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adnexal mass (ovarian mass)

Etiology: 1) endometrioma 2) dermoid cyst (teratoma) 3) broad ligament fibroids 4) ovarian torsion 5) hydrosalpinges 6) ovarian cancer 7) ovarian cyst Laboratory: - serum CA125 (in combination with pelvic ultrasound) [2] Special laboratory: - biopsy of suspected ovarian mass is contraindicated - may result in rupture & dissemination of cancer [1] Radiology: 1) pelvic ultrasound (initial imaging modality of choice) - factors favoring malignancy a) large size b) solid components c) papillary projections d) ascites e) positive CA125 [2] 2) magnetic resonance imaging - useful in distinguishing various etiologies Management: - symptomatic patients - surgical excision - asymptomatic patients - many ovarian masses identified with vaginal ultrasound, including those with complex features, eventually resolve [3] - small (1-6 cm) complex ovarian masses on ultrasound in post-menopausal women are rarely malignant, especially if serum CA-125 levels are normal - complex masses that increase in size or complexity should be surgically excised* [3] - survival benefit of intact removal of adnexal mass in patients with early stage ovarian cancer [1] - follow-up pelvic ultrasound in 3-6 months if no surgery * case presentation of a 58 yo woman with bilateral complex adnexal masses, one 13 cm in size, the other 6 cm in size; exploratory surgery was recommended; there was no discussion regarding criteria for expoloratory surgery vs follow-up pelvic ultrasound [1]

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adnexa

General

abnormal morphologic structure (malformation)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  2. McDonald JM et al. Predicting risk of malignancy in adnexal masses. Obstet Gynecol 2010 Apr; 115:687. PMID: 20308826 - Falcone T. Adnexal masses: When to observe, when to intervene, and when to refer. Obstet Gynecol 2010 Apr; 115:680. PMID: 20308824
  3. NEJM Journal Watch. August 2, 2013 Kaunitz AM. Massachusetts Medical Society http://www.jwatch.org - Pavlik EJ et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol 2013 Aug; 122:210. PMID: 23969786 - Herzog TJ. Enhancing the needle count in the haystack: Serial ultrasonography for low-to-moderate risk adnexal masses. Obstet Gynecol 2013 Aug; 122:198. PMID: 23969785
  4. Suh-Burgmann E et al. Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol 2014 Dec; 211:623.e1 PMID: 25068555 http://www.ajog.org/article/S0002-9378%2814%2900793-5/abstract
  5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007 Jul;110(1):201-14. PMID: 17601923 corresponding NGC guideline withdrawn Nov 2016
  6. Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol. 2011 Aug;205(2):97-102. Review. PMID: 21571247