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Differential diagnosis of the adnexal mass

Mitchel S Hoffman, MD
Section Editors
Howard T Sharp, MD
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


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) [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: Jun 2016. | This topic last updated: Jan 17, 2014.
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  1. Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old. Ultrasound Obstet Gynecol 1999; 13:345.
  2. Castillo G, Alcázar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol 2004; 92:965.
  3. Pavlik EJ, Ueland FR, Miller RW, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol 2013; 122:210.
  4. Guerriero S, Alcazar JL, Ajossa S, et al. Comparison of conventional color Doppler imaging and power doppler imaging for the diagnosis of ovarian cancer: results of a European study. Gynecol Oncol 2001; 83:299.
  5. Norris HJ, Jensen RD. Relative frequency of ovarian neoplasms in children and adolescents. Cancer 1972; 30:713.
  6. Kinkel K, Lu Y, Mehdizade A, et al. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization--meta-analysis and Bayesian analysis. Radiology 2005; 236:85.
  7. Simpkins F, Zahurak M, Armstrong D, et al. Ovarian malignancy in breast cancer patients with an adnexal mass. Obstet Gynecol 2005; 105:507.
  8. Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol 2002; 87:77.
  9. Gilman, J, Stein H. The corpus luteum of pregnancy. Surg Gynecol Obstet 1941; 72:129.
  10. Clement PB. Tumor-like lesions of the ovary associated with pregnancy. Int J Gynecol Pathol 1993; 12:108.
  11. Guerriero S, Alcazar JL, Coccia ME, et al. Complex pelvic mass as a target of evaluation of vessel distribution by color Doppler sonography for the diagnosis of adnexal malignancies: results of a multicenter European study. J Ultrasound Med 2002; 21:1105.
  12. Killackey MA, Neuwirth RS. Evaluation and management of the pelvic mass: a review of 540 cases. Obstet Gynecol 1988; 71:319.
  13. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2010; 256:943.
  14. Herbst AL. Neoplastic Diseases of the Uterus. In: Comprehensive Gynecology, Manning S, Steinborn E, Salway J (Eds), Mosby-Year Book, Inc, St. Louis 1992. p.924.
  15. Vang R, Wheeler JE. Diseases of the fallopian tube and paratubal region. In: Blaustein's Pathology of the Female Genital Tract, 6th ed., Kurman RJ, Ellenson LH, Ronnett BM. (Eds), Springer, New York 2011. p.529.
  16. Katz VL. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary. In: Comprehensive Gynecology, 5th ed, Katz VL, Lentz GM, Lobo RA, Gershenson DM (Eds), Mosby Elsevier, Philadelphia 2007. p.452.
  17. Savelli L, Ghi T, De Iaco P, et al. Paraovarian/paratubal cysts: comparison of transvaginal sonographic and pathological findings to establish diagnostic criteria. Ultrasound Obstet Gynecol 2006; 28:330.
  18. Samaha M, Woodruff JD. Paratubal cysts: frequency, histogenesis, and associated clinical features. Obstet Gynecol 1985; 65:691.
  19. Smorgick N, Herman A, Schneider D, et al. Paraovarian cysts of neoplastic origin are underreported. JSLS 2009; 13:22.
  20. Terada T. Borderline serous papillary tumor arising in a paraovarian cyst. Eur J Obstet Gynecol Reprod Biol 2010; 150:215.
  21. Valentin L, Skoog L, Epstein E. Frequency and type of adnexal lesions in autopsy material from postmenopausal women: ultrasound study with histological correlation. Ultrasound Obstet Gynecol 2003; 22:284.
  22. Dørum A, Blom GP, Ekerhovd E, Granberg S. Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study. Am J Obstet Gynecol 2005; 192:48.
  23. Greenlee RT, Kessel B, Williams CR, et al. Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial. Am J Obstet Gynecol 2010; 202:373.e1.
  24. Modesitt SC, Pavlik EJ, Ueland FR, et al. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol 2003; 102:594.