ADNEXAL MASS: SYMPTOMS, CAUSES AND TREATMENTS - MEDICINE - 2025

An adnexal mass is a lump of tissue in the organs located on the side of the uterus: the ovaries, ligaments, and fallopian tubes. It is also known as a pelvic mass or ovarian mass.

Normally the ovary can produce cysts several times during the year, and most of the masses that are found are benign. In fact, in common cases, these functional cysts disappear without treatment. However, in some situations if the cyst persists or enlarges, it can turn into a pathological adnexal mass.

The age of the patient is a crucial factor in determining the probable etiology of an adnexal or pelvic mass. Since the ovaries produce physiological cysts in menstruating women, the probability of a benign process is higher than in women of reproductive age. In contrast, the presence of an adnexal mass in prepubertal girls and postmenopausal women increases the risk of a malignant neoplastic etiology.

You may also be interested in The 9 types of main cysts to know a little more about this pathology.

Causes of adnexal mass

Ectopic pregnancy

It occurs when a pregnancy forms outside the uterus. The most common is an ectopic pregnancy in the fallopian tube and can cause pain. If you have a positive pregnancy test and a sudden onset of pelvic pain, call your doctor immediately because these pregnancies can exceed the fallopian tube, rupture, and cause severe bleeding.

Polycystic ovary

This ovary becomes enlarged due to the development of many small follicles, and this is typically seen in women who have polycystic ovary syndrome.

Twisted ovary

If the ovarian mass is large, ovarian torsion can occur. Ovarian torsion can completely cut off the blood supply, resulting in a non-functional or "dead" ovary.

Any type of adnexal mass, benign or malignant, can suffer torsion. Typically, a woman with torsion has pelvic pain, possible low-grade fever, and an adnexal mass.

Endometrioma

It is an ovarian cyst that contains tissue from the uterine lining or endometrium. It is also known as the "chocolate cyst" because the fluid inside is the blood from the endometrial tissue and it appears the color of chocolate.

Functional cysts

During ovulation an egg matures into a follicle that develops and then breaks to release the egg. This indicates that a corpus luteum will grow to help maintain hormones if pregnancy is achieved.

The corpus luteum is reabsorbed if a pregnancy is not conceived. If the follicle does not rupture, it can continue to grow until it becomes a follicular cyst. If the corpus luteum does not resorb and continues to grow, it is called the corpus luteal.

Fibroma

It is a solid benign tumor of the ovary that may be associated with fluid in the abdomen and lungs (Meigs syndrome). This is generally seen in postmenopausal women.

Dermoid

This cyst arises in the ovary and is a benign tumor that usually contains tissue such as hair, muscle, and teeth.

Fibroid

It is a benign tumor of the uterine muscle that can grow adjacent to the uterus, appearing in the adnexal region.

Cystadenoma

It is a common benign tumor that can contain serous or mucinous fluid within the cyst.

Some can produce increased levels of different types of hormones, such as androgens, estrogens (granulosa cell tumors), male hormones (Sertoli-Leydig cell tumors), or thyroid hormone (Struma Ovarii).

Tubo-ovarian abscess

It is a collection of pus in the tubes and ovaries that is often accompanied by symptoms of abdominal pain, fever, and vaginal discharge. It is sexually transmitted and can cause infertility. Tubo-ovarian abscess implies an acute infection and therefore requires immediate medical attention.

Hydrosalpinx

It is a benign process of fluid trapped within a fallopian tube. This can cause pain and lower fertility rates.

Cancer

Cancer can develop in the ovary or the fallopian tube. Other cancers, especially of the breast and gastrointestinal tract, can also spread to the adnexal region.

Treatment

Treatment options are based on age, medical history, physical exam, and laboratory and imaging tests. Here are some more common adnexal masses treatment options:

Ectopic pregnancy

In an asymptomatic patient, a drug called methotrexate can be administered with serial ultrasound and followed by laboratory monitoring until the pregnancy is reabsorbed.

Depending on the characteristics of the ectopic pregnancy and the severity of its symptoms, the patient may be a candidate for medical or surgical therapy.

Polycystic ovary

There are no specific treatments per se. However, women with the syndrome may consider losing weight and taking birth control pills to help regulate their menstrual cycles.

Functional cysts

Observation is adequate with ultrasound. Some women are suggested birth control pills to prevent ovulation and the formation of these cysts. Surgery to preserve the ovary is recommended if the cyst is large enough to twist.

Dermoid

Surgery is recommended to prevent growth, torsion, and rupture.

Endometrioma

These cysts do not usually disappear spontaneously or respond to medication. Therefore, surgery may be recommended for its removal.

Cystadenoma

Surgical removal is recommended to prevent growth, torsion, rupture, and rule out malignancy.

Fibroma

Since this cyst is more common in postmenopausal women, surgical removal of that ovary and tube is recommended. In some cases, preservation of the ovary can be accomplished by removing the fibroid alone.

Hydrosalpinx

If fertility is desired, the tube may need to be surgically repaired.

Tubo-ovarian abscess

A visit to the hospital is required to assess the signs of infection and the response to intravenous antibiotics. Drainage of the abscess can be done, especially if symptoms do not improve within 24-48 hours, or it can be removed surgically.

Cancer

Referral to an oncologist is recommended for a thorough treatment discussion.

Other considerations

If the ovarian mass is thought to be benign, preservation of the ovary simply by removing the cyst (cystectomy) from the ovary is strongly recommended. Sometimes the entire ovary can be removed. If this is done, the fallopian tube is usually removed as well. This procedure is called a Salpingo-oophorectomy.

Any mass, whether it be the cyst wall or the ovary, is referred to pathology to confirm whether it is benign or malignant.

Surgeries are generally performed through the laparoscope and are ambulatory, which makes recovery faster and causes less pain.

References

1. Michel E Rivlin (2017). Adnexal Tumors. Medscape. Recovered from: emedicine.medscape.com.
2. Aspira Labs Staff. What is Pelvic Mass ?. Aspira Labs. Recovered from: vermillion.com.
3. Janet Drake (1998). Diagnosis and Management of the Adnexal Mass. American Family Physician. Recovered from: aafp.org.
4. The Editors of Encyclopædia Britannica (2017). Postpartum hypertension. Encyclopædia Britannica, Inc. Recovered from: britannica.com.