adnexal mass (ovarian mass)
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Etiology
- endometrioma
- dermoid cyst (teratoma)
- broad ligament fibroids
- ovarian torsion
- hydrosalpinges
- ovarian cancer
- ovarian cyst
Laboratory
- serum CA125 (in combination with pelvic ultrasound)[2]
Diagnostic procedures
- biopsy of suspected ovarian mass is contraindicated
- may result in rupture & dissemination of cancer[1]
Radiology
- pelvic ultrasound (initial imaging modality of choice)
- factors favoring malignancy
- large size
- solid components
- papillary projections
- ascites
- positive CA125[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]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
- ↑ 2.0 2.1 2.2 McDonald JM et al. Predicting risk of malignancy in adnexal masses. Obstet Gynecol 2010 Apr; 115:687. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20308826
Falcone T. Adnexal masses: When to observe, when to intervene, and when to refer. Obstet Gynecol 2010 Apr; 115:680. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20308824 - ↑ 3.0 3.1 3.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/23969785 - ↑ 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25068555 <Internet> http://www.ajog.org/article/S0002-9378%2814%2900793-5/abstract
- ↑ American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007 Jul;110(1):201-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17601923 corresponding NGC guideline withdrawn Nov 2016
- ↑ Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol. 2011 Aug;205(2):97-102. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21571247