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What Do My Lab Test Results Indicate?
Question: Hello in November I bled for 3 weeks had a vaginal scan showing enlarged heterogenous texture to right ovary,follow up scan January showed it had changed to 3 irregular cysts thick walled and increased blood flow,largest cyst being 20x14 mm.gyno ordered another scan which I had yesterday now showing largest cyst 3 x 1 cm still all irregular but now with nodule in each cyst and one septation in 1 cyst.colour Doppler was done and no vascularity to cysts or nodule present.i had my ca 125 and was normal at 24.im
Now waiting for follow up appt.from what I have googled this all indicates malignancy please can you help as I seem more concerned than my gyno.is no blood flow good or bad ? Many thanks XXXXXXX
Now waiting for follow up appt.from what I have googled this all indicates malignancy please can you help as I seem more concerned than my gyno.is no blood flow good or bad ? Many thanks XXXXXXX
Brief Answer:
ct scan and tumour markers to be done...pls read
Detailed Answer:
Hello,
Thanks for the query to HCM ,
I would have been happier if you would attached the ultrasound report with the query. Nevertheless, there are 3 irregular ovarian cysts in the right ovary of which the largest is 3x1cm and with a nodule in each cyst and septation can be appreciated. It is worth noting that there is no increased vascularity which goes against any malignancy and also your CA125 levels are normal.
This could possibly be an endometriotic cysts and often give a similar finding of spittoons and nodule on ultrasound. The tumours markers for ovarian tumour are CA 125, CEA, BETA HCG, AFP AND CA 119.9 ( specific), so even the other tumour markers should be done now as the diagnosis has still not been reached. Also the next radiological study which could be definitive would be CT SCAN pelvis and not an ultrasound. Act scan would be able to differentiate between nodules and septations more clearly and confirmatively.
I would like you to discuss the option with your gyno and take an informed decision. There is no role of ovarian biopsy because it its malignant then it would just cause a rupture of capsule and spread of disease making it straight away stage 4, so it is contraindicated.
TUMOUR MARKERS AND CT SCAN are the next best option and if the tumour markers especially CA 19.9 are normal then these are benign cysts and can be operated upon laparoscopically and a cystectomy or a oophorectomy can be done for that side.
I hope i have answered your query in detail,
Wishing you good health,
Regards
ct scan and tumour markers to be done...pls read
Detailed Answer:
Hello,
Thanks for the query to HCM ,
I would have been happier if you would attached the ultrasound report with the query. Nevertheless, there are 3 irregular ovarian cysts in the right ovary of which the largest is 3x1cm and with a nodule in each cyst and septation can be appreciated. It is worth noting that there is no increased vascularity which goes against any malignancy and also your CA125 levels are normal.
This could possibly be an endometriotic cysts and often give a similar finding of spittoons and nodule on ultrasound. The tumours markers for ovarian tumour are CA 125, CEA, BETA HCG, AFP AND CA 119.9 ( specific), so even the other tumour markers should be done now as the diagnosis has still not been reached. Also the next radiological study which could be definitive would be CT SCAN pelvis and not an ultrasound. Act scan would be able to differentiate between nodules and septations more clearly and confirmatively.
I would like you to discuss the option with your gyno and take an informed decision. There is no role of ovarian biopsy because it its malignant then it would just cause a rupture of capsule and spread of disease making it straight away stage 4, so it is contraindicated.
TUMOUR MARKERS AND CT SCAN are the next best option and if the tumour markers especially CA 19.9 are normal then these are benign cysts and can be operated upon laparoscopically and a cystectomy or a oophorectomy can be done for that side.
I hope i have answered your query in detail,
Wishing you good health,
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thank you.scan lady requested a repeat scan in two months but I'm not happy with that.in Novembers scan all showing was enlarged right ovary with heterogenous texture.then January's scan showed it had changed to 3 irregular cysts with thick walls with increased vascularity.but yesterday's scan showed same 3 irregular cysts grown by 1cm each but I am bleeding.would this make them grow? But the nodule is a new thing in each ovary but the blood flow had changed from January's scan as no blood flow on colour Doppler was seen yesterday.do all malignant cysts have blood flow ? As I look at Google a lot it says ovarian malignant tumours do not have much blood flow to them ? I was told it is a very good sign to not have blood flow.i do suffer extreme heavy periods but sonograohers said definitely not endomitriomas.what is the difference between cysts and rumours can they see the difference in the scan ? Many thanks
XXXXX
So I do have the characteristics of a malignant growth as I have irregular shape and nodules? By coincidence my gyno has just rung as I had requested a call.he said the shape and nodules were all there in January's scan and the XXXXXXX radiologist has reviewed the images and nothing has changed in 8 weeks apart from its a little bigger so follow up scan in 2 months ? Would you agree? He said my ca 125 was normal only 4 weeks ago and he is going to have a meeting with other specialists to see their opinion which will probably be Mri and more blood tests .my ovary is 19cc with these cysts and the last two scans they couldn't find my left ovary ? Is there any reason for this as novembers scan left ovary was visible showing two simple cyst? No free fluid has not been seen on any scans what does This mean please?
XXXXX
So I do have the characteristics of a malignant growth as I have irregular shape and nodules? By coincidence my gyno has just rung as I had requested a call.he said the shape and nodules were all there in January's scan and the XXXXXXX radiologist has reviewed the images and nothing has changed in 8 weeks apart from its a little bigger so follow up scan in 2 months ? Would you agree? He said my ca 125 was normal only 4 weeks ago and he is going to have a meeting with other specialists to see their opinion which will probably be Mri and more blood tests .my ovary is 19cc with these cysts and the last two scans they couldn't find my left ovary ? Is there any reason for this as novembers scan left ovary was visible showing two simple cyst? No free fluid has not been seen on any scans what does This mean please?
Brief Answer:
Need to investigate further to reach a diagnosis....pls read
Detailed Answer:
Hello,
Welcome back.
See there can be simple follicular cysts, endometriotic cysts, dermoid cysts ( germ cell tumour, benign) and then ovarian tumours ( a whole variety of it is present).
The distinction between benign and malignant ovarian masses is made based on its solid state, regularity of capsule, septations , nodularity, solid components within the mass/cyst, any lymphovascular invasion.
The best mode remains CT SCAN and tumour markers. Vascularity is generally decreased in chronic growing cysts and in endometriotic cysts but blood supply is required for tumour to grow , hence high vascularity is not a good sign but low vascularity simply doesn't rule out tumour.
So presently, tumour markers profile and CT SCAN should be done and even if they are unable to reach a diagnosis which is unlikely, then the gyn should go in for a laparoscopic oophorectomy and then send the sample for a frozen section on table , for histology and if the report comes as benign then operation is completed and you are cured.
But if it comes malignant then the best option would be to convert into a laparotomy and perform total abdominal hysterectomy with bilateral slapping oophorectomy and para-aortic lymph node dissection and pelvis lymph node dissection + omentectomy, and then you would be followed up with 6 monthly with Ultrasound and CA125 Levels. So thats the protocol.
I have given you an overview, so more you google more confused you would get.
Get tumour markers complete profile and CT scan done and take a second opinion as well.
You may send me the reports.
Regards
Need to investigate further to reach a diagnosis....pls read
Detailed Answer:
Hello,
Welcome back.
See there can be simple follicular cysts, endometriotic cysts, dermoid cysts ( germ cell tumour, benign) and then ovarian tumours ( a whole variety of it is present).
The distinction between benign and malignant ovarian masses is made based on its solid state, regularity of capsule, septations , nodularity, solid components within the mass/cyst, any lymphovascular invasion.
The best mode remains CT SCAN and tumour markers. Vascularity is generally decreased in chronic growing cysts and in endometriotic cysts but blood supply is required for tumour to grow , hence high vascularity is not a good sign but low vascularity simply doesn't rule out tumour.
So presently, tumour markers profile and CT SCAN should be done and even if they are unable to reach a diagnosis which is unlikely, then the gyn should go in for a laparoscopic oophorectomy and then send the sample for a frozen section on table , for histology and if the report comes as benign then operation is completed and you are cured.
But if it comes malignant then the best option would be to convert into a laparotomy and perform total abdominal hysterectomy with bilateral slapping oophorectomy and para-aortic lymph node dissection and pelvis lymph node dissection + omentectomy, and then you would be followed up with 6 monthly with Ultrasound and CA125 Levels. So thats the protocol.
I have given you an overview, so more you google more confused you would get.
Get tumour markers complete profile and CT scan done and take a second opinion as well.
You may send me the reports.
Regards
Above answer was peer-reviewed by :
Dr. Deepak
Brief Answer:
I agree with your gyn's approach of further investigations....
Detailed Answer:
Hello,
No free fluid in POD simply means that there has been no rupture and that a good sign.
Inability to find left ovary is not good as its seen in cases when the ovary is obscured by a mass or have become clearly irregular.
If the contours of ovary has not changed much and nodules were present even earlier , then I agree with your gynecologist's approach of discussion with XXXXXXX specialists and opting for an MRI and further tests ( should be tumour markers), before actually planning an intervention.
Actually CA 125 level being low goes against malignancy but physical characteristics point towards malignancy.
So a better radiological mode is warranted to further investigate. Its fine as there is no particular need to hurry up things as of now considering the increase in size has been minimal.
Hope this helps you.
Regards
I agree with your gyn's approach of further investigations....
Detailed Answer:
Hello,
No free fluid in POD simply means that there has been no rupture and that a good sign.
Inability to find left ovary is not good as its seen in cases when the ovary is obscured by a mass or have become clearly irregular.
If the contours of ovary has not changed much and nodules were present even earlier , then I agree with your gynecologist's approach of discussion with XXXXXXX specialists and opting for an MRI and further tests ( should be tumour markers), before actually planning an intervention.
Actually CA 125 level being low goes against malignancy but physical characteristics point towards malignancy.
So a better radiological mode is warranted to further investigate. Its fine as there is no particular need to hurry up things as of now considering the increase in size has been minimal.
Hope this helps you.
Regards
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Deepak
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