What is an Adnexal Mass?

When is an Adnexal Mass a Problem?

Young woman holding painful abdomen on sofa
BJI /Lane Oatey/Getty Images

Definition: Adnexal Mass

An adnexal mass is a growth or lump next to the uterus, most commonly arising from the ovary or fallopian tube.  These masses are usually benign, but can be cancerous.

What is Meant by an Adnexal Mass?

An adnexal mass refers to an abnormal mass of tissue that could be cystic or solid in the region near the ovaries. It can help to think about what other structures "live" in this region of the body when thinking of the possibilities for masses in this area.

  The ovaries, fallopian tubes, uterus, and connective tissue lie in this region.

Adnexal masses may occur at any age, though the most likely cause of masses varies with age.

Possible Causes of an Adnexal Mass

What could an adnexal mass be? There are literally hundreds of causes of adnexal masses. Some causes include:

Concerning Features of Adnexal Masses

Since adnexal masses are so common, physicians have looked at features that make them more concerning. That said, a mass could be cancer even if none of these features are present.  Features that raise more concern include;

  • When a mass is solid instead of cystic, or at least part solid
  • When the mass isn't regular, but has parts which have different densities
  • When the mass occurs in girls before their periods begin, or in women who are beyond menopause
  • When the cyst is painful
  • When the cyst is very large - though ovarian cysts can get quite large

    Imaging of an Adnexal Mass

    If an adnexal mass is felt on physical exam, there are several different imaging tests that may be done. These include:

    • Pelvic ultrasound - An ultrasound, especially a transvaginal ultrasound is often the first test done to evaluate an adnexal mass
    • Pelvic CT scan - A CT scan can help better characterize a mass found on ultrasound
    • Pelvic MRI
    • PET scan

    Lab Tests

    Diagnosing an Adnexal Mass - First Decisions

    The first decision is to decide if the mass is an emergency.  The second decision is to decide if the mass is something that can be followed for awhile to see if it is changing, or is it important to do surgery right away.

    If a pregnancy test is positive and a patient is looking very sick, the chance of a ruptured tubal pregnancy has to be considered as this is an emergency. If not pregnant, bleeding into a cyst or pelvic mass could also pose an emergency.

    Most of the time an adnexal mass is not an emergency, and there is time to further determine what it may be. A combination of imaging tests and lab tests may then be done.

    Mangement of Adnexal Masses

    Doctors look at several criteria when deciding if a mass should be removed by surgery, or if it can be monitored for some time.

    Since most ovarian cancers arise from the fallopian tubes instead of the ovaries, this is kept in mind.

    It would seem like, especially if it looks cystic, a sample of the fluid could simply be taken. This is not usually done (aspiration) because if it is cancer, there is a risk of seeding - in other words, cancer cells could be spread along the opening made by a needle.

    Surgery for Adnexal masses

    If there is a chance that an adnexal mass could be cancer, getting an opinion with a gynecologic oncologist is important, as ovarian cancer surgery performed by gynecologic oncologists seems to increase the likelihood of survival more than those surgeries performed by obstetrician gynecologists or general surgeons. When doing surgery, a physician should be prepared to do careful staging for ovarian cancer if this turns out to be the cause.

    Pronunciation: ad-NEK-suhl mass

    Also Known As: ovarian mass, pelvic mass

    Common Misspellings: adenexal mass

    Examples: On routine pelvic examination, the gynecologist felt an adnexal mass. On ultrasound it looked like it came from the ovary, but could be from the fallopian tube.

    Sources:

    Suh-Bergmann, E. and W. Kinney. Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses. American Journal of Obstetrics and Gynecology. 2015. 213(6):816.e1-4.

    Suh-Burgmann, E., and W. Kinney. The Value of Ultrasound Monitoring of Adnexal Masses for Early Detection of Ovarian Cancer. Frontiers in Oncology. 2016. 6:25.

    Dodge, J., Covens, A., Lacchetti, C. et al. Management of a suspicious adnexal mass: a clinical practice guideline. Current Oncology. 2012. 19(4):e244-57.

    Hall, T., and T. Randall. Adnexal mases in the premenopausal patient. Clinical Obstetrics and Gynecology. 2015. 58(1):47-52.

    Muto, M. Management of an adnexal mass. UpToDate. Updated 01/27/16. http://www.uptodate.com/contents/management-of-an-adnexal-mass

    Perera, D., and H. Prabhakar. Imaging of the adnexal mass. Clinical Obstetrics and Gynecology. 2015. 58(1):28-46.

    Rauh-Hain, J., Melamed, A., Buskowofie, A., and J. Schorge. Adnexal mass in the postmenopausal patient. Clinical Obstetrics and Gynecology. 2015. 58(1):53-65.

    Continue Reading