ESSENTIALS OF DIAGNOSIS
Benign adnexal mass refers not only to ovarian abnormalities but also to masses originating in the fallopian tube (ectopic pregnancy, pyosalpinx), ovaries (ovarian cyst, tuboovarian abscesses, adnexal torsion), uterine ligaments, lateral uterine masses (myomas), and gastrointestinal tract (diverticulitis, appendicitis) and even the urinary system (pelvic kidney).
Benign adnexal masses originating from the genital system are common in women in the reproductive age group and are caused by physiologic cysts or benign neoplasms.
Most adnexal masses are discovered incidentally, and the management of these benign masses is dictated by their presentation.
The evaluation of these masses should be assessed according to the algorithm shown in Figure 43–1, including a thorough patient history, physical examination, laboratory tests, and imaging modalities.
It is difficult to determine the frequency of benign disorders of the ovaries and tubes in women because many of these pelvic disorders are not symptomatic and are not treated with surgery. However, once an adnexal disorder is diagnosed, a meticulous evaluation should be performed, starting with a thorough history taking.
Patient history should include review of patient age and family history, in particular for the occurrence of ovarian or breast familial cancers. A full physical examination should be performed, including a node survey and breast, abdominal, and pelvic examination. In many cases, radiologic studies, including ultrasonography of the pelvis and sometimes computed tomography (CT), are of most importance in the assessment of the patient with an adnexal mass (Fig. 43–1). One way to approach the adnexal mass is to think of it in regard to the patient’s age. For the young woman, the majority of ovarian cysts are benign: hemorrhagic corpus luteum follicular cysts and dermoid cysts are common in this age group; however, tubal abnormalities, including ectopic pregnancies, and sequela from tubal infection should be strongly considered (Table 43–1). On the other hand, the majority of ovarian or tubal cancers occur postmenopausally.
Triage for evaluation of an adnexal mass. CT, computed tomography; MRI, magnetic resonance imaging.
Table 43–1.Differential diagnosis of adnexal masses. |Favorite Table|Download (.pdf) Table 43–1. Differential diagnosis of adnexal masses.
|Associated with pregnancy |
|Ovarian or adnexal masses |
|Functional cysts |
|Inflammatory masses |
|Tubo-ovarian complex |
| Benign |
| Malignant |
|Paraovarian or paratubal cysts |
|Intraligmentous myomas |
|Nongynecologic masses |
|Diverticular abscess |
|Appendiceal abscess |
|Peritoneal cyst |
|Stool in sigmoid |
|Less common conditions that must be excluded |
|Pelvic kidney |
|Carcinoma of the colon, rectum, appendix |
|Carcinoma of the fallopian tube |
|Retroperitoneal tumors (anterior sacral meningocele) |
|Uterine sarcoma or other malignant tumors |
The clinical challenge in assessing an adnexal mass is to distinguish between a benign and malignant mass (Table 43–1) or findings that indicate ...