What does the pelvis MRI report indicate?

default
Posted on Tue, 9 Jun 2015 in Women's Health
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
doctor
Answered by Dr. Manisha Jain 16 minutes later
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Manisha Jain 22 minutes later
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.
doctor
Answered by Dr. Manisha Jain 3 hours later
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Manisha Jain

OBGYN

Practicing since :2007

Answered : 5136 Questions

premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,  
Medical Procedures ,   ,  
Lab Tests

Recent questions on  Miscarriage

doctor1 MD

can i take zincofer in substitute if duphaston is not available? what is the difference? (2) i just had my miscarriage recently. trying to find...

doctor1 MD

My name is Amy I am 20 and have always had my period exactly on time for years, I m talking like shortly after mid-night every 28 days. I thought...

doctor1 MD

I had a blighted ovum at 10 weeks nothing was present in the sac from 4weeks. blood levels were 2500 on thursday and dropped to 1950 sat. confirmed...

doctor1 MD

My daughter had a miscarriage she is 23. For approx 6 months after this she has had a terrible acne type rash on her face and now just spread to...

doctor1 MD

I m three moths pregnant last night i bleeded and i hav hypothyroidism i m taking thronorm 88mcg and after bleeding i had a mole around my nose so...

doctor1 MD

I am in my 3rd month of pregnancy but i hav observed blood strains is it misscariage or anything else plz let me knw

doctor1 MD

Hello doctor, I had few conversation with you during last two months.I am in the UK and currently at 35 weeks pregnant. History: two miscarriages,...

Get personalised answers from verified doctor in minutes across 80+ specialties

178 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
backtotop2