Women's Health Community

Dear Humptydumpty: A complex ovarian cyst does generate more concern. A cyst that is a mixture of solid and fluid elements, or is solid, is not a simple follicular cyst. The presence of irregular borders, or septations (internal walls dividing the cyst into separate spaces) are more concerning features found in complex cysts. Other terms which may be linked to complex cysts are: mural nodule, fluid-debris level, retracting blood clot, or a mix of anechoic to hyperechoic appearances.

While a complex cyst might raise the spectre of ovarian cancer, there can be other causes which have nothing to do with malignancy. For example I had a patient in her late 30's with a worrisome cyst seen on ultrasound. After surgical removal it was found to be an endometrioma (endometriosis cyst). She had no personal or family history of endometriosis, nor any symptoms of "endo".

While simple ovarian cysts can usually be diagnosed by vaginal ultrasound, the question arises "How reliable is ultrasound when the cyst is complex?" One well done study (Jermy, 2001), looked at the reliability of ultrasound to make a correct diagnosis for possible endometriosis or dermoid types of complex ovarian cysts. After the mass was removed it was found that ultrasound was successful in predicting 96% of endometriosis cysts and 97% of dermoids. There were no ovarian cancers found.

Your GYN is doing a correct thing in repeating the ultrasound to take a second look at the cyst. In my clinical experience, if a radiologist (or GYN) strongly suspects ovarian cancer there is no delay to get more and different imaging (eg CT scan). Everyone is worried about the medical-legal liability of a delay to diagnosis cancer.

In terms of the pain, pain is not a great diagnostic feature of ovarian cancer. Remember most women have vague symptoms even with advanced, obvious ovarian cancer. One does need to determine the cause of the pain, if it is GYN or even GI in origin. As you have likely read, there can be a lot of overlap between GYN and GI symptoms.

Yes, at vitamin D level of 12 is low, especially if the unit of measure is nonomol/Liter (nmo/L). In many cases the "normal" or preventative level of Vitamin D has yet to be determined. Cardiovascular risk begins to rise steeply when the blood level of 25(OH)D is below 10-15 ng/mL. Optimal levels may be at least 30 ng/mL. Depending upon all other factors present it might take a daily intake of 1000-2000 IU per day get to blood levels of 30 ng/mL (Giovannucci, 2009). The following blood 25(OH)D levels are taken from an updated National Institutes of Health document:

Blood level Health Status
Ng/mL nmo/L
<10-15 <25-37 Consistent with rickets, low bone density, poor health
>15 >37.5 Adequate for healthy persons

It sounds like your GYN is being very thorough. One would suspect that she will follow up the pain and complex cyst issue until there is a "for sure" diagnosis.

Yours,
Jane

Thank you for responding. It seems my pain is getting worse. My stomach looks very bloated and can see some swelling where the cyst is and below it Could there be some swollen lymph nodes? I am calling the doc on Monday.

Just checking to see if you ever found out what was causing your symptoms?

Dear dnh: Since you were able to locate three older posts (all with concerns about ovarian cysts and urinary symptoms) I would wonder if you were having similar symptoms. Feel free to write back it a more specific description of your symptoms or concerns so your can receive a reply targeted to your unique history.

Yours,
Jane