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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Joseph Miller for taking part in the program.

December : Gynecological Surgery

Question 1
I have had two pelvic ultrasounds 10/11/06 and 11/20/06 which the radiologists who've read them recommended an MRI. The MRI shows a very complex result. Within the L ovary there are two components seen. #1 a simple cyst #2 there is a hyperintense area on the images which shows enhancement on the post-contrast study. Size is approx. 7mm in widest dimension. The etiology of this enhancing solid appearing mass within the L ovary is undetermined. It is suggesting either a hemorrhagic cyst or endomentrioma. An underlying mass within the L ovary cannot be definately exluded. The radiologist who read this MRI is recommending ANOTHER ultrasound. I don't understand why. My GYN wants to send me to a fertility specialist. I understand they deal with ovarian problems, but I am a 46 year old woman who is NOT planning for anymore children. I do not want another ultrasound after two of them showed something that couldn't be defined, and recommended I have an MRI which is still undetermined or definitive as to what this "mass" is. I guess I just need another opinion as to what to do, or where to go. Is removing the ovary a fair option, the right option? Is there a high risk that whatever this mass is, will burst, or could it be a malignant mass INSIDE the ovary? I bleed about two weeks out of every month, and with the bleeding I do have a lot of pain on the L side. It's more a tugging pain, and a menstrual type pain, associated with a very bad lower lumbar pain that just aches so bad. I did have a bone scan on 11/2/06 to rule out any metastasis done along with these other tests, and it was negative.

Thank you for your time, I hope you find this interesting enough to have posted, or answer me through an email. Anything would be appreciated.

7mm area most probably is endometrium or hemorrhagic cyst and if no pain is present then does not need to be removed at this time. You do not need another ultrasound at this time. If any strong family history for ovarian or breast carcinoma exists I would recommend blood testing the CA-125 level. Removing the ovary is definitely a valid option especially since you have increased pain on that side. It sounds like you need a laparoscopic removal of your left ovary and fallopian tube and I recommend you speak to your physician about this.

Question 2
I'm wondering if you could provide me with some advice regarding a possible exposure to toxins during pregnancy. When I was 5 weeks and 6 days pregnant, my our new leather couch was delivered to our flat. The flat is very small. The lounge room is downstairs and the bedroom is upstairs. I was there when the couch was delivered to the downstairs area and it was wrapped in plastic and paper. The couch was made in China I think and had recently arrived in Australia. The couch smelled very strongly of toxins, so I did my best to hold my breath while it was delivered and I left the flat shortly after it was delivered. My boyfriend subsequently went home and unwrapped the couch and then told me that most of the smell was on the plastic and the couch itself didn't smell much. So, I went home, but to be on the safe side, I stayed upstairs with the bedroom door shut. Unfortunately, I couldn't leave the bedroom window open for ventilation because the people in the coffee shop three floors below were refurbishing and painting that very night, and I was afraid the fumes would come into my bedroom!

In the morning I felt fine when I woke up and I couldn't smell the couch toxins in the bedroom. However, after getting out of bed, I started coughing. I had a dry cough that was activated if I breathed deeply or exerted myself. When I went downstairs, I realised that the couch was emitting a strong toxic odor. I am very worried that perhaps the toxins offgassing from the couch came upstairs and under the door while I was sleeping and exposed the fetus to harm. My boyfriend didn't seem to suffer any symptoms and thinks I'm being parnoid. Another possible cause of my cough is that I quit smoking about two weeks ago. I understand that quitting smoking can bring on a cough. However, I'm worried because the cough only started after I slept in the flat with the couch and I don't have any other flu-like symptoms. I have since done my best to avoid the flat, but I'm still very worried. I still have the cough now, two days later.

I would be very grateful for your opinion on whether it's likely that I was exposed to toxic substances and the likelihood the exposure caused any harm.

Exposure to volatile aromatic agents and toxins for such a short term has absolutely no effects on our pregnancy, something which I tell patients especially in the 1st trimester is that exposure to environmental toxins is an all or nothing phenomenon. If any harm was done you would have presented with symptoms of a miscarriage at this point pertaining to your cough – 1st rule out an infection/bronchitis. Also, occasionally I prescribe an inhaler and I recommend mucinex TABS T orally 2x a day for mucous reduction.

Question 3
I have been suffering with ovarian pain, particularly on the left side every other month. It usually lasts for five days and by the fifth day I am in such pain its unbearable. I ususall take advil, but it does not seem to help. My Mother was diagnosed on mid-October with ovarian cancer. She was operated on November 2nd and we were told that the cancer had spread to her uterus, abdomen and small bowel. She died on November 25th. My Mother swore she never had any pain before they told her of this. I am worried that I will get the ovarian cancer and she died before they could do a genetic marker test on her. Is there any test to determine if the pain I have might one day be cancer? Also we have a strong history of breast cancer in our family. My Mother had a masectomy 12 years ago, and her Mother had breast cancer while pregnant with my Mom and died shortly after giving birth to her.

There is a connection between Familial Inheritance of breast and ovarian cancer. Depending on your age there are several ways we can approach this. Initial work-up and evaluations would require pelvic and transvaginal ultrasound along with serum tumor markers including a CA-125 level. If you are over 30 years old you would need a mammogram and you would also be a candidate for genetic counseling and possibly BRCA1 & 2 gene mutation testing."

Question 4
What is a subserosal fibroid ( 2.2 x2.1 x1.9 cm ) located in the uterus and is it dangerous? Also what does it mean when the uterus is anteverted

Subserosal Fibroid is in the outer layer of the uterus closer to your intestines. These types of fibroids do not usually cause increased bleeding however they can cause pain. This fibroid is relatively small at less than 3cm and if you do not have any pain or abnormal bleeding it probably does not require removal.

An anteverted uterus is not abnormal and means it is tilted forward towards the bladder. Retroverted would be tilted toward the rectum. If you have bladder pressure symptoms you may need to treat the fibroid.

Dr. Miller's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.