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INTRODUCTION

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Pelvic masses are common and may involve reproductive organs or nongynecologic structures. Affected women can be symptom-free or may complain of pain, pressure, dysmenorrhea, infertility, or uterine bleeding. Treatment varies with patient age and therapeutic goals. Medical management is possible for many with pelvic masses, but for others, procedural interventions offer highest success rates.

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DEMOGRAPHIC FACTORS

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Of associated factors, pelvic mass rates and underlying pathology change with age. In prepubertal girls, most gynecologic pelvic masses involve the ovary. Even before puberty, ovaries are active, and masses are often functional, rather than neoplastic, cysts (de Silva, 2004). Of neoplastic lesions, most are benign germ cell tumors, especially mature cystic teratomas (dermoid cysts) (Brown, 1993). Malignant ovarian tumors in children and adolescents are rare, and this age group accounts for only 1.2 percent of all ovarian cancers (National Cancer Institute, 2014). Most cancers are germ cell tumors, and among children and adolescents, rates increase with age (American Cancer Society, 2014).

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In adolescents, the incidence and type of ovarian pathology in general mirrors that of prepubertal girls. However, with the onset of reproductive function, pelvic masses in adolescence may also include endometriomas and the sequelae of pelvic inflammatory disease (PID) and pregnancy.

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In adult women, the differential diagnosis for a pelvic mass expands. Uterine enlargement due to pregnancy, functional ovarian cysts, and leiomyoma are among the most common. Endometrioma, mature cystic teratoma, acute or chronic tuboovarian abscess (TOA), and ectopic pregnancies are other frequent causes. Most pelvic masses in this age group are benign, but malignancy rates increase with age.

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In postmenopausal women, with cessation of reproductive function, the causes of pelvic mass also change. Simple ovarian cysts and leiomyomas are still frequent. Menopause typically results in leiomyoma atrophy, but some uterine bulk may still persist. Importantly, malignancy is a more frequent cause in this demographic group. Ovarian cancer accounts for nearly 3 percent of new cancers among all women (American Cancer Society, 2014). Uterine tumors, including adenocarcinoma and sarcoma, can enlarge the uterus.

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LEIOMYOMAS

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Uterine enlargement most frequently reflects pregnancy or leiomyomas. Less often, enlargement is from adenomyosis, hematometra, an adhered adnexal mass, or malignancy. Of these, leiomyomas are benign smooth muscle neoplasms that typically originate from the myometrium. They are often referred to as uterine myomas, and they are colloquially called fibroids. Their incidence among women is generally cited as 20 to 25 percent, but is as high as 70 to 80 percent in studies using histologic or sonographic examination (Baird, 2003; Cramer, 1990). The health care consequences of these tumors are substantial. From 1998 to 2005, 27 percent of inpatient gynecologic admissions were for uterine leiomyoma care (Whiteman, 2010).

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Pathophysiology

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Pathology
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