Management of Adnexal Masses

Abstract

The differential diagnoses of an adnexal mass range from benign functional ovarian cysts to metastatic ovarian carcinoma. The goal of the clinician is to differentiate benign conditions from more serious life-threatening or malignant conditions. Work-up of an adnexal mass demands a thorough history and physical exam followed by gray-scale transvaginal ultrasonography (Givens et al. Am Fam Physician 2009;80(8):815–20). Findings that are suspicious for carcinoma include symptoms of bloating, increasing pelvic or abdominal pain, weight loss coupled with the presence of a solid component or complex mass, positive Doppler flow in the mass, thick septations, mural nodules, or presence of ascites. In an asymptomatic postmenarchial woman, [regardless of age] with an adnexal mass, transvaginal ultrasonography is the initial imaging study of choice (Guideline Summary. American College of Obstetricians and Gynecologists NGC.006539 2007 Jul reaffirmed 2011. https://www.guideline.gov/summaries/summary/12631. Assessed 2 Sept 2016). Simple ovarian “simple cysts” can be found routinely in both premenopausal and postmenopausal women (Healy et al. Menopause 2008;15(6):1109–14), and hemorrhagic corpus luteum cysts (3–5 cm in size) can occur in early (within 5 years of) menopause (Seungdamrong and Weiss. Fertil Steril 2007;88(5):1438 e1-2). A serum Ca-125 should not be used routinely in premenopausal women (US Preventive Service Task Force 2016; American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110(1):201–14).