Differential diagnosis of the adnexal mass
- Mitchel S Hoffman, MD
Mitchel S Hoffman, MD
- Professor of Obstetrics & Gynecology
- University of South Florida College of Medicine
- Section Editors
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
In gynecology, the adnexa refers to the region adjoining the uterus that contains the ovary and fallopian tube, as well as associated vessels, ligaments, and connective tissue. Pathology in this area may also arise from the uterus, bowel, retroperitoneum, or metastatic disease from another site, such as the breast or stomach.
A mass in the adnexa may be symptomatic or discovered incidentally. Some will regress spontaneously; others require a surgical procedure for histologic diagnosis and treatment.
The differential diagnosis of a woman with an adnexal mass will be reviewed here. Evaluation and management of adnexal masses in women and adnexal masses in children are discussed in detail separately. (See "Approach to the patient with an adnexal mass" and "Ovarian cysts and neoplasms in infants, children, and adolescents".)
An adnexal mass may be found in females of all ages, fetuses to the elderly. The reported prevalence varies widely depending upon the population studied and the criteria employed. In a random sample of 335 asymptomatic women aged 25 to 40 years, the point prevalence of an adnexal lesion on ultrasound examination was 7.8 percent (prevalence of ovarian cysts 6.6 percent) . In another series, transvaginal ultrasonography was performed on 8794 asymptomatic postmenopausal women as part of their routine gynecological check-up and 2.5 percent had a simple unilocular adnexal cyst . A study of 33,739 women in the University of Kentucky Ovarian Cancer Screening Program showed similar results .
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- RISK OF MALIGNANCY
- DIFFERENTIAL DIAGNOSIS
- Infants and adolescents
- Premenopausal women
- - Physiologic/functional cysts
- - Polycystic ovary syndrome
- - Pregnancy-related etiologies
- - Inflammatory etiologies
- - Benign ovarian neoplasms
- - Malignant ovarian neoplasms
- - Leiomyoma
- - Paraovarian/paratubal cysts and other tubal and broad ligament neoplasms
- Postmenopausal women
- - Ovarian carcinoma
- - Fallopian tubal carcinoma
- - Metastatic carcinoma
- - Benign ovarian cysts
- - Other etiologies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS