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What does a hard nodule between vagina and rectal wall indicate?

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Posted on Fri, 11 Jul 2014
Question: I have a hard nodule between my vaginal and rectal wall. It seemed to shrink after I had my ovaries out due to endometriosis, but it has gotten bigger. I did not take my replacement hormones for two weeks when I ran out and that is when it seemed to get the biggest. I had a CT scan, but it did not show up. I meet again with my gynecologist in a week to decide whether to have surgery to remove it. I am not sure what I should do. I would hate to ignore it and later find out it was cancerous. I did have level III squamous cell dysplasia o my vulva. What do you recommend I do?Also, I will be having a procedure to dilate my urethra that requires anesthesia and I will be having a third shoulder surgery for severe osteoarthritis. Is there a time frame I must wait between surgeries that require anesthesia?
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Answered by Dr. Aarti Abraham (1 hour later)
Brief Answer:
AS BELOW

Detailed Answer:
Hello
Thanks for writing to us with your health concern.
From your description ( the lesion shrinking after endometriosis surgery and getting enhanced post skipping your hormones ), it does sound like an endometriotic deposit.
The location is also typical of an endometriotic nodule.
If you can feel it, it HAS to show up on imaging - MRI is better than a CT scan for endometriotic deposits.
I think the replacement hormone therapy would take care of it.
If it does not, it can easily be biopsied to rule out cancerous changes.
I recommend having your gynecologist confirming it clinically as endometriosis, and MRI followed by a biopsy if necessary.
Also, Urethral dilatation can be done under local anesthesia, hence anytime.
THe shoulder surgery can be taken up anytime after fitness is ascertained.
If the nodule mandates a surgery, you can opt for general anesthesia wherein all 3 problems can be dealt with simultaneously.
All the best
Please feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Aarti Abraham (8 hours later)
Thank you for this information. I just want to make sure I understand. My gynecologist never mentioned biopsy of the nodule, she only mentioned removal of it. Is it more beneficial to biopsy the nodule, considering that it is behind the vaginal wall, rather than just removing it all together. If for example, it was a cancerous lesion verses endometriosis, should it be handled differently? Also, what is the benefit of getting an MRI, if my physician can feel the nodule?

Thanks,
XXXX
doctor
Answered by Dr. Aarti Abraham (1 hour later)
Brief Answer:
AS BELOW

Detailed Answer:
You did not mention that you physician could feel it.
If she can, that is what I wrote, that she should clinically confirm its diagnosis, and go for MRI / biopsy ONLY IF required.
Also, if the diagnosis is endometriotic nodule, biopsy is unnecessary.
It is only when clinical suspicion or MRI findings raise another diagnosis, that biopsy would be in order.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Aarti Abraham

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Practicing since :1998

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What does a hard nodule between vagina and rectal wall indicate?

Brief Answer: AS BELOW Detailed Answer: Hello Thanks for writing to us with your health concern. From your description ( the lesion shrinking after endometriosis surgery and getting enhanced post skipping your hormones ), it does sound like an endometriotic deposit. The location is also typical of an endometriotic nodule. If you can feel it, it HAS to show up on imaging - MRI is better than a CT scan for endometriotic deposits. I think the replacement hormone therapy would take care of it. If it does not, it can easily be biopsied to rule out cancerous changes. I recommend having your gynecologist confirming it clinically as endometriosis, and MRI followed by a biopsy if necessary. Also, Urethral dilatation can be done under local anesthesia, hence anytime. THe shoulder surgery can be taken up anytime after fitness is ascertained. If the nodule mandates a surgery, you can opt for general anesthesia wherein all 3 problems can be dealt with simultaneously. All the best Please feel free to discuss further.