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MRI showed multiloculated cysts in adnexal area with areas of sub-acute hemorrhage with cyst. Is it hemorrhagic cyst or endometriotic cyst?

The MRI of my wife say: Large Complex multiloculated cystic SOL in right Adnexal area, Measusirn 6.5x6.2x5.7 cm approx. Areas of sub-acute haemorrhage seen within the cyst. Part of Right ovary is abutting the cystic SOL. Smaller T2 hyperintense, T1 hypointense cystic SOL with fluid contents in left adnexal area, measuring 3.2x2.6x2.5 Cm part of left ovary abutting this SOL. Our doctor suggested for Laparoscopic surgery to remove those cysts . As she was under treatment for conceiving, she was given Fertomed 50, on CD-3 to CD-7. USG done on day 12 where they found a large folicle 3.2x2.0x3.0 with two more folicles of normal size, USG done at Day 16 shows Larger folicle 4.5x5.0x5.0. thereafter the MRI was done on day 17th. MRI observations mentioned above. Please suggest, if this is haemorrhagic cyst or endometriotic cyst?, Is it necessary to surgically removing it or it can be treated with medicines? Thanks Harish
Asked On : Mon, 18 Jun 2012
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Radiologist 's  Response
Hi Harish,
Sometimes, during treatment for infertility, there maybe development of large cysts within both ovaries. these are usually large follicles which fail to rupture and form cysts. These may then show hemorrhage within. Differentiation between simple hemorrhagic cysts and endometriotic cysts is often difficult since endometriotic cysts also show hemorrhage within. However, considering her treatment history and assuming that she was not symptomatic for endometriosis (your gynaecologist would have suspected it), the MRI features probably represent simple hemorrhagic cysts. Usually, the protocol is to repeat a USG / MRI her next normal cycle to look for persistence of the cysts and only if these persist over time or show complication, would surgery be considered. Also, at her age although malignancy is rare, your gynaecologist may advice a CA-125 blood investigation.

Hope this helps.

Answered: Fri, 19 Apr 2013
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