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What is meant by large presumed ovarian mass, mucinous cystadenoma primary considerations?

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Dr. Rakhi Tayal

OBGYN

Practicing since :2001

Answered : 13181 Questions

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Posted on Tue, 11 Dec 2012 in Women's Health
Question: Hello - I'm trying to understand my CT scan I had for a large pelvic mass. Normal periods every 26 days without fail. The scan does not identify my left ovary/adnexa, so does this large cyst originate from my left ovary? Two of my immediate female relatives also had large benign cysts on their left ovaries.

Specifically, the CT scan findings state: "There is a large hypodense cystic-appearing lesion measuring 20 Hounsfield units located within the right side of the pelvis extending into the mid abdomen abutting the aorta and IVC posteriorly and the anterior abdominal wall anteriorly. It displaces the bowel. This measures 18 x 10.5 x 16 cm. Several septations are present within this mass particularly inferiorly. It abuts the right adnexa and is likely ovarian in origin. The uterus is normal in appearance. Osseous structures are intact.

Impression: Large presumed ovarian mass. Serous or mucinous cystadenoma are primary considerations. Malignant variation is not excluded.”

I understand the definition of "abut" = end/touch/adjoin (re: "it abuts the right adnexa; abutting the aorta"). So, it appears this mass originates from my right ovary....am I correct since the findings do not even mention the left ovary/adnexa? i.e., if this cyst originated from my right ovary, would my right adnexa even show up on the scan since the cyst measures 18 cm?

Do I also need an ultrasound to get a better look? Thanks in advance for your help!
doctor
Answered by Dr. Rakhi Tayal 23 hours later
Hello,
Thanks for posting your query.
From the CT scan finding, it appears that the mass is originating from the right ovary and is likely to be a benign cyst. To rule out the malignancy, biopsy is needed. CT scan cannot rule out the malignancy.
Since it is a large mass, the right ovary and adnexa is difficult to differentiate separately.
An ultrasound scan is not likely to be more helpful than a CT scan.
You can go for serum CA 125 assessment which is a tumor marker and will help in ruling out any malignancy.
If I were to be your treating doctor, I would suggest the following tests:
1) Serum CA-125 Levels
2) MRI of pelvis to see contents of cyst and density.

Please see gynecologist with these reports who can guide you regarding various surgical & non surgical options of treatment.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakhi Tayal 57 minutes later
Thanks so much, Dr. Tayal; this is very helpful. I did have a CA-125 taken four days before my next period. My CA-125 result was 23.

I do have a couple of follow up questions, based on your reply.

1. I am curious why the CT scan would not identify the left ovary/adnexa at all. This is the primary reason I wondered if an ultrasound would help...not to further assess the 18 cm cyst, but to get a view of both ovaries? I asked my surgeon for an ultrasound, and he informed it it's not necessary. My concern is that my CT scan mentions almost all of my pelvic organs except my left ovary. My mother and sister each had a large benign cyst (football, and grapefruit-sized). Each had their left ovaries/tubes removed, which is why I thought this 18 cm cyst may originate from my left ovary.

2. Can an experienced OB-GYN/GYN Oncologist detect both ovaries during a pelvic/bi-manual exam if a patient has an 18 cm ovarian cyst? I am 50 pounds overweight and have belly fat.

I am pre-menopausal and would like to try and get pregnant after surgery but I would like a view of both ovaries before I am under general anesthesia. My surgeon (gyn oncologist) recommended a TAH-BSO because I just turned 44; to me, this seems unnecessarily aggressive unless I have cancerous cyst and it appears I probably do not. If I would have a cancerous cyst, then I want a GYN Onc to perform the surgery. My surgeon informed me that I needed to have "possible TAH-BSO/possible staging" on the consent form in case I did have cancer, but this "possible" language makes me a bit overly cautious.

I have no family history of breast or ovarian cancer. If I cannot get pregnant post-op, I want to keep my uterus, and healthy ovary for the hormone benefits. Based on my family history of several female relatives who conceived naturally in their 40s, I believe I may have a better chance than most women my age to get pregnant. For example, my grandmother delivered her last baby at age 46, and had no medical fertility assistance and I have several aunts on both sides of my family who conceived naturally and delivered babies in their mid 40s. I know my chances are slim, but with fertility treatment, I am hopeful I can get pregnant. My Mother did not go through natural menopause until age 53 so even though I am nearing the end of my childbearing years, I believe I have a couple of years to try and get pregnant again. As far as I can tell from monthly temperature tracking, I think I still ovulate, and still have very regular, normal periods every 26 days.

Sorry for the lengthy follow up but I hope this additional information helps, and I appreciate your reply at your convenience.

Thank you.
doctor
Answered by Dr. Rakhi Tayal 58 minutes later
Hello.
Thanks for writing again.
1. Ovarian cysts are not always hereditary in nature. To know more details about the left tube and ovary, MRI scan will be more helpful. You will not get better details on an ultrasound scan.
2. With a large ovarian cyst like you have, it is difficult to detect both the ovaries on a bimanual examination. A laparoscopic examination will be more helpful.
TAH-BSO might not be necessary right now as the cyst appears to be benign. You can go for a diagnostic laparoscopy and be sure that your ovaries are healthy. Only removal of the cyst can also be planned and then you can try for pregnancy.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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