Adnexal masses are growths found in the tissues surrounding the uterus. These masses are common in gynecologic practice and can affect women of all ages.
Understanding Adnexal Masses
An adnexal mass is any lump or swelling found in the adnexa of the uterus. The adnexa includes the ovaries, fallopian tubes, and supporting connective tissues. While most adnexal masses originate from these gynecological structures, some can arise from nearby organs like those in the urinary or digestive systems.
These masses can be fluid-filled or solid, and their nature ranges from benign (non-cancerous) to malignant (cancerous).
Common Types and Causes
Adnexal masses can stem from various conditions, with most being benign. In premenopausal women, common causes include ovarian cysts. These can be follicular cysts, which form when an egg-containing follicle grows instead of rupturing, or corpus luteum cysts, which develop when the corpus luteum doesn’t break down after ovulation. Hemorrhagic cysts, involving bleeding into a corpus luteum cyst, are also common.
Endometriomas, or “chocolate cysts,” are benign masses from endometriosis, where uterine lining-like tissue grows on the ovaries and forms cysts filled with old blood. Dermoid cysts, also known as mature cystic teratomas, are benign tumors that can contain various tissues like hair, fat, or teeth. A hydrosalpinx, where a fallopian tube becomes blocked and fills with fluid, can also present as an adnexal mass.
Infections can lead to adnexal masses, such as a tubo-ovarian abscess, a collection of pus in the fallopian tube and ovary, often a complication of pelvic inflammatory disease. An ectopic pregnancy, where a fertilized egg implants outside the uterus, most commonly in the fallopian tube, is a serious cause of an adnexal mass.
While less common, malignant adnexal masses, such as ovarian cancer, can occur. These cancerous growths may originate in the ovaries or fallopian tubes, or spread from other cancers. The risk of malignancy generally increases in postmenopausal women.
Symptoms and Diagnosis
Many adnexal masses cause no symptoms and are often discovered incidentally during routine medical examinations or imaging. When symptoms do occur, they can include pelvic or abdominal pain, which may be localized to one side, and a feeling of fullness or pressure in the pelvis.
Other symptoms include changes in bowel or bladder habits, such as constipation, bloating, frequent urination, or difficulty urinating. Abnormal vaginal bleeding, including heavier or more painful periods or bleeding during intercourse, can also be present. Nausea, vomiting, or fever may accompany the mass, particularly with infections or conditions like ovarian torsion.
The diagnostic process typically begins with a physical examination, including a pelvic exam. Transvaginal ultrasonography is the primary imaging method to evaluate the mass’s characteristics, such as its size, consistency, and presence of solid components. MRI or CT scans may be used for further detailed assessment, especially if malignancy is suspected or if the mass is large or complex.
Blood tests, such as a pregnancy test to rule out ectopic pregnancy, and a CA-125 level, may also be performed. While CA-125 can be elevated in ovarian cancer, it can also be high in benign conditions, so it is not used as a standalone diagnostic tool.
Management Options
The management approach for an adnexal mass is determined by its type, size, characteristics, the patient’s age, and symptoms. Many benign adnexal masses, particularly simple ovarian cysts, resolve on their own within a few months and may only require watchful waiting with regular follow-up examinations and ultrasounds.
Medical management, such as hormonal therapy, may be considered for certain cysts. Oral contraceptive pills may help lower the incidence of some benign ovarian cysts. If a mass grows, causes symptoms, or develops concerning features, surgical intervention may be necessary.
Surgical options include minimally invasive procedures like laparoscopy or open surgery via laparotomy. Laparoscopy involves smaller incisions and is often preferred for benign masses. Laparotomy may be used for larger or more complex masses, or when malignancy is suspected. Following removal, the mass is sent for pathological examination to determine if it is benign or malignant, which guides any further treatment.