The adnexal masses are lumps that occur in the appendages of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or non-gynecological.
An adnexal mass could be:
A family doctor can usually manage benign masses. However, prepubertal and postmenopausal people should consult a gynecologist or oncologist.
Malignant adnexal masses require treatment by a specialist.
In this article, we discuss the characteristics of adnexal masses. We also examine how doctors diagnose and treat them in the appendix.
People report different symptoms, depending on the cause of the adnexal mass.
People with adnexal mass can report:
- severe abdominal or pelvic pain usually on one side
- abnormal uterine bleeding
- pain during intercourse
- worsening of pain for a period
- painful periods
- abnormally heavy bleeding during menstruation
- abdominal symptoms, including feeling full, bloated, constipation, difficulty eating, increased abdominal size, indigestion, nausea and vomiting
- urinary urgency, frequency or incontinence
- weightloss
- lack of energy
- tired
- fever
- vaginal discharge
Different causes of adnexal masses may have similar symptoms, so doctors usually perform additional investigations to determine the exact cause.
Once the doctor has determined the cause of the adnexal mass, he can recommend treatment and management.
Adnexal masses include a variety of different conditions that vary in severity, from benign growths to malignant tumors.
The cause of adnexal masses can be gynecological or non-gynecological.
Some of the causes of adnexal masses include:
- Ectopic pregnancy: A pregnancy where the fertilized egg is implanted somewhere outside the uterus.
- Endometrioma: A benign cyst on the ovary that contains thick old blood that appears brown.
- Leiomyoma: A benign gynecological tumor, also known as a fibroid.
- Ovarian cancer: These ovarian tumors can be ovarian epithelial cancers that start in the cells on the surface of the ovary or malignant germ cell cancers that start in the eggs.
- Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. This happens due to an infection.
- Tubo-ovarian abscess: Infectious adnexal mass that forms due to pelvic inflammatory disease.
- Ovarian twist: Gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts blood flow to the ovary.
A doctor can diagnose an adnexal mass by:
- take a full medical history
- ask about symptoms
- perform a physical exam
- get blood samples
Most of the time, people will need a transvaginal ultrasound to allow doctors to assess the characteristics of an adnexal mass.
Women who have had a positive pregnancy test result and who report abdominal or pelvic pain and vaginal bleeding may have an ectopic pregnancy. Ovarian torsion causes sudden, intense pain accompanied by nausea and vomiting. Immediate medical attention is needed to treat both an ectopic pregnancy and an ovarian torsion.
People with inflammatory pelvic disease or a tubo-ovarian abscess may experience progressive pelvic pain accompanied by nausea and vaginal bleeding.
Early ovarian cancer can sometimes show non-specific symptoms. Sometimes doctors don't detect cancer until the tumor has become malignant.
Malignant tumors can have one or more of the following characteristics:
- a solid component of the tumor
- certain parts of the tumor have thick divisions of more than 2 to 3 centimeters separating them
- they are present on both sides of the reproductive system
- the presence of lumps filled with liquid
A doctor will choose the most appropriate treatment based on the cause of the adnexal mass. Women with an ectopic pregnancy should end their pregnancy. A doctor can choose one of the following procedures:
- one or two doses of intramuscular methotrexate
- laparoscopic surgery
- a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes
Doctors have not yet determined the optimal management of an endometrioma, according to a study presented in Obstetrics and gynecology survey.
Currently, possible treatments for an endometrioma include:
- watchful waiting
- medical therapy
- surgical intervention
- induce ovulation and use assisted reproductive technology in infertile women
People with pelvic inflammatory disease will need intravenous antibiotic courses, which may include:
- cefotetan (Cefotan)
- cefoxitin (mefoxine)
- clindamycin (Cleocin)
Some people may receive treatment outside the hospital with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).
In the past, tubo-ovarian abscesses were necessary surgical removal of the uterus, ovaries and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.
The ovarian torsion is a gynecological emergency. The only treatment is surgery to avoid serious damage to the ovaries and fallopian tubes.
People with leiomyomas or fibroids may receive hormone treatments or nonsteroidal anti-inflammatory drugs to control symptoms. Once a person stops taking medication, symptoms can return and fibroids can continue to grow. Surgery is the most effective treatment for fibroids.
Ovarian cancer treatment options include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:
- the type of ovarian cancer and the amount of cancer present
- stage and grade of cancer
- if the person has an accumulation of fluid in the abdomen causing swelling
- if surgery can remove the whole tumor
- genetic changes
- the person's age and general health
- if it's a new diagnosis, or if the cancer has come back
Risk factors depend on the cause of adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More ... than 80% females with ovarian twist have masses of 5 cm or more.
Doctors diagnose fibroids in about 70% white females and over 80% of black females by the age of 50. Other factors can increase the risk of developing fibroids, such as:
- beginning of the first periods of life
- use oral contraceptives before age 16
- an increase in body mass index (BMI)
Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:
The likelihood of developing cancer also tends to increase with age.
The adnexal masses are lumps that doctors can find in the appendix to the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous and not all of them need treatment.
Different types of adnexal mass can share many of the same symptoms. As a result, doctors should collect a full medical history and data from physical exams, blood tests, and medical imaging, including transvaginal ultrasounds.
Physicians must determine the location and cause of an adnexal mass to determine appropriate care and treatment.
