EpistemisPalpable adnexal mass
Specialty: Gynecology and breast.
Why it occurs
- Functional ovarian cyst (follicular or luteal cyst, benign and self-limiting)
- Endometrioma (chocolate cyst due to endometriosis)
- Benign cystic teratoma (dermoid cyst)
- Serous or mucinous ovarian cystadenoma
- ectopic pregnancy
- Ovarian epithelial or germinal neoplasia (ovarian cancer, fallopian tube or pelvic metastases)
Initial workup
High resolution transvaginal gynecological ultrasound with color Doppler (applying the criteria of the International Ovarian Tumor Analysis - IOTA). Determination of serum tumor markers: Ca-125, HE4 (for calculation of the ROMA index), CEA, Ca 19-9, and in young patients AFP and beta-hCG. MRI of the pelvis with contrast to characterize indeterminate or suspicious masses.
red flags
Palpable mass in a postmenopausal woman (the normal ovary should not be palpable at this stage), mass of solid or fixed consistency in the pelvis, presence of detectable clinical ascites, acute or sudden onset pelvic pain (suggestive of adnexal torsion or cyst rupture), unexplained weight loss and early satiety.
Standard management
- There are no drugs that dissolve organic adnexal tumors. Functional cysts smaller than 5-6 cm are usually managed with expectant management and ultrasound control in 8-12 weeks. The use of combined oral contraceptives can be prescribed to prevent the appearance of new functional cysts, but it does not accelerate the resolution of existing ones (note: if there is a high suspicion of malignancy or adnexal torsion, the therapeutic approach of choice is laparoscopy or surgical laparotomy).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 6
- Treatment options
- 1