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What causes cystic mass in the uterus?

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Posted on Fri, 18 Jul 2014
Question: I had an annual exam with my gynecologist today. She found a mass on my left side, unsure if it was ovarian or uterine because my uterus is enlarged like someone 6 months pregnant. She ordered an ultrasound and found multiple small fibroids but also a mass that that is not fibroid (the large mass). She said the radiologist described it at having cystic interface, and this part I don't remember, maybe with the wall... She said she will consult with the gynecologist who performed a surgery on me 10 years ago to remove 4 large cysts from my ovaries, because the mass is near a site that was involved in that laproscopic surgery. She will try to discern if we should just watch the mass for a while or do something more.

I did not ask more questions because I was on the phone while my kids were around, so I do not understand what she is suggesting the possibilities are. She did say that it might be endometrioma. From looking online and searching things associated with enlarged uterus, I am concerned. Can you clarify what she might be considering in her diagnosis? (I am a 48 year old woman who has been pregnant at least twice never to term--I adopted my kids. I was diagnosed with endometriosis 10 years ago. I had not symptoms other than masses found in an annual exam and then laproscopic surgery to remove them. They called them chocolate cysts. )
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Answered by Dr. Deepika Patil (6 hours later)
Brief Answer:
You need a ct scan

Detailed Answer:
Hi,

Welcome to HealthcareMagic.

The chocolate cyst was as a result of your endometriosis.

Now there are two possibilities for the cystic mass. Either it could be a recurrence of your chocolate cyst or it could a ovarian cyst not related to the endometriosis. Now for this second possibility to occur, you need to have a ovary on that side. This should be what your doctor must be wanting to know from your old gynecologist, that was your ovary removed in the last surgery or not. And if removed, was it fully removed or partially removed.

And as on usg it is difficult to differentiate a chocolate cyst from an ovarian clear cyst, specially if you have already been operated at that site. For this a CT scan will be a much better investigation. It will not only indicate the content of the cyst, but will also throw light on from which structure it is arising.

Also get your CA125 levels done, to rule out any ovarian malignancy.

Further management will depend upon these reports and the details of previous surgery.

Hope I have been helpful.

Regards,
Dr. Deepika Patil
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Deepika Patil (5 hours later)
I have both ovaries. I think she was wondering if it might be in my uterus. She said it felt connected to muscle and moved when she moved my uterus, but it was difficult to know for sure where it was because my Uterus is so enlarged. The consult with my surgeon, who is in the same practice, she said was to figure out if she thought the cyst might be related to the surgery because it is near a surgery entry point or a spot perhaps where they removed a prior cyst. She wanted to see if the other doc thought it was okay to just watch it for a while or if they should be more aggressive. My prior cysts were watched for 4 months and then removed because they were growing not being absorbed.

She said that the ultrasound, instead of providing clarity, actually made the water more murky.


Does that give you anymore info to take a guess? Does it seem like I should be concerned that it is cancer or are the chances small for it to be cancer. That is what the doc made it seem like but was not explicit and I am concerned that she is trying to manage my anxiety as her patient rather than giving me all the possibilities and statistical likelihoods.


Also, what do you think would be causing my uterus to be so enlarged.

Thank you for our input!
doctor
Answered by Dr. Deepika Patil (1 hour later)
Brief Answer:
uterus is enlarged due to fibroids

Detailed Answer:
Hi,

As i said earlier you need a ct scan and CA125 levels to get you all the answers.

If your CA125 levels are normal then you can easily follow the mass over time. Its levels are raised, it will warrant a more aggressive treatment.

And ct scan will show exactly from where it is arising from. As you are having both the ovaries, so possibilities are more.

An the mass, if we presume it to be from the ovary, can still be moved by moving the uterus, it it has infiltrated into it or if there is an adhesion between the two following the previous surgery or your endometriosis. So ct will be important for all these answers.

And uterus masses are usually not cystic.

Regards,
Dr. Deepika Patil
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Deepika Patil

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Practicing since :2008

Answered : 745 Questions

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What causes cystic mass in the uterus?

Brief Answer: You need a ct scan Detailed Answer: Hi, Welcome to HealthcareMagic. The chocolate cyst was as a result of your endometriosis. Now there are two possibilities for the cystic mass. Either it could be a recurrence of your chocolate cyst or it could a ovarian cyst not related to the endometriosis. Now for this second possibility to occur, you need to have a ovary on that side. This should be what your doctor must be wanting to know from your old gynecologist, that was your ovary removed in the last surgery or not. And if removed, was it fully removed or partially removed. And as on usg it is difficult to differentiate a chocolate cyst from an ovarian clear cyst, specially if you have already been operated at that site. For this a CT scan will be a much better investigation. It will not only indicate the content of the cyst, but will also throw light on from which structure it is arising. Also get your CA125 levels done, to rule out any ovarian malignancy. Further management will depend upon these reports and the details of previous surgery. Hope I have been helpful. Regards, Dr. Deepika Patil