- 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 41–1, including a thorough patient history, physical examination, laboratory tests, and imaging modalities.
Triage for evaluation of an adnexal mass.
Patient history should include review of patient age and family history in particular for the occurrence of ovarian familial cancers. A full physical examination should be performed, including a node survey and breast, abdominal, and pelvic examination. In many cases the radiologic studies, including ultrasonography of the pelvis and sometimes computed tomography (CT), would be of most importance in the assessment of the patient with an adnexal mass (Fig. 41–1). 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 41–1). On the other hand, the majority of ovarian or tubal cancers occur postmenopausally.
The clinical challenge in assessing an adnexal mass is to distinguish between a benign and malignant mass (Table 41–1) or findings that indicate a need for intervention or treatment versus masses that can be followed up conservatively (Fig. 41–1). Generally, when malignancy is not suspected, and if clinically the patient is stable, then expectant management is indicated, as many of these cysts are physiologic in nature and thus are expected to regress over time.
Table 41–1. Differential Diagnosis of Adnexal Masses. |Favorite Table|Download (.pdf)
Table 41–1. Differential Diagnosis of Adnexal Masses.
Associated with pregnancy
Ovarian or adnexal masses
Paraovarian or paratubal cysts
Stool in sigmoid
Less common conditions that must be excluded
Carcinoma of the colon, rectum, appendix
Carcinoma of the fallopian tube
Retroperitoneal tumors (anterior sacral meningocele)
Uterine sarcoma or other malignant tumors
Patients should be re-evaluated 6 weeks after initial presentation, and persistent masses should ...