What Does This Ultrasound Report Indicate?

Posted on Wed, 14 Oct 2015

Question: Name;-XXXX               Age:- 43 Sex:-Female
Pregnancy test was negative test then further these tests were got conducted on the advice of the Doctors as the Periods were delayed for five days.
Uterus:-Enlarged in size, irregular in shape, heterogeneous in echo texture due to 28x24mm echopenic area in anterior part of body region, Endometrial echoes are normal. Cavity is empty.
Adnexae:-A 25x24mm anechoic cyst seen in it/echo free area with septa in lumen is seen in Rt.ovary.
     A 70x48 mm echo free area with septa in lumen is seen in Lt.ovary.
Impression:-Findings are suggestive of :-1.SOLin uterus ?Fibroid uterus
2.B/L Ovarian Cyst
Onn Doppler:evidentperilesional low velocity low amplitude vascular flow with broadening of systolic peak &RI.58 noteed with s/0 no evident torsion.
UNILOCULAR SEPTATE LT OVARIAN CYST AS DESCRIBED (likely benign imaging features
Pap Smear Report:-
Microscopic Exam:-Smear show sheet of basal cells, parabasalcells,intermediatecells,metaplasticcells,candidialpseudohyphae,neutrophils and lymphocytes.No evidence of dysplasia/malignancy is seen.
BETHESDA CATEGORY-Given smear show Cytomorphological features-Negative for intra epithelial lesion or Malignancy..
Chronic cervicitis
Test Description
Tumer Marker                Observed Value          Biological Reference Interval
CA 125, serum by CMIA 39.90                    Adults<35 u/ml
                                   *Premenopausal (woman)<200U/ml
                                        *Postmenopausal (Women)<35
                              CMIA:-ChemilumnescenceMicroparticleImmunossary.
So please give your precious Opinion/Advice Regarding it , what should be done and why?

Answered by Dr. Deepti Verma (19 minutes later)

Brief Answer:
MRI and frozen section required

Detailed Answer:
Hi Arshipreet, I have gone through your question and understand your concerns. The ultrasound report mentioned above shows likely a small fibroid in the anterior wall of uterus, and there are 2 complex cysts , one in each ovary. The cysts are complex because they contain septa within each of them. Complex ovarian cysts can be benign or malignant ovarian cysts, or can be endometrioma.The blood flow in Doppler is usually increased in malignant condition.
The pap smear is normal except that it shows candidal infection.
CA 125 is a tumour marker for ovarian cancer. Normally it's value is taken as less than 35 U/ml, the value in the above report is just borderline raised, it's 39.9 U/ml.
In this scenario, a MRI of whole abdomen and pelvis should be done to rule out carcinoma.and based on it the mode of surgery should be decided.
Since the ovarian cyst is of 7 cm size in left ovary and both the cyst are complex, surgical removal should be done, preferably with a facility of intraoperative frozen section for histopathological examination, so that complete surgical management can be done at same time if carcinoma is found on histopathological examination.
Hope you found the answer helpful. Please do get back for further queries.
Wishing you good health.
Regards,
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Pradeep Vitta