What is an adnexal mass?

An adnexal mass is a mass of tissue in the adnexa of the uterus, which refers to the space occupied by the uterus, ovaries, and fallopian tubes. These can take the form of different types of malignant or benign masses. In premenopausal women, most adnexal masses are caused by ectopic pregnancy, ovarian cysts, tumors, polycystic ovaries, and abscesses. After menopause, the most likely causes include fibroid tumors, fibroids, and malignancies. The most common places for an adnexal mass to grow are the fallopian tubes or the ovary.

Most adnexal masses are benign, but diagnosing an adnexal mass is difficult because there are many forms a mass can take. Even in a healthy ovary, follicular cysts can develop half a dozen times in a single year. Most of the time, these cysts develop, shrink, and disappear within a single menstrual cycle. However, in some cases they grow and remain in the ovary, fallopian tubes, or uterus.

A definitive diagnosis of an adnexal mass is often never reached. This is because for a diagnosis to be made, a woman must undergo a surgical biopsy procedure so that a sample of the mass can be obtained for laboratory analysis. Therefore, an adnexal mass should be carefully evaluated using information obtained from ultrasound and other tests to determine whether a mass is likely to be malignant or benign. Another common factor with these types of masses is that most are asymptomatic and are discovered during a pelvic exam or other routine exam, and not because they cause pain or discomfort.

The presence of certain risk factors indicates the likelihood of a cancerous mass or another type of mass that may be of concern. Solid tumors and large cysts are generally considered to be of greater concern than small cysts or those that contain fluid. In prepubescent and postmenopausal women, any mass is of greatest concern because benign follicular cysts are not a likely cause of adnexal masses in these age groups. For example, in girls younger than 9 years old, about 80 percent of adnexal masses are cancerous. By contrast, in women of reproductive age, only 10 percent of masses are malignant.

Small, asymptomatic masses usually do not require any treatment. Instead, these masses are monitored with tests and pelvic exams. In cases where the mass is large or causing symptoms, it is surgically removed. Surgery is generally more aggressive and involves the removal of more tissue when the mass is malignant. This is important to prevent recurrence or spread of cancer. Surgical removal of a malignant tumor is likely to be followed by a course of chemotherapy treatments.

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