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US said bulky uterus and lobulated in appearance, cystic lesions showing. What else should I look out for?

Dear Dr. The menstural cycle commenced on April 24, 2012 last time and slight bleeding continued till May 13, 2012 and then stopped. I had undergone US which revealed the following (as per the report): UTerus is bulky and lobulated in appearance, Intramural Hypoechoic Fibroids measures - 4.2x3.5 cm and 3.2x2.5cm seen within posterior myometium causing antrior displacement of endometrium . Endometrium thickness is of 6.2mm. Cystic lesions showing thin internal septa seen in left adnexal region likely left ovarian cyst (measures - 5.9x3.9 cm). Right Ovary Normal . The local gynocologist advised immediate surgery. She even asked a CA125 which indicated 192.50. We had been to another gyncologist who also advised for surgery but has asked to control the diabetes before surgery. She has askedto wait for about a month and go for another round of US ( Pelvis ) and return. She has dismissed that CA125 is not required at this stage as there is no requirement as per the US clinicals. I am 43 years old. Pre-Menapusal. Have been pregnant before (but did not go through the pregnancy for personal reasons). Am Type II Diabetic (am on 28 ml insulin). No other ailment. I may also give the results of the other tests that I had undergone: CBC ( Complete Blood Count ): *Haemoglobin: 13.7 gm/dl (reference range: 12-15) *Packed Cell Volume: 40.6% (rr: 40-50) *Total Leucocyte Count: 7.5 10-9/L (rr:4-11) *RBC Count: 4.64 (rr: 3.8-4.8) *MCV: 87.7 (rr: 80-100) *MCH: 29.5 (rr: 26-34) *MCHC: 33.7 (rr:32-36) *Platelet COunt: 291 (rr: 150-450) *RDW: 13.8% (rr: 11.5-14.5) Differential Leukocyte Count: *Neutrophils: 71 *Lymphocytes: 24 *Monocytes: 03 *Eosinophils: 02 *Basophils: 00 CA 125 ( Ovarian Cancer Marker) *CA 125 : 190.5 (rr: 35) *CEA (Carcino Emryonic Antigen): 1.29 (rr: 3) Thanks and Regards.
Asked On : Sat, 16 Jun 2012
Answers:  1 Views:  242
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General & Family Physician 's  Response
The cause of excessive bleeding seems to be because of the fibroids or it may be because of ovarian cyst. But one important differential diagnosis of fibroid on USG is adenomyoma specially when it is in the posterior wall of uterus as it is in your case and also in your age group. So you need a perfect diagnosis which can be achieved by MRI Pelvis.

In ovarian cyst there is lower abdominal pain and other symptoms as well about which you have not mentioned anything. So its difficult to comment on that.
CA 125 is tricky. Apart from malignant conditions it is raised in many non malignant conditions as well. But still the malignant conditions are to ruled out specially when the value is 192.50.

You have not completed your family so special consideration has to be given. Consult an experienced radiologist to confirm the diagnosis and then and a gynecologist to construct further work up.

You can contact again in this regard.
Answered: Fri, 16 May 2014
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