An adnexal mass refers to a growth or swelling that develops in the pelvic area, specifically near the uterus. This region, known as the adnexa, includes the ovaries, fallopian tubes, and the supporting ligaments and connective tissues. Adnexal masses are a common finding and can occur in individuals of all ages.
What is an Adnexal Mass?
An adnexal mass is an abnormal growth or lesion found in the adnexa of the uterus. This region includes the ovaries, fallopian tubes, and surrounding ligaments and connective tissues. They vary in composition, appearing as fluid-filled sacs (cystic masses) or solid growths. An adnexal mass does not automatically imply a serious condition; they can be benign (non-cancerous) or, less commonly, malignant (cancerous). Many benign adnexal masses may resolve on their own within a few months.
How Ultrasound Helps Identify and Characterize Adnexal Masses
Ultrasound is the primary imaging method used to detect and characterize adnexal masses. This non-invasive technique uses sound waves to create images of the pelvic organs. The procedure can be performed transabdominally, where a transducer moves across the abdomen, or transvaginally, which involves inserting a slender transducer into the vagina for detailed views. Transvaginal ultrasound offers higher resolution images for better visualization.
Sonographers examine specific features of the mass on ultrasound images to help differentiate between benign and malignant characteristics. These features include the mass’s size, shape, and internal composition, noting if it is purely fluid-filled, entirely solid, or a mixture of both. They also assess the presence and thickness of internal septations, which are dividing walls within the mass, and observe the appearance of its outer borders. Blood flow patterns within the mass, detected using Doppler ultrasound, can suggest malignancy. These detailed characteristics help healthcare providers evaluate the likelihood of a mass being benign or malignant.
Common Types of Adnexal Masses
Adnexal masses encompass a wide range of growths, with most being benign. Functional ovarian cysts are among the most common benign types, including follicular cysts and corpus luteum cysts. Endometriomas, also known as “chocolate cysts,” are benign cysts filled with old blood and associated with endometriosis. Dermoid cysts, or mature cystic teratomas, are benign tumors that can contain various tissues like hair, fat, or teeth. Hydrosalpinx, a fluid-filled fallopian tube, is also a benign adnexal mass.
A pedunculated uterine fibroid, a benign growth from the uterus, may present as an adnexal mass if it extends into the adnexal region. While most adnexal masses are non-cancerous, ovarian cancer is a primary concern for malignant adnexal masses. Ultrasound characteristics such as solid components, thick septations greater than 2 to 3 mm, or the presence of ascites (fluid in the abdomen), can raise suspicion for malignancy. Other cancers, such as those from the breast or gastrointestinal tract, can also spread to the adnexal region.
Next Steps After Detection
Once an adnexal mass is identified on ultrasound, further evaluation is often necessary to determine its nature and guide management. This may involve additional imaging studies, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT), which provide more detailed anatomical information. Blood tests, including tumor markers like CA-125, may also be performed, though CA-125 levels can be elevated due to benign conditions. Consultations with specialists, such as a gynecologist or gynecologic oncologist, may be recommended, especially for complex or suspicious masses.
The management approach for an adnexal mass depends on its characteristics, including size, appearance on imaging, associated symptoms, patient’s age, and medical history. Options range from watchful waiting with repeat ultrasounds, particularly for smaller, simple cysts. Medical management, such as hormonal therapy, may be considered for certain types of cysts. Surgical intervention, performed via laparoscopy or laparotomy, may be necessary for symptomatic masses, those with concerning features, or masses that persist or grow. It is important to remember that many adnexal masses are benign and may not require aggressive intervention, often resolving on their own.