By Tedler D. Depaynos, MD
Cyst in simple terms is just a tumor mainly made up of fluid. If it is located in the ovary, it is called Ovarian Cyst. In general they are mostly benign. In some cases, fluid may be present but the solid components may be significant and even predominate. This could easily be seen through Ultrasound. In these cases, the probability of being malignant becomes higher. This was the case of a 34 year old pregnant patient.
The last time she had a pelvic Ultrasound (UTZ) was more than 4 years ago when she was pregnant with her first child. With her second pregnancy, she was discovered to have a very huge Ovarian Cyst with a diameter of around 15 cm. when a routine UTZ was done. Throughout the years she was asymptomatic so that the discovery was just incidental. Actually she was diagnosed to be in her 7th week of pregnancy or first trimester. Her Obstetrician-Gynecologist (OB-GYN) cannot assure her, however, that it is 100% benign because of the solid components of the Cyst and besides the impression is only thru UTZ.
If the Cyst is malignant she was advised immediate surgery. The risk to the unborn child however, is immeasurable. During the first trimester, the organs of the fetus are still in the process of being formed so that exposure to anesthesia and of course “stress” may result in abnormalities which may be obvious when the child is born. On the other hand, the spread of malignancy may also be detrimental to the mother if the excision is delayed.
Various opinions were expressed. Other experienced OB-Gyn-Ultra –Sonologists who were consulted insisted that just by the looks of it in the ultrasound, it is benign. If it is malignant, just by the mere size, metastasis should already be present. Besides, the healthy condition of the child should be predominantly considered. Actually this became the main opinion. Delay the surgery at least until the 2nd trimester when the fetal organs are more or less already formed. Delaying the surgery until delivery was not an option because of the huge size of the Cyst. It may crowd the enlarging uterus which may not be good to the growing fetus. Besides because of the size of the Cyst possible twisting at its base or leakage due to rupture may suddenly occur as complication.
They also emphasized that excision of the cystic ovary is not a difficult surgery and the anesthesia being given to patients nowadays easily were off. It was the mother however that was made to finally decide what the surgeons would do. She agreed to postpone the surgery until the 2nd semester. She was thinking more of her unborn child and she could not imagine her child to be having abnormalities.
Her OB-Gyn then advised her to have an Ultrasound follow-up monthly and warned her of the possible complications of the huge Ovarian Cyst.
A week before her scheduled UTZ, she was awakened due to severe abdominal pain. She was then rushed to the ER and true enough, the impression was a twisted Ovarian Cyst. She underwent emergency surgery. The twisted Ovarian Cyst was easily removed and the OB-Gyn even left the involved ovary intact. The other was not touched because it appeared normal.
The surgery was uneventful and it was done on the 2nd trimester. She was very much happy which made her forget the post-operative pains when she was discharged especially when she learned that the excised Cyst was benign. She promised herself to name her child in honor of her surgeon.
Her OB-Gyn who related the story mentioned that everything was God’s will as we finished eating our pancakes.
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