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    Ovarian cyst and Protein C Deficiency
    An_250449 posted:
    My 14 year old daughter has been dealing with a 4 cm ovarian cyst for the last 2 weeks. Before her doctor put her on birth control my daughter was tested for protein c def. (Daddy has had blood clots). Her results were positive with her level being 54. (64 and above is preferred). So now we are trying to figure out if there is a relation between the cyst and the deficiency. Last night she began experiencing a shortness of breath, as if the lungs can't fill up. Today she woke up with swollen aching ankles and lover back ache. So many different symtoms going on in her body. On a side note, her last cycle began on Jan 20. With an irregular cycle we don't know if her cycle will arrive in 2 days.

    With all this said, should we be concerned with the cyst and protein c deficiency? Since the deficiency is hereditary, should we be seeking a hematololgist? And are the other symtoms important to pay attention to?
    Jane Harrison Hohner, RN, RNP responded:
    Dear An: For other readers here is important information about protein C deficiency:

    An, it is not clear to me if your daughter was ever started on birth control pills (BCPs) once she was identified as having inherited protein C deficiency. If she was, I would worry about her shortness of breath as possibly being a pulmonary emboli (blood clot in the lung). If she is on BCPs please contact her MD ASAP about the shortness of breath. My best guess is that she is was not started on BCPs, despite the 4 cm cyst. If this is the case her symptoms still need to be reported to her MD so they can be evaluated.

    In terms of her ovarian cyst, it is less likely that it can be linked to protein C deficiency. If she had an ultrasound done, the scan should be able to identify what type of cyst is present.

    There are two types of small ovarian cysts which can be considered "normal". During the first half of the menstrual month estrogen stimulates the growth of a dominant follicle. This follicle fills with fluid which is spilled out when the ready egg is ejected ("ovulation"). After the egg is released, its former follicle closes off and becomes the "corpus luteum" .

    If, in either of these phases, larger than normal amounts of fluid collect, one can develop ovarian cysts that will cause pain or menstrual bleeding changes. A normal ovary is about 2 x 3 cm (almond sized). A follicular ovarian cyst, if the egg is not ejected and the amount of fluid continues to increase, can reach sizes of up to 10 cm. Fortunately most follicular cysts are smaller and will resolve within one to three months. If the size is large (eg greater than 8 cm) the heavy cyst can prompt the ovary to twist on itself like a heavy flower on a too fragile stalk. This twisting ("ovarian torsion") causes intense pain as it cuts off the blood supply to the ovary. While follicular cysts are the most common type of ovarian cysts, torsion is uncommon.

    Normally after ovulation a corpus luteum of less than 3 cm resolves within two weeks. If excessive amounts of fluid collect, a corpus luteum cyst can also get large enough to cause pain—or very rarely, ovarian torsion.

    Bottom line, do call about her symptoms--especially shortness of breath. If she develops escalating pelvic pain; call her GYN. I do not have specialty expertise in hematology so I do not know when it would be appropriate for her to have a formal work up. Her primary care MD or pediatric MD can give you the most "for sure" advice.

    In Concern,

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