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What Does The Pelvis MRI Report Indicate?
Question: Hi,
This is a 38 years old female member, who is presenting with dysmenorrhea.
Presenting complaint:
presented with complaint of dysmenorrhea since 2 weeks.
She is G5P4A1, post Suction curettage for miscarriage 10 days ago, found on ultrasound to have complex ovarian cyst right ovary, CA125 over 200.
Last Menstrual Period: D&C 10 days ago.
Past Medical History
Medical History: hypertension
Surgical History: other (Suction curettage. Laparotomy and laparoscopy for ovarian cyst in the past. )
Physical Exam
External genitalia: normal
Vagina: normal
Cervix: normal
Uterus: tender, enlarged (13 week size. right uterosacral nodularity, tender)
MRI pelvis
The uterus is anteverted. It measures 8.3cm TR x 6.2cm AP x 9.2cm CC. the myometrium appears edematous/congested and hyperenhances, probably reflecting recent post-partum state. The junctional zone is overall fairly well demarcated. Endometrial thickness measures 1.2cm AP. The endometrial surface is irregular, especially along the anterior uterine body. Trace fluid in the endometrial cavity. Trace amount of cul-de-sac free fluid.
The right ovary is larger (containing cystic foci) than the left, measuring 6.4cm TR x 4.4cm AP x 4.3cm CC. the largest is bilobed, measuring 4.4cm TR x 4.1cm AP and T1/T2 Hyperintense (without fat suppression) with thin walls/peripheral enhancement (and a 2mm thick internal septum) while the others are smaller and T1 hypotense. No solid intracystic component seen.
The left ovary appears unremarkable, measuring 2.5cm TR x 2.5cm AP with few follicles
Diagnosis:
Complex right Ovary cyst suggestive of Endometrioma, elevated ca125 over 200.
Kindly advice on what is the best surgical approach in this case
This is a 38 years old female member, who is presenting with dysmenorrhea.
Presenting complaint:
presented with complaint of dysmenorrhea since 2 weeks.
She is G5P4A1, post Suction curettage for miscarriage 10 days ago, found on ultrasound to have complex ovarian cyst right ovary, CA125 over 200.
Last Menstrual Period: D&C 10 days ago.
Past Medical History
Medical History: hypertension
Surgical History: other (Suction curettage. Laparotomy and laparoscopy for ovarian cyst in the past. )
Physical Exam
External genitalia: normal
Vagina: normal
Cervix: normal
Uterus: tender, enlarged (13 week size. right uterosacral nodularity, tender)
MRI pelvis
The uterus is anteverted. It measures 8.3cm TR x 6.2cm AP x 9.2cm CC. the myometrium appears edematous/congested and hyperenhances, probably reflecting recent post-partum state. The junctional zone is overall fairly well demarcated. Endometrial thickness measures 1.2cm AP. The endometrial surface is irregular, especially along the anterior uterine body. Trace fluid in the endometrial cavity. Trace amount of cul-de-sac free fluid.
The right ovary is larger (containing cystic foci) than the left, measuring 6.4cm TR x 4.4cm AP x 4.3cm CC. the largest is bilobed, measuring 4.4cm TR x 4.1cm AP and T1/T2 Hyperintense (without fat suppression) with thin walls/peripheral enhancement (and a 2mm thick internal septum) while the others are smaller and T1 hypotense. No solid intracystic component seen.
The left ovary appears unremarkable, measuring 2.5cm TR x 2.5cm AP with few follicles
Diagnosis:
Complex right Ovary cyst suggestive of Endometrioma, elevated ca125 over 200.
Kindly advice on what is the best surgical approach in this case
Brief Answer:
Laparoscopic cyst removal
Detailed Answer:
Hello Mr. XXXXXXX thanks for trusting health care magic.
According to MRI findings and seeing history of dysmenorrhea and levels of CA 125, it is evident that this cyst is endometriotic cyst only.
But the size is big and causing symptoms so best management will be to get the cyst removed for complete cure.
This cyst can respond to hormones and will slight decrease in size but the response will only be transient.
It cannot be cured completely by drugs alone and thus surgery should be opted soon especially when she has already completed her family.
Laparoscopic removal will be best, but it is at the discretion of the surgeon as in case on examination, surgeon finds decreased mobility of the cyst or dense adhesions then he might like to do open laparotomy to remove the cyst.
In case you have any questions about it, I will be glad to answer.
Regards
Dr Manisha
Laparoscopic cyst removal
Detailed Answer:
Hello Mr. XXXXXXX thanks for trusting health care magic.
According to MRI findings and seeing history of dysmenorrhea and levels of CA 125, it is evident that this cyst is endometriotic cyst only.
But the size is big and causing symptoms so best management will be to get the cyst removed for complete cure.
This cyst can respond to hormones and will slight decrease in size but the response will only be transient.
It cannot be cured completely by drugs alone and thus surgery should be opted soon especially when she has already completed her family.
Laparoscopic removal will be best, but it is at the discretion of the surgeon as in case on examination, surgeon finds decreased mobility of the cyst or dense adhesions then he might like to do open laparotomy to remove the cyst.
In case you have any questions about it, I will be glad to answer.
Regards
Dr Manisha
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
dear doctor thank you so much for your consultation. in view of her raised CA 125, can more radical surgery (as hysterectomy with bilateral oophorectomy) be a surgical option in this particular case? or Laparoscopy, right oophorectomy, resection of endometriosis, hysteroscopy and D&C should be followed. can you please specify the reason for opting either of the surgical approach.
Brief Answer:
No need for radical surgery
Detailed Answer:
I understand your confusion related to the issue but in my opinion there is no need to opt for a radical surgery as she is just 38 years of age and thus no major risk of cancer plus the levels of CA 125 are not highly raised.
So just excision of endometriotic cyst and D&C will suffice as they will be sent for histopathological analysis and thus we will be sure of the presence of any cancerous change if at all present.
Take care
No need for radical surgery
Detailed Answer:
I understand your confusion related to the issue but in my opinion there is no need to opt for a radical surgery as she is just 38 years of age and thus no major risk of cancer plus the levels of CA 125 are not highly raised.
So just excision of endometriotic cyst and D&C will suffice as they will be sent for histopathological analysis and thus we will be sure of the presence of any cancerous change if at all present.
Take care
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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