A 23 years old unmarried lady had reported during last week of August 2016 with C/O amenorrhea of approximately 55 days' duration. She used to have regular menstrual periods before that. Ultrasound of pelvis revealed complex cystic lesion in right adnexa ? Haemorrhagic cyst. She had normal periods on 01 Sep and 01 Oct. Repeat ultrasound on 14 Oct revealed complex rt adnexal cystic lesions. MRI pelvis was advised. Patient got MRI done on 10Nov. It shows rt adnexal complex cystic lesions showing septa and solid components. Contrast study has been suggested. She hasn't had periods after 01Oct. Otherwise, she is asymptomatic. How to go further in this case?
Dear Veena Vidyasagar
I think the picture goes with ovarian mass, I would advice tumor markers too
Go ba k to basics.Relook at BMI. Examine for other contibutory factors namely other stress,medication use,misuse,weight pattern in last several years,thyroid , galactorrhea,hirsuitism,
Dear Vidyasagar
all the time you had to think a malignant lesion. solid component of an ovarian mass is an alarming for malignancy so although the tumor marker such as CA125 or HEP4 is not so sensitive for pre menopause lady but hi level of these marker can be suggestive of malignant lesion. Now MRI with contrast is great help to distinguish benign from malignant lesion.
so I suggest tumor marker plus MRI with and without contrast of pelvic urgent
if the finding is equivocal , I recommend diagnostic laparoscopy and if the finding is not compatible with hemorrhagic cyst, resection of mass for definitive pathology must be done.
Check the endometrium for hormonal effects with TV or Transabdominal usg, measure the endometrial thickness. It may be a hormone secreting tumour.
Dear Veena Vidyasagar
How big is the right adnexa? Is she confirm that she doesnt get pregnant?
Because size of mass does matter for gynecologoc case ^^ and most common of amennorhea in reproductive age was pregnant.
For this patient laparoscopy is mandatory: germ cell tumor is the First hypothesis
Dear Veena
I agree with Dr Cassani as I recommend in my first answer besides I suggest if during laparoscopy you are suspect for malignant lesion , it is advise to take a biopsy from contralateral normal ovary also.
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