What Is an Adnexal Mass?

An abnormal collection of tissue near the ovaries

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An adnexal mass is a growth or lump next to the uterus, most commonly arising from the ovaries, fallopian tubes, or connective tissues. These abnormal masses of tissue can be cystic or solid and, while usually benign, can be cancerous. Adnexal masses may occur at any age, though the most likely cause does in fact vary with age.

Causes & Testing

There are literally hundreds of causes of adnexal masses.

Some include:

Since adnexal masses are so common, physicians have to consider a variety of worrisome features before diagnosis. That said, a mass could be cancer even if none of these features are present. Such 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.

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

  • 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

Other lab tests that can also be performed include:

Diagnosis

When diagnosed with an adnexal mass, 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 tracked for awhile to see if it changes or if surgery is needed right away.

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.

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

Management

Doctors look at several criteria when deciding if a mass should be removed by surgery or if it can be monitored for some time. This is a very important consideration since most ovarian cancers arise from the fallopian tubes instead of the ovaries.

If it looks especially cystic, it would seem like a sample of the fluid could simply be taken, called an aspiration. This is not usually done 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.

Treatment

If there is a chance that an adnexal mass could be cancer, getting an second opinion from a gynecologic oncologist is important.

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 performing surgery, a physician should be prepared to do careful staging for ovarian cancer if this turns out to be the cause.

Sources:

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

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

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

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

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

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