Adnexal mass

An adnexal mass denotes a growth that appears in the adnexa of the uterus, which encompasses structures intimately related to the uterus both structurally and functionally. This category includes the ovaries, fallopian tubes, and associated connective tissue. The nature of adnexal masses varies, with some being benign and others malignant. They can also be classified as simple or complex. The sonographic appearance of an adnexal mass serves as a key determinant in assessing its malignancy risk.

Clinical Features

Sonographic indications suggestive of a heightened risk of malignancy in an adnexal mass include:

• Presence of loculations
• Existence of nodules or papillary structures
• Appearance of septations
• Size exceeding 10 cm

Causes

Premenopausal Women

In females who are still menstruating, adnexal masses manifest due to a variety of reasons:

• Ovarian Cysts: These include both follicular cysts and corpus luteum cysts, with the former being more prevalent.
• Ectopic Pregnancies: When the pregnancy implants outside the uterus, primarily in the fallopian tubes.
• Benign and Malignant Tumors: Growth can either be noncancerous or cancerous.
• Endometriomas: Cysts formed due to endometriosis.
• Polycystic Ovaries: Characterized by the presence of many small cysts on the ovaries.
• Tubo-Ovarian Abscess: Pus-filled pockets that can arise as a complication of pelvic inflammatory disease (PID).

Postmenopausal Women

In women who have ceased menstruating, potential causes for adnexal masses include:

• Cancer: Ovarian or other gynecological malignancies.
• Fibroids: Noncancerous growths in the uterus.
• Fibromas: Benign tumors made up of fibrous or connective tissue.
• Diverticular Abscess: Pus-filled pockets forming as a complication of a diverticulitis attack.

Diagnosis and Management

Evaluating the exact nature of an adnexal mass is crucial for appropriate management. While sonography remains the primary diagnostic modality, further tests such as MRI, CA-125 levels, or biopsy might be required based on initial findings.

Treatment strategies are tailored according to the type, size, and suspected nature of the mass, patient age, and symptomatology. Options range from conservative monitoring to surgical intervention.

See Also

• Ovarian Cysts
• Pelvic Inflammatory Disease
• Endometriosis
• Gynecological Cancer

References

• Gynecologic Sonography: Principles and Techniques. Journal of Gynecologic Imaging, 21(1), 25-33.

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