Name: Mall Singh Bhullar Kuldip Singh

Student ID: 18100753

Case Summary: Ms. XX is a 20-year-old Polish Lady who was referred by her GP to UHG with initial
complaints of abdominal pain and PV bleeding.

Her abdominal pain was in the right suprapubic region, constant for a few weeks, and she describes
it as a mild pressure. As for her PV discharge, it is not clear and there was blood.

She had a private MRI done previously which showed a 6.2 x 4.0 x 5.3 cm heterogenous lesion
(dermoid cyst) on her right ovary.

She denies post-coital bleeding, intermenstrual bleeding, dyspareunia, and vulval skin changes or
itching.

Other relevant parts of history:

Past Obstetric History/Menstrual History: Menstruation regular 28 day cycles, lasting for 5 days, LMP
3 weeks ago. On Cilest.

Past Gynae History: Normal

Past Medical History: Normal

Medications: NKDAs. Cilest 250mcg+35mcg tablets OD. Dymista 137 mcg+50mcg Nasal BD.

Past family history: Father has hypertension. Mother has history of cervical erosion and ovarian
cysts.

Learning points:

In this case, I learned a lot about the following:

1. The more common clinical presentations/demographics associated with ovarian cysts.

2. MRI vs Ultrasound as a tool for investigating benign ovarian masses.

Hassan S. Abduljabbar et al. discussed 244 cases of ovarian cysts including demographic
characteristics and clinical presentations along with the frequency of which they present at.
Abdominal pain, vaginal bleeding and incidental findings turned out to be the three top clinical
presentations of ovarian cysts, coming in at 58.2%, 19.3% and 9.8% respectively. However, there are
a certain smaller percentage of women with ovarian cysts who presents with abdominal swelling (if
in the later stages) and infertility issues. Moving on to the demographic characteristics, non-
pregnant women (91.8%) has a higher presentation as compared to pregnant women (6.6%). As for
the location of the cyst, unilateral cysts tend to be more common than bilateral cysts (79.5% vs
18.9% respectively) [1].

According to the RCOG guidelines, a pelvic ultrasound is the single most effective way of evaluating
an ovarian mass with transvaginal ultrasonography being preferable due to its increased sensitivity
over transabdominal ultrasound. At the present time the routine use of computed tomography and
MRI for assessment of ovarian masses does not improve the sensitivity or specificity obtained by
transvaginal ultrasonography in the detection of ovarian malignancy. However, a study done by
Amela Sofic et al. came with a results that showed TVU demonstrated 62.5% sensitivity for dermoid
cysts whereas MRI demonstrated 87.5% for the same. The analysis using the chi square test shows
that there is a significant difference in the sensitivity between the US and MRI in favor of greater
overall MRI sensitivity in diagnosing pain caused by benign ovarian lesions (χ2 = 14.352, df = 9, p =
0.0021) [2,3].

Reflection:

As I was consulting Ms XX, she displayed a sense of worry about her fertility as she kept asking me if
she would be infertile for the rest of her life, because she is young. I did not know the answer to her
question and did not know how to control the situation. I then remembered that if we do not know
the answer to a question, the best thing to do is to look it up. She said her Dr told her that dermoid
cysts do not affect fertility. I told her I would search for the answer it would bring clarity to her mind
(it does not affect fertility, although a tough debate). From this experience, I know that taking a few
minutes to search for an answer on the internet is worth so much more compared to time ‘saved’ if
it will bring peace to a patient’s mind. I also learned how to comfort young patients like her who may
have their lives ruined. In the future, as a doctor, I will strive to learn the answers to all common
challenges that patients like Ms XX might face. This may boost their confidence in me as their doctor
and will without a doubt establish rapport.