Adnexal mass

Gyn Normal external appearance of labia minora and majora, vaginal walls within normal limits, cervix well visualized and without lesions, midposition uterus, no cervical motion tenderness, no adnexal masses palpated... 

The approach to diagnosing an adnexal mass discovered on pelvic examination depends on several factors, including the patient s reproductive age, adnexal mass size, menopausal status, and symptoms. Exploratory laparotomy is indicated in premenarchal women, women with masses greater than 8 cm, women with masses that increase or persist through several menstrual cycles or that are fixed to peritoneal surfaces, women with bilateral masses, or women with intra-abdominal pain or ascites. ... 

Another measure of outcome is the effectiveness of UFE in avoiding other treatments for fibroids, as measured by subsequent medical therapies or additional surgery. For example, hysterectomy or additional hysteroscopic resection or myomectomy for clinical failure or recurrence after UFE is an important measure of safety and a key outcome measure of UFE [2]. Spies et al. [9] reported nine (4.5%) hysterectomies out of 200 patients within 12 months of therapy. Seven of the patients underwent hysterectomy for clinical failure after UFE. The other two patients underwent incidental hysterectomy for treatment of a tubo-ovarian abscess and an adnexal mass. In a series of 400 women. Walker and Pelage [7] reported 23... 

Scoutt LM, McCarthy SM, Lange R, Bourque A, Schwartz PE (1994) MR evaluation of clinically suspected adnexal masses. J Comput Assist Tomogr 18 609-618... 

Adnexal Masses Characterization of Benign Ovarian Lesions 199... 

Discrimination between benign and malignant ovarian tumors in patients who present with an adnexal mass is important for several reasons. It may directly affect the surgical decisions, including the adequate therapeutic... 

Fig. 9.6. Incomplete septations. Parasagittal T2-weighted images of a left adnexal mass. Incomplete interdigitating septa (arrows) are typical findings of a hydrosalpinx arising from the uterus. Widening of the fallopian tube to a diameter of 4 cm at the fimbriated end is seen...

Fig. 9.13. Struma ovarii. Transaxial CT in a young woman who presented with a complex adnexal mass at sonography and no evidence of hyperthyreosis. A left adnexal (arrow) surrounded by ascites is demonstrated in the cul-de-sac. It is well defined, shows a thin wall, and demonstrates a solid and cystic architecture. Within the lesion a locule (asterisk) of high density presents hemorrhage. By bladder. Courtesy of Dr. T.M. Cunha, Lisbon...

The value of imaging in patients with clinically suspected functioning ovarian tumors is to rule out an adnexal mass. In case of virilization, it may also confirm the diagnosis of polycystic ovaries, and rule out an adrenal mass by thorough assessment of the adrenal glands. 

With the widespread use of abdominal ultrasound during pregnancy, adnexal masses are concurrently diagnosed with increasing frequency. Adnexal mass-... 

Pain or an acute abdomen should alert to complications due to hemorrhage, rupture, and torsion of the adnexal mass (Fig. 9.17) or caused by nongyne-cological pelvic diseases. 

Fig. 9.31. Collision tumor of the ovary. CT at the level of the mid pelvis in a 65-year-old woman with sonographically suspected ovarian cancer. A cystic right adnexal mass is demonstrated showing multiple thin septa-tions and a 3-cm lesion with fat density and mural calcifications (asterisk). Pathologically, a collision tumor composed of a benign mucinous cystadenoma and a benign dermoid was diagnosed...

Fibromas and fibrothecomas are solid ovarian tumors accounting for 3%-4% of all ovarian tumors and 10% of solid adnexal masses. They are typically unilateral (90%), and occur in peri- and postmenopausal age women. 

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