A Adnexal mass Is a lump of tissue in the organs located on the side of the uterus: the ovaries, ligaments and fallopian tubes. It is also known as pelvic mass or ovarian mass.
Normally the ovary can produce cysts several times during the year, and most of the masses found are benign. In fact, in the common cases, these functional cysts disappear without treatment. However, in some situations if the cyst persists or becomes enlarged, it may become a pathological adnexal mass.
The age of the patient is a crucial factor in determining the probable etiology of an adnexal or pelvic mass. Since the ovaries produce physiological cysts in women who menstruate, the probability of a benign process is greater than in women of reproductive age. In contrast, the presence of an adnexal mass in prepubertal and postmenopausal women increases the risk of a malignant neoplastic etiology.
You may also be interested in The 9 types of main cysts To know a little more about this pathology.
Causes of the adnexal mass
Ectopic pregnancy
It occurs when a pregnancy forms outside the uterus. The most common is an ectopic pregnancy in the fallopian tube and can cause pain. If you have a positive pregnancy test and a sudden onset of pelvic pain, call your doctor immediately because these pregnancies can overcome the fallopian tube, rupture and cause severe bleeding.
Polycystic ovary
This ovary is enlarged due to the development of many small follicles, and this is typically observed in women who have polycystic ovary syndrome .
Ovary twisted
If the ovarian mass is large, ovarian torsion may occur. Ovarian torsion can completely cut off blood supply, resulting in a nonfunctional or"dead"ovary. Any type of adnexal mass, benign or malignant, can suffer torsion. Typically, a woman with twisting has pelvic pain, possible low-grade fever, and an adnexal mass.
Endometrioma
It is an ovarian cyst that contains tissue from the uterine lining or endometrium. It is also known as the"chocolate cysts,"because the fluid inside is the blood of the endometrial tissue and is seen the color of chocolate.
Functional cysts
During ovulation an ovum matures into a follicle that develops and then breaks to release the ovum. This indicates that a corpus luteum will grow to help maintain hormones if pregnancy is achieved.
The corpus luteum is reabsorbed if pregnancy is not conceived. If the follicle does not rupture, it can continue to grow into a follicular cyst. If the corpus luteum is not resorbed and continues to grow, it is called the luteal corpus.
Fibroma
It is a solid benign tumor of the ovary that may be associated with fluid in the abdomen and lungs (Meigs Syndrome). This is usually seen in postmenopausal women.
Dermoide
This cyst appears in the ovary and is a benign tumor that usually contains tissue such as hair, muscle, and teeth.
Fibroid
It is a benign tumor of the uterine muscle that can grow adjacent to the uterus, appearing in the adnexal region.
Cystadenoma
It is a common benign tumor that may contain serous or mucinous fluid inside the cyst.
Some may produce increased levels of different types of hormones, such as androgens, estrogens (granular cell tumor), male hormones (Sertoli-Leydig cell tumors), or thyroid hormone (Struma Ovarii).
Tubeovaric abscess
It is a collection of pus in the tubes and ovaries that is usually accompanied by symptoms of abdominal pain, fever and vaginal discharge. This is transmitted sexually and can cause infertility. Tubo-ovarian abscess involves an acute infection and therefore requires immediate medical attention.
Hydrosalpinx
It is a benign process of fluid trapped within a fallopian tube. This can cause pain and decrease fertility rates.
Cancer
Cancer can develop in the ovary or fallopian tube. Other cancers, especially of the breast and gastrointestinal tract, may also spread to the adnexal region.
Treatment
Treatment options are based on age, medical history, physical examination, and laboratory and imaging analyzes.
The following are some treatment options for the most common adnexal masses:
Ectopic pregnancy
In an asymptomatic patient, a drug called methotrexate can be given with serial ultrasound and laboratory follow-up until the pregnancy is reabsorbed.
Depending on the characteristics of the ectopic pregnancy and the severity of its symptoms, the patient may be a candidate for medical or surgical therapy.
Polycystic ovary
There are no specific treatments per se. However, women with the syndrome may consider losing weight and taking birth control pills to help regulate their menstrual cycles.
Functional cysts
Observation is adequate with ultrasound. Some women are suggested birth control pills to prevent ovulation and the formation of these cysts. Surgery to preserve the ovary is recommended if the cyst is large enough to undergo twisting.
Dermoide
Surgery is recommended to prevent growth, torsion and rupture.
Endometrioma
These cysts do not usually disappear spontaneously or respond to medication. Therefore, surgery may be recommended for excision.
Cystadenoma
Surgical removal is recommended to prevent growth, torsion, rupture and rule out malignancy.
Fibroma
Since this cyst is more common in postmenopausal women, surgical removal of this ovary and tube is recommended. In some cases, preservation of the ovary can be done with the removal of the fibroma alone.
Hidrosálpinx
If fertility is desired, the tube may need to be surgically repaired.
Tubeovaric abscess
It is necessary to go to the hospital to evaluate the signs of infection and the response to intravenous antibiotics. Drainage of the abscess can be performed, especially if the symptoms do not improve within 24-48 hours, or can be surgically removed.
Cancer
Referral to an oncologist is recommended for a thorough discussion on treatment.
Other considerations
If ovarian mass is thought to be benign, the preservation of the ovary is strongly recommended by simply removing the cyst (cystectomy) from the ovary. Sometimes the entire ovary can be removed. If this is done, the fallopian tube is also generally removed. This procedure is called Salpingo-oophorectomy.
Any mass, either the cyst wall or the ovary, is sent to the pathology to confirm whether it is benign or malignant.
Usually surgeries are performed through the Laparoscope And are ambulatory, which makes recovery faster and cause less pain.
References
- Michel E Rivlin (2017). Adnexal Tumors. Medscape. Retrieved from: emedicine.medscape.com.
- Aspira Labs Staff. What is Pelvic Mass?. Aspira Labs Retrieved from: vermillion.com.
- Janet Drake (1998). Diagnosis and Management of the Adnexal Mass. American Family Physician. Retrieved from: aafp.org.
- The Editors of Encyclopædia Britannica (2017). Postpartum hypertension. Encyclopædia Britannica, Inc. Retrieved from: britannica.com.