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Have complex ovarian cyst with peripheral vascualrity and free fluid in the POD. Any suggestion?

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hello i have been told I have a complex ovarian cyst with peripheral vascualrity and free fluid in the POD i have had a round of IVF 18 months ago. I am in some pain from the front left round to the back and also the top of my leg too? I am just wondering if you can advise what usually happens with this situation?
Posted Sat, 24 Nov 2012 in Cervical and Ovarian Cancer
Answered by Dr. Asra Ishtiaq Ahmed 4 hours later
Hello there.

A complex cyst is any mass of the ovary having solid and/or cystic components with septations or excressances (projections on the surface).

Any complex mass with any of the above features beyond the age of 40 must be evaluated immediately to ensure that cancer is not present.

The complex cyst in your case can be a dermoid cyst, infected ovarian cyst,serous or mucinous cyst of the ovary.

Dermoid cysts are the most common complex masses of the ovary. They are benign with only 1% or less of dermoids being cancerous.

Serous cysts are composed of thin fluid and mucinous cysts contain thicker fluid. They are usually benign(harmless) and present as complex masses. Cancer can occur in either of these types of cysts with serous cyst being the most common.

Definite diagnosis of cancer can only be made on tissue diagnosis obtained after removal of the cyst.

CA125 is a blood marker found high in ovarian cancer but is NOT DIAGNOSTIC. It is used only for understanding the prognosis and for follow up.

Since ovarian cancer has long term survival in the earlier stages, it is important that complex masses be evaluated, followed closely or removed and prevent progression of disease to higher stages.

So you have two options.
You can either follow it up with a repeat ultrasound 3 months later or go for a definite procedure lie surgery now.
The definite management will depend more on the size, if its more than 4 cm it is unlikely to resolve on its own.

I hope I have answered your query.

take care.
Above answer was peer-reviewed by
Follow-up: Have complex ovarian cyst with peripheral vascualrity and free fluid in the POD. Any suggestion? 15 hours later
Thankyou very much that has helped to clarify things a little better. Could the free fluid in the POD be from this cyst? And is it more concerning that the Cyst has Vascularity as well? Also the ovary is enlarged went from 4cc to 18cc.

Thankyou for your help!
Answered by Dr. Asra Ishtiaq Ahmed 10 hours later
Hello there.

Thanks for writing back.

Yes, the free fluid in the POD can be due to the cyst.

The pouch of XXXXXXX is the lowest area of the peritoneal cavity in women. It is a small extension of the peritoneal cavity which lies between the uterus and the rectum.
Since it is a dependent area, any fluid in abdomen will first start collecting in the POD first.
It is very likely that the fluid has leaked from the cyst you have or there might have been few more cysts which have ruptured and resulted in fluid collection.

Infected ovarian cyst can also lead to fluid in POD due to inflammation. These cysts are generally associated with pain, vaginal discharge and fever.

Also in ovarian cancers, there is collection of fluid in the abdominal cavity which first starts collecting in the POD.

VASCULARITY in the area of the cyst indicates it is an active tissue.
This can be due to infection or actively dividing tissue of cancer.

I suggest you can take a week course of antibiotics. If it is an infected cyst which is usually less than 5cm, the cyst might resolve. Also the POD fluid will be resolved. You can repeat the ultrasound after 3 months (or as early as 1 month) to look for the progress.

If it does not resolve you need to get it removed.

If your CA125 is normal then the probability of the cyst being cancerous is less. Remember it is diagnostic marker but is used only for giving the prognosis and follow up.

I hope I have answered your query.

Take care.
Above answer was peer-reviewed by
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