Ovaries and fallopian tubes constitute adnexes. As fallopian tube masses are very rare, an adnexial mass usually points to an ovarian mass. These masses may be ovarian cysts as well as inflammatory masses. It is not always easy to know the exact origin of a palpable adnexial mass. These masses may also originate from uterus, intestines or bladder. In the presence of an adnexial mass, a comprehensive history and diagnostic tests maya aid accurate diagnosis.
History
As for all other diseases, a complete history is important for accurate diagnosis of adnexial masses. Details in the history may help in decision making.
Patient age is important. A postmenopausal adnexial mass is highly suspicious for malignancy. In the case of an adnexial mass below 20 years, a dermoid cyst is probable. Functional cysts are common for reproductive age women. Palpable ovaries are pathologic during postmenopausal years. Ovaries may be palpated in young women.
After patient age, complaints are important in the history. As adnexial masses have few symptoms, complaints in the history are important. Pain points to an inflammatory process or to endometriosis rather than a follicle cyst or tumor. If menstruel irregularity accompanies an adnexial mass, a follicle cyst or corpus luteum cyst is most probable.
Physical examination
Gynecologic examination is important for differential diagnosis. Mobility, size and localization of the cyst are important. Midline masses usually originate from the uterus whereas adnexial masses usually originate from ovaries. Cystic and unilateral masses are usually benign. Solid and bilateral masses are suspicious for malignancy. Presence of ascites is an evidence for malignancy.
Ultrasonography
Ultrasonography has utmost importance for modern gynecologic practice. Ultrasonography renders diagnosis of most diseases and follow-up of pregnancy easier. With its lower price, almost every gynecolog has an ultrasonography machine in his office. Development of doppler sonography is a facility for evaluation of adnexial masses.
Ultrasonography is the most important diagnostic tool for adnexial masses. Ultrasonography determines the size, localization and nature of the cyst. Presence of septa points to a possible malignancy. Malignancy may also be assessed by using doppler sonography which shows resistance to blood flow.
Computerized tomography (CT) and magnetic resonance imaging (MRI)
CT and MRI provide more information about bigger lesions and malignancies. They are useful for staging malignancies. Their routine use for adnexial masses is not advised.
Biochemical tests
Some malignancies produce molecules that are called “tumor markers”. Most commonly used marker is called CA-125. It is especially produced by serous cystadenocarcinomas. But the marker is not specific for malignancies as its levels may be increased in case of endometriosis, infection or smoking.
Other markers are CA-19-9, beta hCG, alpha-fetoprotein and CEA. But these markers are not specific. They are less useful for diagnosis than for follow-up.
As an adnexial mass is diagnosed, next thing to do is to decide whether this mass requires surgery.
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