suggested.

COMMENT:
The uterus measures 9.1 x 4.2 x 6.5 cm. It is hemogenous in echotexture. The endometrial stripe measures 13mm and contains a 1.5 x 0.6 x 2.0cm in diameter region of nodular echogenicity probably representing a polyp. The right ovary measures 3.7 x 2.6 x 2.8cm and contains multiple follicles with the leargest measuring 1.3 cm in diameter. A hypoechoic nodule with an echogenic rim measures 2.3 x 1.4 x 1.8. The left ovary measures 3.3 x 1.3 x 2.2 cm. It contains multiple follicles. The largest is exophytic measuring 1.3cm in diameter. There is a small amount of pelvic fluid adjacent to the fundus in the uterus.

I'm supposed to wait three months to repeat the ultrasound, but I'll be crazy by then. Is there anyway to biopsy this "nodule" now?

Thanks

[teenabeen09]

A related discussion, Ovarian Cysts was started.

[swen]

I am a 38 yr. old female who was diagnosed a year ago with ovarian cysts and a possible dermoid cyst.  A CA 125 was done which was negative (15).  I have since changed doctors and had two more ultrasounds which showed different results.  My results now are as follows (via vaginal ultrasound)...

UTR is heterogenous and within which is contained a solid heterogenous mass located adj to the endometrium and measures 31x23x31mm.  This moves with the utr with palpatation, demonstrates scattered shadowing and is connected to the lateral utr via a stalk that demonstrates color flow.

Lt ovary has a cystic mass 9x7x7mm.  Moves independantly from teh solid utr mass prev. described.

My Dr. stated I have a pedunculated fibroid and ovarian cyst.  He stated that we could watch this via ultrasound every few months or I could have a laproscopic procedure to remove the cysts and fibroid.  I have opted for surgery as I am concerned about what is really there.

Six months ago, I started taking bioidentical progesterone to help with the heavy bleeding that I have monthly.  My periods used to be every 3-35 days with heavy intense bleeding & cramping.  Since starting the progesterone, my periods are now every 28 days and I only have 1-2 days of heavy bleeding and cramping.  My periods last 7-9 days on average.  I do have pain on the left side (sharp and aching pain) before my cycle.I also have had over the last 5 years a weight gain of 50 pounds with excessive hair growth on my chin. Diet and exercise are making a small dent in the weight loss, but not much, it's a large struggle. I don't have any childre and am not planning on having a family.

At 20, I had HPV which was treated and no further occurance. The HPV was typed but I don't recall what type it was.

I don't have any family history of uterine or ovarian cancer.  

My question is this....

How accurate are ultrasounds in detecting cancer?  What are the chances that the cysts and fibroid are canereous?  Should I be looking at a different type of surgery? Do I need to be worried that this could be more than cysts and fibroids?  

Please help.

Steph

[Annekathryn Goodman, M.D.]

Hi There,
It seems from your ultrasound that two different things are present:
1- You have a thickening in the lining of your uterus (the endometrium). This may somehow be related to your abnormal bleeding. The usual follow up for this would be one of the following:
          -a special ultrasound called a sonohysterogram where sterile saline is instilled into the uterus and the area that is thickened is evaluated.
          
          -or a minor procedure in the operating room called a D&C (dilation and curettage)
You should ask your doctor about these options

2. You have cysts in both your ovaries. It may be that you have a condition called polycystic ovarian syndrome (PCO) which is associated with irregular periods, hormone imbalance , and benign cysts in the ovaries. These cysts could also represent cysts from endometriosis. I understand your worry about cancer but it is not possible to know this by ultrasound alone.
I agree with repeating an ultrasound in 6weeks to 3 months for follow-up. You can also ask your doctor about checking your hormone levels such as an FSH (follicle Stimulating hormone), LH (luteinizing hormone), Additionally you could get a CA 125. In a young woman this can be inaccurate. It can be elevated by many benign conditions such as endometriosis but it is another guide to decide what to do next.

If your cysts are persistent, your discomfort remains, or your CA 125 is elevated, those are reasons to consider a laparoscopy to take a look.
best wishes