Dermoid cyst

[sarahckitten]

I'm hoping to get some clarity about what I've just gone through. I have had problems with my periods for many years i'm 29. They have been irregular for as long as I can remember, since the age of 12 I have suffered with acne or spots all be it not the worst I have seen but since that age I have never had a year without them. Alongside this I had also developed other symptoms: milky discharge from my breasts, facial hair (again very mild) and pain in my left hand side lower abdomen. I am nurse so have a fairly good comprehension of what the likelihood of the cause was. In august last year, after years of putting it off or going to the gp and getting no where I finally plucked up the courage to go back to my GP and discuss all of my problems, particularly in view that the pain in the left hand side had developed which I had never had before. This pain was persistant for a period of about 3-4 weeks, but then began to subside although I still experienced sharp stabbing pain at least once a week and often pain which would radiate to my shoulder. I had some blood tests and a ultra sound scan. The blood tests showed a raised prolactin levels and the ultra sound showed lots of small follicles but inside my left ovary what was thought to be a dermoid cyst. I was referred to a gynaecologist and an endocrinologist. After a couple of MRI's and some more tests I was given a diagnosis of a microprolactinoma, as well as a 2cm dermoid cyst in the left ovary and what they thought to be polycystic. Due to they prolactinoma I cant have the contraceptive pill to help with the polycystic and initially the consultant gynaecologist I saw initially said they wanted to wait until I had got my prolactinoma sorted out before doing anything about the dermoid, however when I said I was experiencing pain, my consultant said that it would have to be removed so we may as well operate. I have been started on bromocriptine 2.5mg and surgery planned for my dermoid. Unfortunately my initial gynaecology consultant left and I was allocated a new gynaecologist. I had not met her prior to surgery but prior to this had receicved a letter saying to stop taking the contraceptive pill that they had started me (they hadn't) and that she would see me as planned for my laparoscopy- I had consented for a laparotomy due to risks around spillage of the dermoid.
To try and cut this story short, on the day of my surgery my consultant said that she was going to do a laparoscopy first then the laparotomy her reasoning was to establish whether the cyst was a true dermoid. After coming round the consultant said that I had signs of endometriosis but it was too near my bladder to remove and they cant put me on the pill due to my prolactinoma. She said the left ovary was enlarged and there was no cyst on the covary. I asked whether she had removed the cyst on the inside to which she replied how did I know it was the inside, which I explained that I had seen my results and my previous consultant had explained this, she then asked me what scans I had had to which I explained a mri and uss, surely she should have known this prior to operating on me. I am left feeling confused and struggling to understand what has happened I went in to have a cyst removed and come back out with a cyst still knowing what I knew before. Is there any rationale as to why this would have happened or is my gut feeling right whereby I feel that she hasn't read my notes. I know this is difficult to comment on but I am genuinely upset and distressed by this, I would say I have a good knowledge considering I am a general nurse but really am struggling with this. I hope you can help.

[Professor Sean Kehoe]

Can I suggest that you ask for a consultation with the Consultant who operated on you. Scan and MRIs are not 100% accurate as you know and it may well be that your ovary looked normal - hence no reason to remove, and indeed the endometriosis may explain your pain. Its difficult to answer all - naturally- but often a chat with the Consultant can permit some explanation and should give you some clarity as to the plans for the future. Hope this helps.

[sarahckitten]

Thank you. Can I ask if there is a dermoid cyst on the inside of the ovary would there be anything that would indicate this on the outside of the ovary. For example I know that my left ovary is enlarged, however otherwise the appearance is normal, if there is still a dermoid cyst there would there be other signs??

[Professor Sean Kehoe]

Yes indeed - you could have the outside looking normal and a small dermoid inside - the difficulty would be trying to remove it without damaging or indeed removing all the ovary

[Mr. Hugh Byrne, MRCOG]

Could I add few thoughts?

There is no need to stop the pill in advance of laparoscopic surgery.
If a prolactinoma is well controlled you can use the pill, according to recent guidelines from the faculty of family planning at the RCOG.
If the dermoid is as small as the scan suggest, it may not require at all but if it does then a laparoscopy should suffice - even if they contents are spilled these can be washed out laparoscopically.