Materiały źródłowe

• #1 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Most of the adnexal masses are benign, without symptoms diagnosed incidentally, and can have expectant management. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] Transvaginal ultrasonography is the single most effective way of evaluating an ovarian mass. […] The diagnosis of adnexal mass in women with pelvic symptoms or incidentally represents a routine in gynecological practice and often presents diagnostic and management dilemmas. […] The mainstream to management of adnexal masses is excluding malignancies. […] The characterization of malignancy findings on the image (TVUS or MRI) is the key since women with ovarian cancer should preferably be treated in oncological referral centers as soon as possible.

• #2 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Most of the adnexal masses are benign, without symptoms diagnosed incidentally, and can have expectant management. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Correct differential diagnoses of benign and malignant mass matter. […] Transvaginal ultrasonography is the single most effective way of evaluating an ovarian mass. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The suspicious ovarian cysts should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan. […] Spillage of cyst contents should be avoided preoperative and intraoperatively.

• #3 Adnexal Mass: Tumor, Cyst, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22015-adnexal-mass-tumors

  An adnexal mass forms near your ovaries, fallopian tubes or surrounding connective tissues. Most adnexal tumors are benign (noncancerous), but they can be malignant (cancerous). Many adnexal masses go away on their own, but some require treatment, which may include surgery. […] Treatment for adnexal masses depends on the specific cause. There are generally three options for treatment: No treatment. If the mass is small and painless and your provider is certain its not cancerous, they may recommend no further treatment. Monitoring. If your provider isnt entirely sure whats causing the mass or they have concerns about your symptoms, the size of the mass or the possibility its cancer, they may watch the mass over time. Most adnexal masses grow slowly. Monitoring involves follow-up appointments to check on how the mass changes and grows. Surgery. If your provider believes the mass is suspicious, or if its large and causing you pain, removing the mass is an option. Surgery may be necessary at any time if a mass gets too large, resembles cancer or causes you discomfort. If the mass is an ectopic pregnancy, you may need surgery immediately.

• #4 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  The normal functioning ovary produces a follicular cyst 6-7 times each year. In most cases, these functional cysts are self-limiting and resolve within the duration of a normal menstrual cycle. In rare situations, a cyst persists longer or becomes enlarged. At this point, it represents a pathological adnexal mass. […] Adnexal masses present a diagnostic dilemma; the differential diagnosis is extensive, and most masses are benign. However, without histopathologic tissue diagnosis, a definitive diagnosis is generally precluded. Physicians must evaluate the likelihood of a concerning pathologic process using clinical and radiologic information and balance the risk of surgical intervention for a benign versus malignant process. […] Since ovaries produce physiologic cysts in menstruating women, the likelihood of a benign process is higher in women of reproductive age. In contrast, the presence of an adnexal mass in prepubertal girls and postmenopausal women heightens the risk of a malignant neoplastic etiology.

• #5 eMedicine – Adnexal Tumors : Article by Nelson Teng, MD, PhD

  http://www.csh.org.tw/dr.tcj/Educartion/f/web/Adnexal%20Tumors/index.htm

  During the course of her lifetime, every woman develops several adnexal masses. […] In rare situations, they will persist longer or become greater than 7 cm in diameter. It is at this point that they become a pathological condition. […] When a woman presents with the symptoms of abdominal bloating, gastrointestinal upset, and pelvic pressure, she should be considered a likely candidate for a malignant adnexal mass. […] The following masses pose the greatest concern: Those that are greater than 7 cm in diameter, Those that persist beyond the length of a normal menstrual cycle, Those that have solid components, Those that have a complex internal structure, Those that are associated with pain. […] Determining the frequency of adnexal masses is impossible because most develop and resolve without clinical detection.

• #6 Adnexal tumors and masses – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/adnexal-tumors-and-masses/

  Adnexal tumors and masses are growths of cells that form on the organs and connective tissue around the uterus. Adnexal tumors and masses most often aren’t cancer, but they can be cancer. […] Diagnosis of adnexal tumors and masses involves a careful physical exam, imaging tests and blood tests. Treatment depends on the size of the tumor or mass and its cause. […] To diagnose adnexal tumors and masses, a healthcare professional may start with a pelvic exam. Other tests and procedures might include imaging tests and blood tests. […] Treatment for adnexal tumors and masses depends on the type of growth and what’s causing it. In some situations, such as with a small cyst, no treatment may be needed. […] Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it’s causing symptoms or if it could be cancer.

• #7 Evaluation and Management of Adnexal Masses | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2016/11/evaluation-and-management-of-adnexal-masses

  ABSTRACT: Adnexal masses (ie, masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetriciangynecologists and often present diagnostic and management dilemmas. […] Management decisions often are influenced by the age and family history of the patient. […] Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. […] The purpose of this document is to provide guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women and to outline criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist.

• #8 Adnexal tumors and masses // Middlesex Health

  https://middlesexhealth.org/6D45A9E4-E604-A092-1C3D05EBD13B3C7F

  Adnexal tumors and masses are growths of cells that form on the organs and connective tissue around the uterus. Adnexal tumors and masses most often aren’t cancer, but they can be cancer. […] Diagnosis of adnexal tumors and masses involves a careful physical exam, imaging tests and blood tests. Treatment depends on the size of the tumor or mass and its cause. […] Many adnexal tumors and masses don’t cause symptoms. They’re often found during a medical exam that’s done for another reason. […] When adnexal tumors and masses cause symptoms, the symptoms may include: Pain, including pain in the pelvis or belly, painful period cramps that are worse than usual, and painful sex. […] Treatment for adnexal tumors and masses depends on the type of growth and what’s causing it. In some situations, such as with a small cyst, no treatment may be needed. […] Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it’s causing symptoms or if it could be cancer.

• #9 Adnexal/pelvic mass – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/obstetrics-and-gynecology/adnexal-pelvic-mass/

  In the United States, the diagnosis of an adnexal or pelvic mass will occur in five to ten percent of women in their lifetime. Although commonly benign, a small percentage (15 to 20 percent) will be malignant and diagnosis of these at the earliest possible stage is of critical importance. […] The most common symptoms encountered in a patient with an adnexal or pelvic mass are abdominal fullness, abdominal bloating, pelvic pain, difficulty with bowel movements, and increased frequency of urination, abnormal vaginal bleeding, or pelvic pressure. […] The presence of a pelvic or adnexal mass, as stated earlier, is most commonly demonstrated on an imaging study for either gynecologic or other unrelated issues. Imaging studies are most commonly performed in response to symptoms rather than concern on a pelvic or abdominal exam.

• #10 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Pelvic examination has low sensitivity for detecting an adnexal mass; negative pelvic examination findings in a symptomatic woman should not deter further workup. […] Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. […] If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated. […] The clinician needs to interpret symptoms and findings from multiple organ systems and use appropriate imaging to differentiate expeditiously between a benign and a malignant cause of an adnexal mass.

• #11

  https://www.ijrcog.org/index.php/ijrcog/article/view/676

  The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. […] Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal. […] Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis.

• #12 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. […] Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Family physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.

• #13 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Most of the adnexal masses are benign, without symptoms diagnosed incidentally, and can have expectant management. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Correct differential diagnoses of benign and malignant mass matter. […] Transvaginal ultrasonography is the single most effective way of evaluating an ovarian mass. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The suspicious ovarian cysts should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan. […] Spillage of cyst contents should be avoided preoperative and intraoperatively.

• #14 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass, with a sensitivity of 93.5% and a specificity of 91.5%. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases. […] If an adnexal mass persists for longer than 12 weeks, referral to a gynecologist is indicated.

• #15 Management of a suspicious adnexal mass: a clinical practice guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3410836/

  Sonography (particularly 3-dimensional sonography), magnetic resonance imaging (mri), and computed tomography (ct) imaging are each recommended for differentiating malignant from benign ovarian masses. […] Where technically feasible, transvaginal sonography should be the modality of first choice in patients with a suspicious isolated ovarian mass. […] To help clarify malignant potential in patients in whom ultrasonography may be unreliable, mri is the most appropriate test. […] In cases in which extra-ovarian disease is suspected or needs to be ruled out, ct is the most useful technique. […] Evaluation of an adnexal mass by Doppler technology alone is not recommended. Doppler technology should be combined with a morphology assessment. […] Ultrasonography-based morphology scoring systems can be used to differentiate benign from malignant adnexal masses.

• #16 Management of a suspicious adnexal mass: a clinical practice guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3410836/

  As a standalone modality, serum cancer antigen 125 is not recommended for distinguishing between benign and malignant adnexal masses. […] Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow. […] To improve survival, comprehensive surgical staging with lymphadenectomy is recommended for the surgical management of patients with early-stage ovarian cancer. […] Laparoscopy is a reasonable alternative to laparotomy, provided that appropriate surgery and staging can be done. […] Fertility-preserving surgery is an acceptable alternative to more extensive surgery in patients with low-malignant-potential tumours and those with well-differentiated surgical stage i ovarian cancer.

• #17 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  Most adnexal masses resolve spontaneously over time; therefore, care must be taken to not overreact to such a finding. For example, in the International Ovarian Tumor Analysis Phase 5 (IOTA5) study, the incidence of spontaneous resolution within 2 years of follow-up among patients with an adnexal mass with benign ultrasound morphology was 20.2%. Surgeons who rush women with small, asymptomatic masses into surgery often create more pathology than they cure. Any surgery performed on adnexal structures can result in impaired fertility. […] On the other hand, these same asymptomatic masses can be early ovarian cancers that require immediate attention. The use of radiologic testing often helps determine which women require attention. Serum testing of CA-125 can be used in combination with radiologic testing to stratify the risk of adnexal masses. However, it is important to recognize the limitations of this serum marker. A large Swedish study has shown that approximately 50% of women with stage I ovarian cancer have a normal CA-125 test value. In addition, a high false-positive rate can be caused by pregnancy, endometriosis, cirrhosis, and pelvic or other intra-abdominal infections. CA-125 screening does not add useful information for specific diagnosis of benign adnexal tumors except for endometrioma. An elevated level significantly increases the probability of such a lesion.

• #18 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  The goal of evaluation is to differentiate between benign and more serious conditions, such as ovarian cancer. […] The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination. […] Gray-scale transvaginal ultrasonography is the preferred imaging modality for the evaluation of adnexal masses. […] Management of adnexal masses in women of reproductive age depends on pregnancy status and the size and complexity of the mass. If the pregnancy test is positive, ectopic pregnancy must be ruled out. Adnexal masses coincidental with intrauterine pregnancy have a low risk of becoming symptomatic during pregnancy, and they are most often benign; therefore, they may be observed until the postpartum period.

• #19 Adnexal Tumors Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/258044-treatment

  Asymptomatic, small, well-characterized adnexal masses may be observed with regular pelvic examinations and radiologic evaluations. A surgical approach should be used if growth occurs in these masses, if the patient becomes symptomatic, or if the cyst develops more concerning features, such as solid components. […] Cyst aspiration is contraindicated, especially in postmenopausal patients. In benign cysts, cyst wall removal is necessary to prevent recurrence and aspiration has little therapeutic benefit. […] All adnexal masses that are symptomatic or have characteristics of a malignancy should be considered for surgical evaluation. […] Among women undergoing minimally invasive resection of adnexal masses, a transvaginal approach for specimen removal is associated with less postoperative pain than a transumbilical approach.

• #20 eMedicine – Adnexal Tumors : Article by Nelson Teng, MD, PhD

  https://www.csh.org.tw/dr.tcj/educartion/f/web/Adnexal%20Tumors/index.htm

  Asymptomatic, small, well-characterized adnexal masses can be observed with regular pelvic examinations and radiological evaluations. A surgical approach should be employed if any growth occurs in these masses. […] All adnexal masses that are symptomatic or have characteristics of a malignancy must be addressed with surgical removal. […] Most adnexal masses require little more than the normal annual gynecological examination for follow-up as they rarely recur. […] Women found to have a malignancy will require additional therapy, such as chemotherapy or radiation therapy. Their follow-up will include frequent re-examinations to determine the disease status.

• #21 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Nonpregnant, premenopausal women with an adnexal mass most likely have a follicular cyst. Simple cysts 10 cm or smaller can be managed conservatively with serial ultrasonography. […] Postmenopausal women with a complex adnexal mass of any size or a simple cyst larger than 10 cm should be referred to a gynecologist or gynecologic oncologist.

• #22 Evaluation of the Adnexal Mass in an Older Patient

  https://exxcellence.org/pearls-of-exxcellence/list-of-pearls/evaluation-of-the-adnexal-mass-in-an-older-woman/

  The evaluation and management of an adnexal mass in an older patient is a common clinical challenge. […] The goal is to identify malignancy while minimizing unnecessary surgery. […] Serum markers such as Cancer Antigen 125 (CA125), Human Epididymis 4 (HE4) and newer Multivariate Index Assays (OVA1, OVA2, ROMA) are added tools to evaluate adnexal masses. […] The American College of Obstetricians and Gynecologists (ACOG) and Society of Gynecologic Oncology (SGO) recommend that patients presenting with the following be referred to a gynecologic oncologist: […] Asymptomatic simple unilocular cysts up to 10 cm in size have less than 1% risk of malignancy and should be followed with ultrasound imaging in four to six months. […] If the tumor is 5 cm or there is any evidence of papillary projections or ascites, the patient should be referred to a gynecologic oncologist.

• #23 Approach to the patient with an adnexal mass – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-an-adnexal-mass

  Surveillance – Surveillance is an option if the suspicion of malignancy is low but has not been completely excluded. Surveillance usually includes one or more pelvic ultrasounds and/or measurement of serum tumor markers. […] Surgery – Surgery is performed when there is a high risk of malignancy, histologic diagnosis is desired, or the patient has persistent pain or other symptoms.

• #24 Mayo Clinic Health Library – Adnexal tumors and masses | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20212893

  Adnexal tumors and masses are growths of cells that form on the organs and connective tissue around the uterus. Adnexal tumors and masses most often aren’t cancer, but they can be cancer. […] Diagnosis of adnexal tumors and masses involves a careful physical exam, imaging tests and blood tests. Treatment depends on the size of the tumor or mass and its cause. […] Treatment for adnexal tumors and masses depends on the type of growth and what’s causing it. In some situations, such as with a small cyst, no treatment may be needed. […] Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it’s causing symptoms or if it could be cancer. […] If your health professional suspects that an adnexal tumor or mass could be cancer, you may be referred to a doctor who specializes in cancer of the reproductive organs, called a gynecologic oncologist.

• #25 Adnexal Masses | Oncohema Key

  https://oncohemakey.com/adnexal-masses/

  Masses that raise a suspicion for malignancy require surgical intervention. […] In addition, consultation with a specialist trained in the management of ovarian cancer should be considered. […] Minimally invasive surgery (MIS), either laparoscopic or robotic, is the preferred approach for a presumptively benign adnexal mass. […] If the preoperative risk for finding malignancy is high enough, referral to a surgeon prepared to proceed with staging or surgical debulking if malignant disease is uncovered is warranted.

• #26 Adnexal Mass Removal | Kelsey-Seybold Clinic

  https://www.kelsey-seybold.com/medical-services-and-specialties/obgyn/minimally-invasive-surgery/laparoscopy-overview/adnexal-mass-removal

  With advancements in minimally invasive, robotic-assisted technology, adnexal masses can be removed via laparoscopic surgery using the da Vinci Surgical System. […] In the female reproductive system, the area where the uterus, fallopian tubes, and ovaries connect is called the adnexa. When a growth or tumor develops in this area, it’s called an adnexal mass. Most adnexal masses develop in the ovary and can be cancerous or non-cancerous. While some women may have no symptoms, others may experience pain, bleeding, bloating, and other issues due to the mass. Depending on the size of the mass and whether it is suspected to be benign or malignant, surgery may be necessary. […] Laparoscopic removal of an adnexal mass refers to the removal of either benign or malignant tissue from the uterus, ovaries, fallopian tubes, or any of the surrounding tissues using a tiny camera called a laparoscope.

• #27 Adnexal Mass Removal | Kelsey-Seybold Clinic

  https://www.kelsey-seybold.com/medical-services-and-specialties/obgyn/minimally-invasive-surgery/laparoscopy-overview/adnexal-mass-removal

  Laparoscopic, robotic-assisted adnexal mass removal reduces exposure of internal organs, minimizes the chance of infection, reduced blood loss, results in a shorter hospital stay, and reduces recovery time compared to a traditional surgery. […] If your doctor suspects an adnexal mass that may be cancerous or is causing issues, the experts at Kelsey-Seybold Clinic can determine if you are a candidate for removal through minimally invasive laparoscopic surgery.

• #28 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  The surgical specimen should be removed from abdominal cavity without intraperitoneal spillage in the plastic retrieval bag through the umbilical port, small Pfannenstiel incision, or transvaginally. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation. […] Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow. […] Referrals to oncology specialists for additional treatment should occur when malignancy is found during laparoscopy or after histology. […] Adnexal masses are anomalies that affect women of all ages, from the earliest childhood to senility.

• #29 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  The surgical specimen should be removed from abdominal cavity without intraperitoneal spillage in the plastic retrieval bag through the umbilical port, small Pfannenstiel incision, or transvaginally. […] The minimally invasive surgery (MIS) is a well-established route in propaedeutic and treatment of benign adnexal masses and has been progressively indicated in oncology. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival.

• #30 Adnexal tumors and masses – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adnexal-tumors/symptoms-causes/syc-20355053

  People who have gone through menopause are more likely to have an adnexal tumor or mass that is cancer than are people who haven’t gone through menopause. […] People who have used infertility medicines with hormones are at a higher risk of a cancerous adnexal tumor or mass. […] People with family members who have had breast cancer, ovarian cancer or fallopian tube cancer are at higher risk of developing a cancerous adnexal tumor or mass. […] Cigarette smoking raises the risk of developing an adnexal tumor or mass that is cancer. […] Adnexal tumors and masses care at Mayo Clinic.

• #31 Adnexal/pelvic mass – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/obstetrics-and-gynecology/adnexal-pelvic-mass/

  Complications of management depend on the strategy pursued. Surgical risks include, but are not limited to bleeding, blood clots, infection, damage to adjacent organs, and anesthesia. […] The majority of adnexal masses in pregnancy are benign, given that this is a premenopausal population, with dermoids and corpus luteum cysts being the most common. However, clinical management is based on a balance of radiologic or exam based suspicion versus the possibility of pregnancy loss should intervention be considered.

• #32 A guide to management: Adnexal masses in pregnancy | MDedge

  https://community.the-hospitalist.org/content/guide-management-adnexal-masses-pregnancy

  Operative intervention is required in 3 situations: malignancy is suspected, an acute complication develops, or the sheer size of the tumor is likely to cause difficulty […] Surgery is indicated when physical examination or imaging of a pregnant woman reveals an adnexal mass that is suspicious for malignancy, but the physician must weigh the benefit of prompt surgery against the risk to the pregnancy […] Elective surgery for an adnexal mass any time during pregnancy increases the risk of pregnancy loss and the likelihood of intrauterine growth restriction (IUGR) and preterm delivery […] Close observation is a reasonable alternative to operative intervention during pregnancy, unless a malignancy is suspected

• #33 Adnexal Masses in Adolescents

  https://exxcellence.org/list-of-pearls/adnexal-masses-in-adolescents/

  The prevalence of adnexal masses in adolescents is unknown. Of those adnexal masses requiring surgical intervention in specialty care centers, 7-25% are malignant in pediatric and adolescent ages combined, with germ cell tumors being the most common. […] Adolescents with adnexal masses can present with symptoms, although even large masses may be asymptomatic. Acute pain may suggest a ruptured or hemorrhagic ovarian cyst, ovarian torsion, ectopic pregnancy, or tubo-ovarian or appendiceal abscess. Nausea and vomiting with acute or intermittent pain may occur with torsion. Other symptoms of adnexal masses may include abdominal distention or endocrine manifestations such as precocious puberty, uterine bleeding, amenorrhea, or virilization. […] Management of asymptomatic functional cysts up to 10 cm may be expectant with serial ultrasound imaging. Oral contraceptives do not hasten resolution of existing cysts but may prevent new ones from forming. Patients with suspected hemorrhagic cysts should be followed expectantly if clinically stable and the pain can be managed medically. Torsion requires prompt surgical intervention for reduction of the torsion with concomitant ovarian cystectomy for identified pathology to preserve ovarian function.

• #34 Adnexal Masses in Adolescents

  https://exxcellence.org/list-of-pearls/adnexal-masses-in-adolescents/

  A gynecologic oncologist should be involved when imaging and laboratory testing suggests malignancy. A hydrosalpinx may be managed expectantly if it has the characteristic ultrasound appearance of a sonolucent, elongated, extraovarian structure. Paratubal and inclusion cysts appearing as extraovarian, sonolucent structures may also be followed with serial ultrasound imaging. If surgical intervention is needed, attempt should be made to use minimally invasive techniques and preserve ovarian function if possible. Anomalies resulting in menstrual outflow obstruction are managed surgically.

• #35 Relaxation-Focused Nursing Program for Women with Adnexal Mass in the Preoperative Period [J Educ Res Nurs]

  https://jer-nursing.org/jvi.aspx?pdir=jern&plng=eng&un=JERN-96237&look4=

  Adnexal masses, mostly benign, carry the risk of ovarian cancer in the postmenopausal period. The masses give late symptoms, and the definitive diagnosis is determined by surgery. For this reason, patients experience psychological problems such as anxiety and depression due to uncertainty in the diagnosis and treatment process, the burden of symptoms, the suspicion of cancer, and the lack of knowledge about the procedures to be performed. […] Relaxation-focused nursing program that will be applied to women in the preoperative period can contribute to the solution of these problems. Relaxation-focused nursing program includes Lazarus’ methods of dealing with stress, giving information and using relaxation exercises, to create a positive language and environment, to reduce anxiety. […] As a result of the experience of the authors, literature review, and their academic research, it has been shown that the relaxation-focused nursing program used in patients diagnosed with adnexal mass is effective in reducing preoperative anxiety and pain and increasing the level of knowledge. This article explains the relaxation-focused nursing program and how it can be used during the preoperative period for women with adnexal mass/ovarian cancer. The program can be practiced safely as it does not require costs and has no side effects. It was aimed to reduce anxiety and pain because of the practice of this program in preoperative period in patients hospitalized with a diagnosis of an adnexal mass.

• #36 Adnexal Mass: Tumor, Cyst, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22015-adnexal-mass-tumors

  Most adnexal tumors arent dangerous, and they may even go away on their own over time. In rare instances, the tumor may be cancerous. Only a healthcare provider can determine if the mass is serious or life-threatening (like with an ectopic pregnancy or cancer). Try not to panic until you know what kind of adnexal mass you have.

• #37 Adnexal Tumors Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/258044-treatment

  Preoperative preparation is vital to the proper care of a woman with an adnexal mass. […] Given the limitations of preoperative diagnostic testing in accurately determining the risk of malignancy, the American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncologists have established referral guidelines for a newly diagnosed pelvic mass. […] Most adnexal masses can be removed with relative ease and are associated with little postoperative complexity; however, in women with significant preexisting medical problems and/or cancer, major postoperative problems can be encountered. […] Most adnexal masses require little more than the normal annual gynecologic examination for follow-up because they rarely recur. On the other hand, women found to have a malignancy require additional therapy, such as chemotherapy or radiation therapy.

• #38 Adnexal tumors and masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adnexal-tumors/diagnosis-treatment/drc-20580221

  To diagnose adnexal tumors and masses, a healthcare professional may start with a pelvic exam. Other tests and procedures might include imaging tests and blood tests. […] Our caring team of Mayo Clinic experts can help you with your adnexal tumors and masses-related health concerns. […] Treatment for adnexal tumors and masses depends on the type of growth and what’s causing it. In some situations, such as with a small cyst, no treatment may be needed. […] Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it’s causing symptoms or if it could be cancer. […] If your health professional suspects that an adnexal tumor or mass could be cancer, you may be referred to a doctor who specializes in cancer of the reproductive organs, called a gynecologic oncologist.

• #39 Evaluation of the Adnexal Mass – The ObG Project

  https://www.obgproject.com/2023/01/09/evaluation-adnexal-mass/

  Evaluation of the patient with an adnexal mass is intended to exclude malignancy, identify patients in need of emergent surgery and allow appropriate scheduling for those who need nonemergent surgery. Patients with tubo-ovarian abscesses may respond to medical management or interventional radiologic drainage. Those with small cysts can often be followed with ultrasound in anticipation of spontaneous resolution. Metastatic cancers, especially from breast, colon or stomach may present as adnexal masses. Those with findings suggestive of malignancy should have consultation with or referral to a gynecologic oncologist. […] The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours. […] Serum biomarker panels may be used as an alternative to CA 125 level alone in determining the need for referral to or consultation with a gynecologic oncologist when an adnexal mass requires surgery.

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