Complex adnexal ovarian cyst


Q: I had a pelvic and transvaginal ultrasound which reads the following: left ovary has cyst 9 x 8 x 9 mm
Other findings: Right adnexal, compressible, well circumscribed complex collection- 7.8 x 3.5 x2.3 cm, containing vascular septations. No pain.
Opinion: complex right adnexal collection with vascular septations, this may be in keeping with a peritoneal inclusion cyst- has patient any history of PID or endometriosis? Follow up MR recommended to better evaluate collection.
I have no history of anything. Had a MIRENA IUD removed in January 2014. I am very worried about this and want to know what the chances are of ovarian cancer. Thank you.

Symptoms:  Minor pelvic pain

A:   Hello,
Thanks for the query to for an opinion.
The ultrasound pelvis and abdomen indicates a small ovarian cyst on the left side less than 1cm in size, which is normal and likely to be a follicular cyst and not the causes of concern, but a large right adnexal mass of size 7.8 x 3.5 x2.3 cm with internal septations which appear to be vascular on ultrasound which appears more like a complex cyst of the right ovary. The possibilities can be either an endometriotic or hemorrhagic cyst or probably a complex cyst with thick internal separations suspicious of an ovarian malignancy. The MRI is hence definitive in diagnosis and establishing the contour differences and also tumour markers like CEA, CA-125, AFP and Beta HCG would be required to differentiate from other differential diagnoses against the possibility of ovarian malignancy.
A raised levels of tumour markers and confirmed thick separations on MRI would confirm an ovarian malignancy ( which is also suspected if there is a rapid growth in the size of the cyst over few months ). It would then require a surgical staging of the disease with either a laparoscopic or an open surgical approach. If the levels are normal, then it is more likely to be an endometriotic or hemorrhagic cyst which can then be removed with a laparoscopic approach.
You may consult your physician with reports and discuss in details to take an informed decision.
I Hope I have answered your query in details,
Wishing you good health,

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