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Differential diagnosis of the adnexal mass

INTRODUCTION

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".)

PREVALENCE

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) [1]. 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 [2]. A study of 33,739 women in the University of Kentucky Ovarian Cancer Screening Program showed similar results [3].

The distribution of histologic types of adnexal masses in one study of over 600 women is shown in the table (table 1) [4]

                    

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Literature review current through: Mar 2014. | This topic last updated: Jan 17, 2014.
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