Materiały źródłowe

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. […] Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. […] Most adnexal masses in reproductive age women are benign cysts. Only 10% of masses are malignant. The rate of malignancy is low in patients aged under 30. […] A research conducted by the Duke Evidence-based Practice Center on a contract with the Agency for Healthcare Research and Quality found that ovarian cancer is the leading cause of death from gynecologic malignancies in the US. The annual incidence of ovarian cancer was over 25,000 with an annual mortality of about 14,000.

• #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. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The literature does not support routine screening for ovarian cancer in the general population, and any professional society does not currently recommend it. […] 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.

• #3 Adnexal masses in children, adolescents and women of reproductive age in the Netherlands: A nationwide population-based cohort study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27421754/

  Objective: To provide an accurate incidence of adnexal masses in children and young women which can significantly improve the performance of current risk prediction models. […] The incidence of adnexal masses increased exponentially with age, from 0.43 per 100,000 women years at age 1 to 152 per 100,000 women years at age 35. […] A (borderline) malignancy was found in 898 (7.7%) patients, ratios between benign and malignant masses varied with age and were lowest in premenarchal children. […] Our results show that adnexal masses in different age groups do not only differ in histological subgroups but also in malignancy rate which is of high value in presurgical risk evaluation.

• #4 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 risk for malignancy in an adnexal or pelvic mass increases with age. […] In general, postmenopausal women are at greater risk than premenopausal women. […] The most commonly performed imaging study for the suspicion of a pelvic mass is an ultrasound. […] It is recommended that transvaginal as well as transabdominal ultrasound be performed whenever possible. […] Transvaginal imaging has been demonstrated to be superior to other imaging techniques for evaluation of a pelvic mass and allows for the specific characterization of the mass as close as possible to its actual gross appearance.

• #5 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. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The literature does not support routine screening for ovarian cancer in the general population, and any professional society does not currently recommend it. […] 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.

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  According to the study, the incidence of cancer dramatically increases with age, though it is relatively uncommon before age 50. The incidence of ovarian cancer also varies by race and ethnicity. Incidence as well as mortality is the highest for white women. […] The research collected data from case studies and screening studies with results given for all women having an undiagnosed mass. Results from the 20 articles that satisfied the inclusion criteria showed that in post-menopausal women the incidence of malignant masses is between 0.09 and 0.18% and that of benign tumors is 0.08 to 1.3%. […] In a study group that included women with a family history of ovarian, breast, or colorectal cancer and postmenopausal women, the prevalence of malignant tumors was 0.10 to 0.11%, that of borderline tumors was 0.02%, and that of benign tumors was 1.1 to 1.2%.

• #7 Epidemiology of Adnexal Tumors – Women’s Healthcare

  https://www.npwomenshealthcare.com/epidemiology-adnexal-tumors/

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. Nearly 80% of ovarian cysts in girls under 9 years are malignant and those are mostly germ cell tumors. About half of the adnexal neoplasms in adolescent girls are mature cystic teratomas or dermoid cysts. Women who have a Y chromosome-carrying gonad stand a 25% chance of developing a cancerous growth. Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. Endometriosis, though not common in adolescence, may be present in about half of women who have a painful mass. In adolescent women who are sexually active, tubo-ovarian abscess must be considered as a possible cause of an adnexal mass.

• #8 Epidemiology of Adnexal Tumors – Women’s Healthcare

  https://www.npwomenshealthcare.com/epidemiology-adnexal-tumors/

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. Nearly 80% of ovarian cysts in girls under 9 years are malignant and those are mostly germ cell tumors. About half of the adnexal neoplasms in adolescent girls are mature cystic teratomas or dermoid cysts. Women who have a Y chromosome-carrying gonad stand a 25% chance of developing a cancerous growth. Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. Endometriosis, though not common in adolescence, may be present in about half of women who have a painful mass. In adolescent women who are sexually active, tubo-ovarian abscess must be considered as a possible cause of an adnexal mass.

• #9 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. […] Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. […] Most adnexal masses in reproductive age women are benign cysts. Only 10% of masses are malignant. The rate of malignancy is low in patients aged under 30. […] A research conducted by the Duke Evidence-based Practice Center on a contract with the Agency for Healthcare Research and Quality found that ovarian cancer is the leading cause of death from gynecologic malignancies in the US. The annual incidence of ovarian cancer was over 25,000 with an annual mortality of about 14,000.

• #10 Epidemiology of Adnexal Tumors – Women’s Healthcare

  https://www.npwomenshealthcare.com/epidemiology-adnexal-tumors/

  Most adnexal masses in reproductive age women are benign cysts. Only 10% of masses are malignant. The rate of malignancy is low in patients aged under 30. About 25% of adnexal growths are endometriomas, 33% are mature cystic teratomas, and the rest are functional cysts or serous or mucinous cystadenomas. No matter what the age group is, physicians must take into account the possibility of structural deformities and uterine masses. Also, in all premenopausal women, pregnancy-related adnexal masses such as ectopic pregnancy, corpus luteum cysts, theca lutein cysts, and luteomas should be considered. […] A research conducted by the Duke Evidence-based Practice Center on a contract with the Agency for Healthcare Research and Quality found that ovarian cancer is the leading cause of death from gynecologic malignancies in the US. The annual incidence of ovarian cancer was over 25,000 with an annual mortality of about 14,000.

• #11 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  According to the study, the incidence of cancer dramatically increases with age, though it is relatively uncommon before age 50. The incidence of ovarian cancer also varies by race and ethnicity. Incidence as well as mortality is the highest for white women. […] The research collected data from case studies and screening studies with results given for all women having an undiagnosed mass. Results from the 20 articles that satisfied the inclusion criteria showed that in post-menopausal women the incidence of malignant masses is between 0.09 and 0.18% and that of benign tumors is 0.08 to 1.3%. […] In a study group that included women with a family history of ovarian, breast, or colorectal cancer and postmenopausal women, the prevalence of malignant tumors was 0.10 to 0.11%, that of borderline tumors was 0.02%, and that of benign tumors was 1.1 to 1.2%.

• #12 Diagnosis and Management of Adnexal Masses | AAFP

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

  Ovarian cancer is the leading cause of death from gynecologic malignancy. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,280 deaths in 2007. The risk of ovarian cancer increases steadily with age, with the greatest risk occurring after menopause. There is a 1.42 percent lifetime risk of dying from ovarian cancer. There is no effective screening method for ovarian cancer that has been shown to significantly improve clinical outcomes. […] Ovarian cancer is rare in premenopausal women. Other etiologies, such as functional cysts, leiomyomata, and ectopic pregnancy, are more common and can cause significant morbidity. In pregnant women, the most common cause of an adnexal mass is a corpus luteum cyst. In nonpregnant patients, the most common etiologies are functional cysts and leiomyomata.

• #13 adnexal mass — Weekly Notes — CREOGS Over Coffee

  https://creogsovercoffee.com/notes/tag/adnexal+mass

  Thanks for sticking with us until the end of this adnexal mass journey! Today were going to cover some rare tumors that always find themselves on CREOGs the sex cord stromal tumors. These only comprise about 1.2% of primary ovarian cancers. Most people are fortunately diagnosed at an early stage due to the fact that symptoms tend to be much more overt with these types of tumors. […] Germ cell tumors are our next foray into these adnexal masses. They comprise 20-25% of ovarian neoplasms, can be benign or malignant, and occur generally in younger women: between ages 10-30 years. […] On todays episode, we start into epithelial neoplasms of the ovary, which comprise about 90% of cancers of the ovary, fallopian tube, and peritoneum. […] Generally speaking, signs more suggestive of malignancy include: Patient age/menopausal status: One of the biggest contributing risk factors, even before you know what the cyst looks like. In postmenopausal women with asymptomatic adnexal masses, the incidence of malignancy approaches 30%, while it is only 6-11% in premenopausal women.

• #14 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  According to the study, the incidence of cancer dramatically increases with age, though it is relatively uncommon before age 50. The incidence of ovarian cancer also varies by race and ethnicity. Incidence as well as mortality is the highest for white women. […] The research collected data from case studies and screening studies with results given for all women having an undiagnosed mass. Results from the 20 articles that satisfied the inclusion criteria showed that in post-menopausal women the incidence of malignant masses is between 0.09 and 0.18% and that of benign tumors is 0.08 to 1.3%. […] In a study group that included women with a family history of ovarian, breast, or colorectal cancer and postmenopausal women, the prevalence of malignant tumors was 0.10 to 0.11%, that of borderline tumors was 0.02%, and that of benign tumors was 1.1 to 1.2%.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  According to the study, the incidence of cancer dramatically increases with age, though it is relatively uncommon before age 50. The incidence of ovarian cancer also varies by race and ethnicity. Incidence as well as mortality is the highest for white women. […] The research collected data from case studies and screening studies with results given for all women having an undiagnosed mass. Results from the 20 articles that satisfied the inclusion criteria showed that in post-menopausal women the incidence of malignant masses is between 0.09 and 0.18% and that of benign tumors is 0.08 to 1.3%. […] In a study group that included women with a family history of ovarian, breast, or colorectal cancer and postmenopausal women, the prevalence of malignant tumors was 0.10 to 0.11%, that of borderline tumors was 0.02%, and that of benign tumors was 1.1 to 1.2%.

• #16 Adnexal masses in children, adolescents and women of reproductive age in the Netherlands: A nationwide population-based cohort study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27421754/

  Objective: To provide an accurate incidence of adnexal masses in children and young women which can significantly improve the performance of current risk prediction models. […] The incidence of adnexal masses increased exponentially with age, from 0.43 per 100,000 women years at age 1 to 152 per 100,000 women years at age 35. […] A (borderline) malignancy was found in 898 (7.7%) patients, ratios between benign and malignant masses varied with age and were lowest in premenarchal children. […] Our results show that adnexal masses in different age groups do not only differ in histological subgroups but also in malignancy rate which is of high value in presurgical risk evaluation.

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  According to the study, the incidence of cancer dramatically increases with age, though it is relatively uncommon before age 50. The incidence of ovarian cancer also varies by race and ethnicity. Incidence as well as mortality is the highest for white women. […] The research collected data from case studies and screening studies with results given for all women having an undiagnosed mass. Results from the 20 articles that satisfied the inclusion criteria showed that in post-menopausal women the incidence of malignant masses is between 0.09 and 0.18% and that of benign tumors is 0.08 to 1.3%. […] In a study group that included women with a family history of ovarian, breast, or colorectal cancer and postmenopausal women, the prevalence of malignant tumors was 0.10 to 0.11%, that of borderline tumors was 0.02%, and that of benign tumors was 1.1 to 1.2%.

• #18 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  Granulosa cell tumors, primary ovarian carcinoma such as mucinous and serous cystadenocarcinoma, and undifferentiated adenocarcinoma were the most prevalent malignant masses. The most common benign masses were paratubal cyst – 0.1 – 0.16%, serous cystadenoma – 0.4 – 0.7%, mature teratoma – 0.02 – 0.08%, and endometrioma – 0.03 – 0.3%. […] An estimation of age-specific incidence of specific adnexal tumor types is difficult with the literature available.

• #19 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Adnexal-Tumors.aspx

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. […] Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. […] Most adnexal masses in reproductive age women are benign cysts. Only 10% of masses are malignant. The rate of malignancy is low in patients aged under 30. […] A research conducted by the Duke Evidence-based Practice Center on a contract with the Agency for Healthcare Research and Quality found that ovarian cancer is the leading cause of death from gynecologic malignancies in the US. The annual incidence of ovarian cancer was over 25,000 with an annual mortality of about 14,000.

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

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

  The following masses pose the greatest concern: […] Determining the true frequency of adnexal masses is impossible because most adnexal cysts develop and resolve without clinical detection. […] In women of reproductive age who have had adnexal masses removed surgically, most are benign cysts or masses. Ten percent of masses are malignant; though in patients younger than 30 years many are of low malignant potential. […] Historically, postmenopausal women with clinically detectable ovaries were thought to be at great risk of having a malignant neoplasm. […] Overall, approximately 10% of ovarian cancers are hereditary. […] In all age groups, the physician must also consider the possibility of uterine masses or structural deformities.

• #21 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. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The literature does not support routine screening for ovarian cancer in the general population, and any professional society does not currently recommend it. […] 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.

• #22 Diagnosis and Management of Adnexal Masses | AAFP

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

  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. A serum CA 125 levels should not be routinely used during the diagnostic workup of an adnexal mass in a premenopausal patient. Serum CA 125 levels should be drawn in postmenopausal patients with adnexal masses to guide treatment options. Gray-scale transvaginal ultrasonography is the preferred imaging modality for the evaluation of adnexal masses. 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. Asymptomatic simple cysts 10 cm or less in diameter with a CA 125 level less than 35 U per mL (if drawn) may be managed with close follow-up, regardless of patient’s age (if past menarche). Oral contraceptives are not effective in the management of ovarian cysts in premenopausal women.

• #23 Adnexal mass: diagnosis and management

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

  Patients treated in general hospitals who not adhere to strict protocols compared to referral centers have an overall survival in five years of 11.4 versus 49.5 months, respectively. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] Adnexal masses are anomalies that affect women of all ages, from the earliest childhood to senility. […] There are recommendations against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination. […] The differential diagnosis between benign adnexal masses is made by clinical history, ultrasound, other imaging methods and tumor markers. […] However, they are useful to differentiate patients with low probability of malignancy, who can be treated in general hospitals, from those with a high probability of malignancy, who must be treated in referral centers with multidisciplinary teams and high volume, within defined protocols.

• #24 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #25 Diagnosis and Management of Adnexal Masses | AAFP

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

  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.

• #26 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 risk for malignancy in an adnexal or pelvic mass increases with age. […] In general, postmenopausal women are at greater risk than premenopausal women. […] The most commonly performed imaging study for the suspicion of a pelvic mass is an ultrasound. […] It is recommended that transvaginal as well as transabdominal ultrasound be performed whenever possible. […] Transvaginal imaging has been demonstrated to be superior to other imaging techniques for evaluation of a pelvic mass and allows for the specific characterization of the mass as close as possible to its actual gross appearance.

• #27 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The majority of adnexal masses are unfortunately asymptomatic unless they have been complicated with the rupture of cystic lesion or torsion of the mass. […] The sensitivity and false-positive rate of the CA-125 range between 50% and 83% and 14% and 36%, respectively. CA-125 is more useful in the postmenopausal population. […] Pelvic ultrasound is currently considered as the most useful technique for diagnostic evaluation of the adnexal mass. […] The parameters of ultrasonographic evaluation of adnexal mass are: Size, Septum thickness, Cyst wall thickness, Number of loculi, Presence of papillary or solid excrescences, Overall echo density, Pulsatility index (PI), Resistivity index (RI). […] Most adnexal masses are benign, with malignancy found in only 7% to 13% of premenopausal and 8% to 45% of postmenopausal patients.

• #28 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The majority of adnexal masses are unfortunately asymptomatic unless they have been complicated with the rupture of cystic lesion or torsion of the mass. […] The sensitivity and false-positive rate of the CA-125 range between 50% and 83% and 14% and 36%, respectively. CA-125 is more useful in the postmenopausal population. […] Pelvic ultrasound is currently considered as the most useful technique for diagnostic evaluation of the adnexal mass. […] The parameters of ultrasonographic evaluation of adnexal mass are: Size, Septum thickness, Cyst wall thickness, Number of loculi, Presence of papillary or solid excrescences, Overall echo density, Pulsatility index (PI), Resistivity index (RI). […] Most adnexal masses are benign, with malignancy found in only 7% to 13% of premenopausal and 8% to 45% of postmenopausal patients.

• #29 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #30 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #31 Adnexal/pelvic mass – Cancer Therapy Advisor

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

  The addition of color Doppler to the routine transvaginal ultrasound gives information about blood flow in and around a mass. […] In general, for both pre- and post-menopausal women, the presence of mural nodules, excrescences, and ascites is suspicious for a malignancy, while simple cystic masses without associated pelvic fluid are usually benign. […] Serum marker screening can play a significant role in the further evaluation of a pelvic mass. […] The most commonly used marker is CA-125, a serum protein. […] Although sensitive for the presence of an advanced malignancy, elevations in CA-125 in multiple benign conditions and the low sensitivity for early stage ovarian cancer make CA-125 an ineffective screening test for the general population. […] The most effective diagnostic approach is a combination of physical examination, imaging and serum marker assessment.

• #32 Adnexal/pelvic mass – Cancer Therapy Advisor

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

  The addition of color Doppler to the routine transvaginal ultrasound gives information about blood flow in and around a mass. […] In general, for both pre- and post-menopausal women, the presence of mural nodules, excrescences, and ascites is suspicious for a malignancy, while simple cystic masses without associated pelvic fluid are usually benign. […] Serum marker screening can play a significant role in the further evaluation of a pelvic mass. […] The most commonly used marker is CA-125, a serum protein. […] Although sensitive for the presence of an advanced malignancy, elevations in CA-125 in multiple benign conditions and the low sensitivity for early stage ovarian cancer make CA-125 an ineffective screening test for the general population. […] The most effective diagnostic approach is a combination of physical examination, imaging and serum marker assessment.

• #33 Adnexal/pelvic mass – Cancer Therapy Advisor

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

  The addition of color Doppler to the routine transvaginal ultrasound gives information about blood flow in and around a mass. […] In general, for both pre- and post-menopausal women, the presence of mural nodules, excrescences, and ascites is suspicious for a malignancy, while simple cystic masses without associated pelvic fluid are usually benign. […] Serum marker screening can play a significant role in the further evaluation of a pelvic mass. […] The most commonly used marker is CA-125, a serum protein. […] Although sensitive for the presence of an advanced malignancy, elevations in CA-125 in multiple benign conditions and the low sensitivity for early stage ovarian cancer make CA-125 an ineffective screening test for the general population. […] The most effective diagnostic approach is a combination of physical examination, imaging and serum marker assessment.

• #34 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The majority of adnexal masses are unfortunately asymptomatic unless they have been complicated with the rupture of cystic lesion or torsion of the mass. […] The sensitivity and false-positive rate of the CA-125 range between 50% and 83% and 14% and 36%, respectively. CA-125 is more useful in the postmenopausal population. […] Pelvic ultrasound is currently considered as the most useful technique for diagnostic evaluation of the adnexal mass. […] The parameters of ultrasonographic evaluation of adnexal mass are: Size, Septum thickness, Cyst wall thickness, Number of loculi, Presence of papillary or solid excrescences, Overall echo density, Pulsatility index (PI), Resistivity index (RI). […] Most adnexal masses are benign, with malignancy found in only 7% to 13% of premenopausal and 8% to 45% of postmenopausal patients.

• #35 Diagnosis and Management of Adnexal Masses | AAFP

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

  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. A serum CA 125 levels should not be routinely used during the diagnostic workup of an adnexal mass in a premenopausal patient. Serum CA 125 levels should be drawn in postmenopausal patients with adnexal masses to guide treatment options. Gray-scale transvaginal ultrasonography is the preferred imaging modality for the evaluation of adnexal masses. 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. Asymptomatic simple cysts 10 cm or less in diameter with a CA 125 level less than 35 U per mL (if drawn) may be managed with close follow-up, regardless of patient’s age (if past menarche). Oral contraceptives are not effective in the management of ovarian cysts in premenopausal women.

• #36 Adnexal mass: diagnosis and management

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

  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. […] The false-negative rates are uncommon and benign adnexal masses can have expectant management or undergo conservative surgery in general hospitals. […] The effectiveness of using panels of biomarkers combined with clinical and radiologic evaluation for the distinction between benign and malignant adnexal masses has been studied. […] Currently, there is no strong enough evidence to recommend a particular test. […] The risk of malignancy index (RMI) algorithm combines the value of CA 125 serum levels, ultrasound, and menopausal status.

• #37 Adnexal mass: diagnosis and management

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

  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. […] The false-negative rates are uncommon and benign adnexal masses can have expectant management or undergo conservative surgery in general hospitals. […] The effectiveness of using panels of biomarkers combined with clinical and radiologic evaluation for the distinction between benign and malignant adnexal masses has been studied. […] Currently, there is no strong enough evidence to recommend a particular test. […] The risk of malignancy index (RMI) algorithm combines the value of CA 125 serum levels, ultrasound, and menopausal status.

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

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

  The risk of malignancy index (RMI) algorithm combines the value of CA 125 serum levels, ultrasound, and menopausal status. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage. […] Adnexal masses are anomalies that affect women of all ages, from the earliest childhood to senility. […] There are recommendations against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination. […] The differential diagnosis between benign adnexal masses is made by clinical history, ultrasound, other imaging methods and tumor markers. […] However, they are useful to differentiate patients with low probability of malignancy, who can be treated in general hospitals, from those with a high probability of malignancy, who must be treated in referral centers with multidisciplinary teams and high volume, within defined protocols.

• #39 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  The International Ovarian Tumor Analysis (IOTA) group has published extensively on sonographic definitions and patterns that categorize tumors based on appearance. Simple rules and the ADNEX risk model are 2 of the groups approaches. Both methods have been validated as effective for differentiating benign from malignant ovarian tumors, but neither has been used to study serial changes in ovarian morphology. […] […] Regardless of the strategy employed, 25% of ovarian ultrasonography evaluations will be interpreted as indeterminate or risk unknown. The IOTA strategies have been successfully used in Europe for years, but they have not yet been studied or adopted in the United States. […] […] The morphology index (MI) from the University of Kentucky is an ultrasonography-based scoring system that combines tumor volume and tumor structure into a simple and effective index with a score ranging from 0 to 10. A rising Kentucky MI score has a linear and predictable increase in the risk of ovarian malignancy. In a review of almost 40,000 sonograms, 85% of the malignancies had an MI score of 5 or greater. Using this as a cutoff, the sensitivity and specificity for predicting malignancy was 86% and 98%, respectively. […]

• #40 Imaging and diagnostic approach of the adnexal mass: what the oncologist should know – Vázquez-Manjarrez – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/54757/html

  The main objective of the evaluation of ovarian masses is the diagnosis or the exclusion of malignancy, to minimize unnecessary surgical procedures in benign lesions, and to optimize ovarian cancer outcomes by the opportune referral to a gynecologic oncologist in the malignant lesions. […] Although multiple screening trials for detecting early stage ovarian cancer in asymptomatic postmenopausal women have been conducted, to date none of them has shown benefit in terms of survival. On the other hand, screening in high-risk groups is recommended. […] The O-RADS risk stratification and management system by the American College of Radiology was created to unify interpretations and reduce ambiguity in the management and classification of adnexal masses. This system includes the pattern-based approach and algorithm IOTA-ADNEX model system; it consists in a system of six categories (0 to 5). Each of these categories shows an estimated risk percentage of malignancy and provides management recommendations for each risk group, divided into pre and postmenopausal patients.

• #41 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  The International Ovarian Tumor Analysis (IOTA) group has published extensively on sonographic definitions and patterns that categorize tumors based on appearance. Simple rules and the ADNEX risk model are 2 of the groups approaches. Both methods have been validated as effective for differentiating benign from malignant ovarian tumors, but neither has been used to study serial changes in ovarian morphology. […] […] Regardless of the strategy employed, 25% of ovarian ultrasonography evaluations will be interpreted as indeterminate or risk unknown. The IOTA strategies have been successfully used in Europe for years, but they have not yet been studied or adopted in the United States. […] […] The morphology index (MI) from the University of Kentucky is an ultrasonography-based scoring system that combines tumor volume and tumor structure into a simple and effective index with a score ranging from 0 to 10. A rising Kentucky MI score has a linear and predictable increase in the risk of ovarian malignancy. In a review of almost 40,000 sonograms, 85% of the malignancies had an MI score of 5 or greater. Using this as a cutoff, the sensitivity and specificity for predicting malignancy was 86% and 98%, respectively. […]

• #42 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  When comparing the ADNEX risk model with the Kentucky MI, investigators reviewed 45,000 ultrasound results and found that the majority of cancers were categorized by the ADNEX model in the lowest 4 of the 10 risk-of-malignancy groups, compared with only 15% for the MI. This clustering or skew is potentially problematic, since we expect higher scores to be more predictive of cancer than lower scores. It also infers that the ADNEX model may not be useful in serial surveillance strategies. Moreover, the ADNEX model identified only 30% of early stage cancers compared with identification of 80% with use of the MI. […] […] Serial ultrasonography is a concept similar to any longitudinal biomarker evaluation. In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) program, the Risk of Ovarian Cancer Algorithm (ROCA) employs serial measurements of cancer antigen 125 (CA 125) to improve cancer detection. Serial ultrasonography similarly can be applied to better characterize a tumors physiology as well as its morphology. Over time, malignant ovarian tumors grow naturally in volume and complexity, and they do so at a rate faster than nonmalignant tumors. If this physical change can be measured objectively with ultrasonography, then serial sonography becomes a valuable diagnostic aid. […]

• #43 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  When comparing the ADNEX risk model with the Kentucky MI, investigators reviewed 45,000 ultrasound results and found that the majority of cancers were categorized by the ADNEX model in the lowest 4 of the 10 risk-of-malignancy groups, compared with only 15% for the MI. This clustering or skew is potentially problematic, since we expect higher scores to be more predictive of cancer than lower scores. It also infers that the ADNEX model may not be useful in serial surveillance strategies. Moreover, the ADNEX model identified only 30% of early stage cancers compared with identification of 80% with use of the MI. […] […] Serial ultrasonography is a concept similar to any longitudinal biomarker evaluation. In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) program, the Risk of Ovarian Cancer Algorithm (ROCA) employs serial measurements of cancer antigen 125 (CA 125) to improve cancer detection. Serial ultrasonography similarly can be applied to better characterize a tumors physiology as well as its morphology. Over time, malignant ovarian tumors grow naturally in volume and complexity, and they do so at a rate faster than nonmalignant tumors. If this physical change can be measured objectively with ultrasonography, then serial sonography becomes a valuable diagnostic aid. […]

• #44 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  In comparing serial MI scores with clinical outcomes, studies have shown that malignant tumors exhibit a rapid increase, nonmalignant tumors have a stable or gradual rise, and resolving cysts show a decrease in MI score over time. An increase in the MI score of 1 or more per month (1 per month) is concerning for malignancy, and surgical removal should be considered. If the MI score of an asymptomatic ovarian tumor does not increase by 1 per month, it can be surveilled with intermittent ultrasonography. […] […] Serum biomarkers can be used to complement an ultrasonographic evaluation. They are particularly useful when surgery is recommended but the sonographic evaluation is indeterminate for malignancy risk. Many serum biomarkers are commonly used for the preoperative evaluation of an ovarian tumor or for surveillance of a malignancy following diagnosis. […]

• #45 Rapid rate of growth in adnexal masses, despite benign appearance on ultrasound, was associated with malignancy. A retrospective analysis of 48 consecutive cases from a single institution

  https://www.imrpress.com/journal/CEOG/48/5/10.31083/j.ceog4805174/htm

  Rapid rate of growth in adnexal masses, despite benign appearance on ultrasound, was associated with malignancy. […] The rate of malignancy was 9.3%. […] Despite benign appearance on ultrasound and low RMI, adnexal masses with a rapid rate of growth were associated with a risk of malignancy of 9.3%. […] Adnexal masses predicted to be benign according to these diagnostic algorithms have an extremely low likelihood of being malignant and can in general be followed by serial ultrasound if patients are asymptomatic. […] A factor which we noted to be associated with malignancy in our consecutive series of patients operated for benign appearing adnexal masses was the rate of growth. Patients in whom the adnexal mass had grown by over 50% in 6–12 months prior to surgery or in whom the adnexal mass first appeared 6–12 months prior to surgery had a higher likelihood of malignant histology as compared to those in whom the adnexal mass had been growing at a slower pace.

• #46 Imaging and diagnostic approach of the adnexal mass: what the oncologist should know – Vázquez-Manjarrez – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/54757/html

  The main objective of the evaluation of ovarian masses is the diagnosis or the exclusion of malignancy, to minimize unnecessary surgical procedures in benign lesions, and to optimize ovarian cancer outcomes by the opportune referral to a gynecologic oncologist in the malignant lesions. […] Although multiple screening trials for detecting early stage ovarian cancer in asymptomatic postmenopausal women have been conducted, to date none of them has shown benefit in terms of survival. On the other hand, screening in high-risk groups is recommended. […] The O-RADS risk stratification and management system by the American College of Radiology was created to unify interpretations and reduce ambiguity in the management and classification of adnexal masses. This system includes the pattern-based approach and algorithm IOTA-ADNEX model system; it consists in a system of six categories (0 to 5). Each of these categories shows an estimated risk percentage of malignancy and provides management recommendations for each risk group, divided into pre and postmenopausal patients.

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

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

  INTRODUCTION […] An adnexal mass (ie, solid or cystic mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic issue. Adnexal masses may be found in females of all ages and have many etiologies (table 1). […] The principal goals of the evaluation of an adnexal mass are to determine whether the mass is „almost certainly benign,” has a „reasonable chance of being malignant,” and whether there is an urgent condition (eg, ectopic pregnancy, ovarian torsion) that requires prompt medical or surgical treatment. Management of nonurgent conditions may involve: […] ●Expectant management – When the mass is not suspicious for malignancy and there are no other indications for surgery or surveillance, no further follow-up is needed. […] ●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. […] SURVEILLANCE […] Surveillance frequency […] When to stop surveillance or proceed with surgery

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

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

  INTRODUCTION […] An adnexal mass (ie, solid or cystic mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic issue. Adnexal masses may be found in females of all ages and have many etiologies (table 1). […] The principal goals of the evaluation of an adnexal mass are to determine whether the mass is „almost certainly benign,” has a „reasonable chance of being malignant,” and whether there is an urgent condition (eg, ectopic pregnancy, ovarian torsion) that requires prompt medical or surgical treatment. Management of nonurgent conditions may involve: […] ●Expectant management – When the mass is not suspicious for malignancy and there are no other indications for surgery or surveillance, no further follow-up is needed. […] ●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. […] SURVEILLANCE […] Surveillance frequency […] When to stop surveillance or proceed with surgery

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

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

  INTRODUCTION […] An adnexal mass (ie, solid or cystic mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic issue. Adnexal masses may be found in females of all ages and have many etiologies (table 1). […] The principal goals of the evaluation of an adnexal mass are to determine whether the mass is „almost certainly benign,” has a „reasonable chance of being malignant,” and whether there is an urgent condition (eg, ectopic pregnancy, ovarian torsion) that requires prompt medical or surgical treatment. Management of nonurgent conditions may involve: […] ●Expectant management – When the mass is not suspicious for malignancy and there are no other indications for surgery or surveillance, no further follow-up is needed. […] ●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. […] SURVEILLANCE […] Surveillance frequency […] When to stop surveillance or proceed with surgery

• #50 Ovarian masses: Surgery or surveillance? | MDedge

  https://community.the-hospitalist.org/content/ovarian-masses-surgery-or-surveillance

  The recently published recommendations of the First International Consensus Conference report on adnexal masses are summarized in TABLE 1. The expert panel reviewed the evidence and concluded that effective ultrasonography strategies exist and are well validated, and that low-risk asymptomatic ovarian cysts do not require surgical removal. […] […] While no single ultrasonographic finding can differentiate a benign from a malignant mass, morphologic scoring systems improve our ability to estimate a tumors malignant potential. In the United States, most practitioners in womens health have ready access to gynecologic ultrasonography, but individual training and proficiency vary. Since not everyone is an expert sonographer, it is useful to employ an objective strategy when evaluating an ovarian tumor. The focus of a comprehensive ovarian ultrasonography is to recognize morphologic patterns that reflect a tumors malignant potential. While tumor volume is useful, tumor morphology is the most prognostic feature. […]

• #51 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #52 Diagnosis and Management of Adnexal Masses | AAFP

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

  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.

• #53 Adnexal mass: diagnosis and management

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

  Patients treated in general hospitals who not adhere to strict protocols compared to referral centers have an overall survival in five years of 11.4 versus 49.5 months, respectively. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] Adnexal masses are anomalies that affect women of all ages, from the earliest childhood to senility. […] There are recommendations against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination. […] The differential diagnosis between benign adnexal masses is made by clinical history, ultrasound, other imaging methods and tumor markers. […] However, they are useful to differentiate patients with low probability of malignancy, who can be treated in general hospitals, from those with a high probability of malignancy, who must be treated in referral centers with multidisciplinary teams and high volume, within defined protocols.

• #54 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #55 Diagnosis and Management of Adnexal Masses | AAFP

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

  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.

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

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

  Age and a strong family history of breast or ovarian cancer remain important risk factors for ovarian malignancy. […] Transvaginal ultrasonography is the recommended imaging for pelvic masses. […] Serum marker testing in combination with other tests can be used to evaluate likelihood of malignancy. […] The ideal interval and duration for ultrasound follow-up has yet to be defined. However, in one study, masses that were monitored and eventually diagnosed as malignancies all demonstrated growth by 7 months. Some experts recommend limiting observation of stable masses without solid components to 1 year, and stable masses with solid components to 2 years. […] Elevated CA 125 | Suspicious ultrasound or clinical findings. […] Very elevated CA 125 level | Suspicious ultrasound or clinical findings.

• #57 Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials

  https://www.mdpi.com/2075-4418/7/2/25

  Women that are positive for an ovarian abnormality in a clinical setting can have either a malignancy or a benign tumor with probability favoring the benign alternative. […] Surveillance using serial ultrasonography is a reasonable alternative that can be used to discover if changes in the ovarian abnormality will occur that favor either a malignant or benign interpretation. […] The present report examines these experiences and relates them to the current understanding of ovarian cancer ontology, presenting arguments related to the benefits of surveillance. […] The five-year survival rate for women diagnosed with stage I ovarian cancer has been reported to be as high as 95% in contrast to only 30% for women with stage III disease. […] While large prospective screening trials have focused on how best to identify malignancies in asymptomatic women in the general population, adnexal masses are commonly identified by ultrasound ordered for a wide variety of indications in routine clinical practice even when a patient does not present with relevant symptoms.

• #58 Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials

  https://www.mdpi.com/2075-4418/7/2/25

  This paper reviews recent prospective ovarian cancer screening trial findings for clinical application on how women with adnexal masses, found by ultrasound, for various reasons other than for screening purposes, should be managed and followed. […] The consensus agreed that it is reasonable to perform annual ultrasound follow-up of cysts larger than 5 cm in premenopausal women and those larger than 1 cm in postmenopausal women, although such cysts are unlikely to be malignant. […] A recent expert review suggested that low risk abnormalities can undergo an initial three-month follow-up with those that remain stable or decreasing in size being examined every 12 months for five years. […] The present review examines the evidence from recent research in histopathology of ovarian cancer types, ovarian cancer screening trials and ultrasound morphology of adnexal masses to establish a framework for surveillance of these masses.

• #59 Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials

  https://www.mdpi.com/2075-4418/7/2/25

  This paper reviews recent prospective ovarian cancer screening trial findings for clinical application on how women with adnexal masses, found by ultrasound, for various reasons other than for screening purposes, should be managed and followed. […] The consensus agreed that it is reasonable to perform annual ultrasound follow-up of cysts larger than 5 cm in premenopausal women and those larger than 1 cm in postmenopausal women, although such cysts are unlikely to be malignant. […] A recent expert review suggested that low risk abnormalities can undergo an initial three-month follow-up with those that remain stable or decreasing in size being examined every 12 months for five years. […] The present review examines the evidence from recent research in histopathology of ovarian cancer types, ovarian cancer screening trials and ultrasound morphology of adnexal masses to establish a framework for surveillance of these masses.

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

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

  Age and a strong family history of breast or ovarian cancer remain important risk factors for ovarian malignancy. […] Transvaginal ultrasonography is the recommended imaging for pelvic masses. […] Serum marker testing in combination with other tests can be used to evaluate likelihood of malignancy. […] The ideal interval and duration for ultrasound follow-up has yet to be defined. However, in one study, masses that were monitored and eventually diagnosed as malignancies all demonstrated growth by 7 months. Some experts recommend limiting observation of stable masses without solid components to 1 year, and stable masses with solid components to 2 years. […] Elevated CA 125 | Suspicious ultrasound or clinical findings. […] Very elevated CA 125 level | Suspicious ultrasound or clinical findings.

• #61 Imaging and diagnostic approach of the adnexal mass: what the oncologist should know – Vázquez-Manjarrez – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/54757/html

  The main objective of the evaluation of ovarian masses is the diagnosis or the exclusion of malignancy, to minimize unnecessary surgical procedures in benign lesions, and to optimize ovarian cancer outcomes by the opportune referral to a gynecologic oncologist in the malignant lesions. […] Although multiple screening trials for detecting early stage ovarian cancer in asymptomatic postmenopausal women have been conducted, to date none of them has shown benefit in terms of survival. On the other hand, screening in high-risk groups is recommended. […] The O-RADS risk stratification and management system by the American College of Radiology was created to unify interpretations and reduce ambiguity in the management and classification of adnexal masses. This system includes the pattern-based approach and algorithm IOTA-ADNEX model system; it consists in a system of six categories (0 to 5). Each of these categories shows an estimated risk percentage of malignancy and provides management recommendations for each risk group, divided into pre and postmenopausal patients.

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

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

  Age and a strong family history of breast or ovarian cancer remain important risk factors for ovarian malignancy. […] Transvaginal ultrasonography is the recommended imaging for pelvic masses. […] Serum marker testing in combination with other tests can be used to evaluate likelihood of malignancy. […] The ideal interval and duration for ultrasound follow-up has yet to be defined. However, in one study, masses that were monitored and eventually diagnosed as malignancies all demonstrated growth by 7 months. Some experts recommend limiting observation of stable masses without solid components to 1 year, and stable masses with solid components to 2 years. […] Elevated CA 125 | Suspicious ultrasound or clinical findings. […] Very elevated CA 125 level | Suspicious ultrasound or clinical findings.

• #63 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The age of the patient should always be kept in mind in the differential diagnosis of adnexal masses, because the incidence of ovarian cancer increases from 15.7 to 54/100 000 at the age of 40 to 65. […] In the reproductive age group, the majority of adnexal masses are benign, with malignancy found in only 7% to 13%. Functional cysts remain the most common type of adnexal mass found in this age group. […] A large prospective study involving 15,106 asymptomatic patients age 50 or older reported that 18% of patients had unilocular cysts 10cm in diameter. […] The incidence of ovarian cancer in patients with no family history of the disease is nearly 1.4%. A family history of ovarian cancer should alert the clinician in the management of adnexal masses of women especially between 35 and 45 years of age, because inherited forms of ovarian cancer represent 5% of all ovarian malignancies.

• #64 Epidemiology of Adnexal Tumors – Women’s Healthcare

  https://www.npwomenshealthcare.com/epidemiology-adnexal-tumors/

  The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses. Nearly 80% of ovarian cysts in girls under 9 years are malignant and those are mostly germ cell tumors. About half of the adnexal neoplasms in adolescent girls are mature cystic teratomas or dermoid cysts. Women who have a Y chromosome-carrying gonad stand a 25% chance of developing a cancerous growth. Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors. Endometriosis, though not common in adolescence, may be present in about half of women who have a painful mass. In adolescent women who are sexually active, tubo-ovarian abscess must be considered as a possible cause of an adnexal mass.

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

  https://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. […] While most of these masses develop in menstruating women, their presence must be considered in both prepubertal and postmenopausal women, particularly when associated with pain. […] 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. […] Determining the frequency of adnexal masses is impossible because most develop and resolve without clinical detection. […] In females younger than 9 years, 80% of ovarian masses are malignant, generally germ cell tumors. […] During adolescence, 50% of the adnexal neoplasms are adult cystic teratomas. […] Women with gonads that contain a Y chromosome have a 25% chance of developing a malignant neoplasm.

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

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

  Because so many conditions can cause adnexal tumors and masses, there are many things that can raise the risk of developing them. But it’s most important to be aware of factors that can affect the risk of an adnexal tumor or mass being cancer, including: Menopause. 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 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.

• #67 Adnexal tumors and masses // Middlesex Health

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

  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. […] 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.

• #68 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The majority of adnexal masses are unfortunately asymptomatic unless they have been complicated with the rupture of cystic lesion or torsion of the mass. […] The sensitivity and false-positive rate of the CA-125 range between 50% and 83% and 14% and 36%, respectively. CA-125 is more useful in the postmenopausal population. […] Pelvic ultrasound is currently considered as the most useful technique for diagnostic evaluation of the adnexal mass. […] The parameters of ultrasonographic evaluation of adnexal mass are: Size, Septum thickness, Cyst wall thickness, Number of loculi, Presence of papillary or solid excrescences, Overall echo density, Pulsatility index (PI), Resistivity index (RI). […] Most adnexal masses are benign, with malignancy found in only 7% to 13% of premenopausal and 8% to 45% of postmenopausal patients.

• #69 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #70 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #71 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. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. 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.

• #72 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. […] A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. […] 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.

• #73 Laparoscopic Management of Suspicious Adnexal Masses – Society of Laparoscopic & Robotic Surgeons

  https://sls.org/the-3rd-edition-prevention-management/chapter-51/

  The main goal of surgery in the management of adnexal masses should be complete and immediate treatment of the mass. Benign tumors should be treated using ovarian-preserving procedures, and malignant tumors should be staged as soon as possible. […] In reproductive age patients, functional cysts are the most common adnexal masses, usually ultrasonographically benign looking, are 10cm in diameter, and patients have normal CA-125 levels. […] An adnexal mass in a postmenopausal woman needs to be evaluated carefully, and the physician has to exclude malignancy, especially in this age group owing to the high incidence rate (up to 45%).

• #74 Diagnosis and Management of Adnexal Masses | AAFP

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

  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.

• #75 Ovarian Cysts

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/

  The incidence of ovarian cancer is too low, ultrasonography and CA 125 testing are too nonspecific, and the biology of ovarian cancer does not lend itself to screening. […] In one recent large study (N = 78,216), yearly screening with CA 125 and ultrasound did not decrease the mortality rate from ovarian cancer, and the surgical evaluation of false-positive screens was associated with complications. […] Women with ovarian cysts with a high likelihood of malignancy should be referred directly to a gynecologic oncologist. […] High likelihood of malignancy exists if malignant features are found on ultrasound, in women with a personal history or a first-degree relative with history of ovarian or breast cancer, or if cancer antigen 125 (CA 125) is 35 (postmenopausal women) or CA 125 200 (premenopausal women). […] Direct referral to and treatment by gynecologic oncologists has been shown to improve survival rates in women with ovarian cancer.

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

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

  The risk of malignancy index (RMI) algorithm combines the value of CA 125 serum levels, ultrasound, and menopausal status. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage. […] Adnexal masses are anomalies that affect women of all ages, from the earliest childhood to senility. […] There are recommendations against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination. […] The differential diagnosis between benign adnexal masses is made by clinical history, ultrasound, other imaging methods and tumor markers. […] However, they are useful to differentiate patients with low probability of malignancy, who can be treated in general hospitals, from those with a high probability of malignancy, who must be treated in referral centers with multidisciplinary teams and high volume, within defined protocols.

• #77

  https://link.springer.com/article/10.1007/s13669-011-0001-4

  The differential diagnosis includes benign and malignant ovarian lesions, tubal and paratubal cysts, mullerian abnormalities, disorders with infectious etiologies (pelvic inflammatory disease, PID), and pregnancy-related masses (ectopic pregnancy). […] When malignancy is identified, the Childrens Oncology Group (COG) currently has several recommendations: (1) intact removal of the tumor without violation in situ; (2) sparing of the fallopian tube if not adherent; (3) obtaining ascites for cytology; (4) examination and palpation of the omentum, with biopsy or removal of suspicious areas; and (5) examination and palpation of the iliac and aortocaval nodes, with biopsy of abnormal areas. […] Given the rarity of malignant lesions, avoiding overly aggressive surgery is important. […] The differential diagnosis of adnexal masses in pediatric and adolescent females is broad.

• #78

  https://link.springer.com/article/10.1007/s13669-011-0001-4

  The differential diagnosis includes benign and malignant ovarian lesions, tubal and paratubal cysts, mullerian abnormalities, disorders with infectious etiologies (pelvic inflammatory disease, PID), and pregnancy-related masses (ectopic pregnancy). […] When malignancy is identified, the Childrens Oncology Group (COG) currently has several recommendations: (1) intact removal of the tumor without violation in situ; (2) sparing of the fallopian tube if not adherent; (3) obtaining ascites for cytology; (4) examination and palpation of the omentum, with biopsy or removal of suspicious areas; and (5) examination and palpation of the iliac and aortocaval nodes, with biopsy of abnormal areas. […] Given the rarity of malignant lesions, avoiding overly aggressive surgery is important. […] The differential diagnosis of adnexal masses in pediatric and adolescent females is broad.

• #79

  https://link.springer.com/article/10.1007/s13669-011-0001-4

  The differential diagnosis includes benign and malignant ovarian lesions, tubal and paratubal cysts, mullerian abnormalities, disorders with infectious etiologies (pelvic inflammatory disease, PID), and pregnancy-related masses (ectopic pregnancy). […] When malignancy is identified, the Childrens Oncology Group (COG) currently has several recommendations: (1) intact removal of the tumor without violation in situ; (2) sparing of the fallopian tube if not adherent; (3) obtaining ascites for cytology; (4) examination and palpation of the omentum, with biopsy or removal of suspicious areas; and (5) examination and palpation of the iliac and aortocaval nodes, with biopsy of abnormal areas. […] Given the rarity of malignant lesions, avoiding overly aggressive surgery is important. […] The differential diagnosis of adnexal masses in pediatric and adolescent females is broad.

• #80

  https://link.springer.com/article/10.1007/s13669-011-0001-4

  Ultimately, preoperative evaluation and clinical judgment should guide the operative approach. […] The incidence of malignancy ranges from 4% to 9%, accounting for 1% of all pediatric cancers. […] Fertility preservation is the standard of care for adolescent and pediatric patients diagnosed with ovarian germ cell tumors, unlike other types of ovarian cancer. […] The recommended management of young patients with suspected malignant germ cell tumors of the ovary includes (1) intact removal of the tumor (oophorectomy); (2) sparing of the fallopian tube, if not adherent to the tumor; (3) procurement of cytologic washings or harvesting of ascites fluid; (4) examination and palpation of the omentum, with removal of suspicious areas; and (5) examination and palpation of the pelvic and aortocaval nodes, with biopsy of abnormal areas. […] A collaborative approach, incorporating gynecologic surgeons as well as the pediatric surgeons who commonly care for this unique patient population, is paramount to the accomplishment of these goals.

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