Materiały źródłowe

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

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

  Most 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: […] If the mass is small and painless and your provider is certain its not cancerous, they may recommend no further treatment. […] 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. […] If your provider believes the mass is suspicious, or if its large and causing you pain, removing the mass is an option. […] The treatment your provider recommends is unique to you, the type of growth you have and how big it is. […] Not always. In many cases, adnexal masses arent harmful and will eventually resolve on their own.

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

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

  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.

• #3 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. […] Some controversy exists regarding the use of combined hormonal contraceptives in the prevention and treatment of ovarian cysts. Observational studies in women taking higher-dose, early-generation oral contraceptive pills (OCPs) suggested a lower incidence of functional and benign epithelial ovarian cysts. However, more recent data have shown that contemporary oral contraceptive formulations have minimal effects on the incidence of ovarian cysts and that treatment with OCPs does not appear to expedite cyst resolution.

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

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

  Obvious benign masses can be treated with resection of the mass alone or removal of the adnexal structure. In those cases in which the presence of malignancy is questionable, one should limit the resection to the structures involved unless a preoperative decision has been made that a more aggressive approach should be taken. […] When an epithelial ovarian malignancy is encountered, a complete staging protocol must be performed. This generally includes complete exploration of the abdomen, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissections, biopsies of the undersurface of the right and left diaphragms, and biopsies of the colic gutters followed by a maximal resection of the intra-abdominal tumor. […] 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.

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

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

  If a mass has features suspicious for malignancy, care should be made to remove the mass intact. During minimally invasive surgery, the mass may be placed in a bag prior to morcellation or cyst decompression to avoid potential spread of malignancy. Intraoperative tumor rupture is significantly more common during minimally invasive removal of adnexal masses as compared to an open approach. […] 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. Their follow-up care should include frequent reexaminations to determine the disease status. […] The future holds several interesting possibilities. First, the rapid expansion of new laparoscopic equipment, including the robotic surgery platform, makes minimally invasive surgery an area that is gaining increasing importance in the treatment of adnexal masses. Second, the development of new radiologic techniques or expansion of the present techniques will allow the clinician to gain additional characterization of adnexal masses without entering the surgical suite. Third, new molecular, genetic, and biologic markers and therapies should become available that will assist in the diagnosis and treatment of adnexal masses, both benign and malignant.

• #4 Diagnosis and Management of Adnexal Masses | AAFP

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

  Women with any of these findings should be referred to a gynecologist or gynecologic oncologist. […] All prepubescent girls with an adnexal mass should be referred to a specialist with experience in pediatric gynecology. […] 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. […] If a mass persists for more than 12 weeks, the patient should be referred to a gynecologist. […] 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. […] For symptomatic cysts, consider a trial of nonsteroidal anti-inflammatory drugs or a short course of narcotics for pain relief.

• #5 Adnexal Tumors: What Causes Them, and How They Are Treated

  https://www.webmd.com/women/what-are-adnexal-tumors

  How Are Adnexal Tumors Treated? […] The treatment for an adnexal tumor will depend on several factors, including what’s causing it and where it’s located. Generally, there are three options for treating adnexal masses: […] Expectant management. If your adnexal mass is not cancerous and your doctor thinks it will go away on its own, you may not need any treatment or follow-up care. This may be the case if you have a small cyst that will probably go away. […] Continued surveillance. If your doctor doesn’t think your adnexal mass is cancerous but isn’t certain, they may want to come back to be checked again later. You may need to have a pelvic ultrasound or blood tests during follow-up visits. […] Surgery. You may need to have surgery to remove the mass or take a sample of it if your doctor thinks it’s cancer or if it’s causing you problems.

• #6 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. […] 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. […] An adnexal mass in a premenarchal patient, or the presence of symptoms associated with a mass, should prompt referral to a gynecologist with expertise in evaluating these patients. […] If found, ectopic pregnancy should be managed with appropriate pharmacologic or surgical treatment.

• #7 Adnexal mass: Symptoms, treatment, and diagnosis

  https://www.medicalnewstoday.com/articles/327525

  People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include: cefotetan (Cefotan), cefoxitin (Mefoxin), clindamycin (Cleocin). […] Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes. […] The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy.

• #8 Adnexal Mass: Symptoms, Treatments, and How It Affects Pregnancy

  https://www.healthline.com/health/adnexal-mass

  If the adnexal mass is small and you have no symptoms, then it may not require treatment at all. However, your doctor will likely want to monitor you with regular pelvic exams and ultrasounds. […] Surgery will be needed if: the mass begins to grow, you develop symptoms, a cyst develops solid elements. […] Once removed, the adnexal mass will be tested to determine whether or not the cells contained within it are cancerous. If they are, further treatment may be required to ensure all cancerous cells have been removed from your body. […] Surgery would only be considered if: your doctor suspects that the adnexal mass is malignant, a complication occurs, the mass is so big that its likely to cause a problem with the pregnancy. […] The majority of adnexal masses aren’t harmful. They won’t require treatment unless a woman is experiencing uncomfortable symptoms. Many adnexal masses will resolve themselves without any intervention. […] In a very small number of cases, the cause of the adnexal mass will be ovarian cancer. If the cancer is found and treated before its spread outside of the ovary, the five-year survival rate for ovarian cancer is 92 percent, according to the American Cancer Society.

• #9 Management of Adnexal Cysts

  https://www.exxcellence.org/list-of-pearls/management-of-adnexal-cysts/

  Adnexal cysts may be identified based on gynecologic symptoms or may be incidentally noted during pelvic exam or imaging for other indications. […] Treatment options for ovarian cysts include observation or surgery, depending upon the patients symptoms, type and size of the cyst, family history, and the patients age. […] For functional cysts, ovulation suppression with hormonal medications such as oral contraceptives may be an option to prevent new cysts from forming. […] If the ovarian cyst is large or causing significant symptoms, then surgery may be necessary. […] Minimally invasive surgery with laparoscopy is favored over an open surgical approach for benign appearing cysts. […] Ovarian cystectomy is the preferred procedure to preserve ovarian function. […] Adnexal cysts with features concerning for malignancy such as elevated tumor markers, worrisome ultrasound findings, or elevated risk on a formal risk assessment tool such as the multivariate index assay or the Risk of Ovarian Malignancy Algorithm should be referred to a gynecologic oncologist.

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

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

  Several methods are currently used by clinicians to manage adnexal masses. These are aspiration, cystoscopy, biopsy directly from the lesion, cystectomy, oophorectomy, and adnexectomy. […] Given that there is no way to preoperatively identify malignant adnexal masses with 100% sensitivity and specificity, laparoscopy has been used to aid in the triage of these patients and improve the accuracy of assessment. […] The decision to perform laparotomy may be made in the following instances: If an adnexal mass is found to be highly suspicious due to ultrasonographic imaging with high serum levels of CA-125 before surgery; If the mass is macroscopically considered as suspicious during surgery; If malignancy is confirmed by frozen sections; If technical insufficiencies occurred during surgery.

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

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

  Over the last decade, advances in laparoscopic techniques have led to increased use of laparoscopy in gynecologic surgery. As the technology improved, low complication rates for operative laparoscopy in such procedures as adnexectomy have been reported. Recently, scientific data have supported the concept, and the laparoscopic approach for treating adnexal masses is now considered the preferred treatment. […] Despite the advantages of using laparoscopy to manage adnexal masses, there remains the fear of encountering cancer and performing inadequate staging or, worse yet, upstaging of the disease by tumor seeding. Careful patient selection for the appropriate use of laparoscopy in the management of adnexal masses is a critical issue. […] 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.

• #11 Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer

  https://www.wjgnet.com/2218-6220/full/v3/i3/109.htm

  Ovarian cancer is one of the most common causes of cancer-related death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defined prior to surgery and several scoring systems may be useful for this purpose. […] Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. […] Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effective when compared to laparotomy.

• #12 Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer

  https://www.wjgnet.com/2218-6220/full/v3/i3/109.htm

  Intraoperative rupture is one of the main concerns during the laparoscopic management of adnexal masses. […] The standard treatment of AOC includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. […] Laparoscopy offers multiple advantages over traditional laparotomy including smaller incisions, improved visualization, less blood loss, reduction in the need for analgesics, decreased morbidity and a more rapid recovery.

• #13 Ultrasonographic diagnosis and surgical outcomes of adnexal masses in children and adolescents | Scientific Reports

  https://www.nature.com/articles/s41598-022-08015-4

  Minimally invasive surgery (MIS) (laparoscopy or robotic surgery, 76.0%) was performed more frequently than laparotomy (24.0%). […] Ovarian-sparing surgery has successful clinical outcomes, with low rates of recurrence and repeated surgery. […] Approximately 87% of the patients in this study underwent ovarian-sparing surgery. […] MIS has been widely used in many surgeries, including those involving the female genital tract. […] In conclusion, abdominal pain is the most common reason for hospital visits and surgery in adolescents and young women with adnexal masses. The ultrasonographic diagnosis was consistent with histopathological diagnosis. In recent years, ovarian-sparing surgery with laparoscopy or robotic surgery has been increasingly used for the treatment of young patients with adnexal masses.

• #14 Adnexal/pelvic mass – Cancer Therapy Advisor

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

  Deciding between surgery and observation […] In the setting of an acute abdomen, surgical intervention is usually always indicated; the most common causes of this type of presentation are ectopic pregnancy, ovarian torsion, and pelvic inflammatory disease. The surgical management is then guided by the causative factor, the extent of the problem, and the age of the patient. […] In the setting of a mass suspicious for malignancy, surgeon preference and the extent of the problem are important guides. Although not a mandate, laparotomy is generally preferred when an advanced malignancy is suspected (ascites or extrapelvic findings on imaging) or the mass is too large for conventional minimally invasive techniques. […] In the setting of an adnexal or pelvic mass that is considered likely to be benign, conservative management without surgery is preferred in the absence of symptoms that have a major impact on the quality of life of a patient. Ongoing conservative management strategies range from routine annual gynecologic follow-up to repeat imaging, repeat serum marker analysis or both imaging and serum marker follow-up. […] The consensus statement also clearly indicates that cysts that have thick septations, nodules with blood flow, or focal areas of wall thickening have a substantial likelihood of malignancy. Surgical evaluation is strongly encouraged for these findings.

• #15 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. […] Depending on the size of the mass and whether it is suspected to be benign or malignant, surgery may be necessary. […] With advancements in minimally invasive, robotic-assisted technology, removal of an adnexal mass can be done via laparoscopic surgery by Kelsey-Seybold Clinic OB/GYN specialists using the da Vinci Surgical System. […] 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. […] 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.

• #16 Management of Adnexal Masses in Adolescents | Article | GLOWM

  https://www.glowm.com/article/heading/vol-2–adolescent-gynecology–management-of-adnexal-masses-in-adolescents/id/418463

  Management considerations of adnexal masses within an adolescent population are outlined below. […] Within the adolescent population, expectant management is the mainstay of treatment for ovarian cysts in the absence of an indication for intervention such as torsion or concern for malignancy. […] Surgical management is reserved for patients with acute presentations, such as ovarian torsion, large or persistent masses, and lesions with features concerning for malignancy. The goal of any surgical intervention is to relieve symptoms, achieve accurate diagnosis, and preserve ovarian function whenever appropriate. […] For cystic lesions with benign features requiring surgical intervention, ovary-sparing therapy with the goal of preserving ovarian tissue and function is gold standard even in the situation of ovarian torsion. […] For suspected malignancies, intervention usually includes surgical staging with possible exploration, pelvic washings, unilateral salpingoopherectomy, sampling of suspected pathological lymph nodes, peritoneal sampling, and omental biopsy.

• #17 ADNEXAL MASSES & OVARIAN CYSTS – Dr. Charles E. Miller

  https://drcharlesmiller.com/gynecologic/adnexal-masses-ovarian-cysts/

  Surgical removal is recommended to prevent growth, torsion, rupture, and rule out malignancy. […] Hospital admission is required to monitor for signs of the infection spreading to the bloodstream and response to intravenous (IV) antibiotics. Drainage of the abscess may be performed, especially if symptoms do not improve within 24-48 hours. Abscess drainage can be performed under radiologic imaging guidance or can be surgically excised. […] Depending on the severity of the symptoms or characteristic of the ectopic pregnancy, the patient may be a candidate for medical or surgical therapy. […] If fertility is desired, the tube may need to be surgically repaired or removed. […] A referral to an oncologist is strongly recommended for a thorough discussion of the management. […] If the workup for an ovarian mass is thought to be malignant, a referral to a gynecologic oncologist is strongly recommended. If the ovarian mass is thought to be benign, then preservation of the ovary is strongly recommended with only removing the cyst (cystectomy) from the ovary. On occasion the entire ovary may be removed. If this is performed, generally the fallopian tube is removed as well. This procedure is called a Salpingo-oophorectomy. Any specimen, either the cyst wall or the ovary, is sent to pathology to confirm whether it is benign or malignant. We perform our surgeries through the laparoscope as an outpatient surgery for quicker recovery and less pain.

• #18 Adnexal Tumors and Masses:  Symptoms, Types, Causes, Diagnosis and Treatment – MANO FOR HEALTH

  https://manoforhealth.com/adnexal-tumors-and-masses-symptoms-types-causes-diagnosis-and-treatment/

  Treatment of Adnexal Tumors and Masses depends on the nature of the mass, symptoms, age, and desire for fertility preservation. […] Watchful Waiting for small, simple, benign-appearing cysts in premenopausal women. Periodic ultrasound and symptom monitoring. […] Medical Management includes hormonal birth control to prevent recurrence of functional cysts and antibiotics for infectious causes like PID. […] Surgical Intervention includes Laparoscopy for minimally invasive removal of cysts or masses, Laparotomy for open surgery for large or suspicious masses, Oophorectomy for removal of the ovary if cancerous or severely damaged, Salpingectomy for removal of the fallopian tube, and Total hysterectomy with bilateral salpingo-oophorectomy in high-risk or confirmed malignancy. […] Oncology Treatment involves chemotherapy, radiation, or targeted therapy for malignant tumors.

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

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

  Obvious benign masses can be treated with resection of the mass alone or removal of the adnexal structure. […] In those cases in which it is questionable as to whether the mass is malignant, one should limit the resection to the structures involved unless it has been decided preoperatively that a more aggressive approach should be taken. […] When an obvious malignancy is encountered, a complete staging must be performed. This generally includes a complete exploration of the abdomen, a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissections, biopsies of the undersurface of the right and left diaphragms, and biopsies of the colic gutters followed by a maximal resection of the intra-abdominal tumor. In some cases, it may be necessary to resect portions of the small bowel or colon; therefore, preoperative bowel prep is necessary as well as a discussion about possible colostomy or other bowel changes.

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

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

  Most adnexal masses require little more than the normal annual gynecological examination for follow-up as they rarely recur. On the other hand, 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.

• #20 Treatment of Malignant Adnexal Tumors of the Skin: A 12-Year Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8870474/

  Surgical resection is the standard of care for malignant adnexal cancers of the skin. […] The role and efficacy of radiotherapy in the treatment of skin adnexal malignancies are not yet fully defined. Some authors suggest that adjuvant radiotherapy may be considered in locally advanced and regional disease. […] Surgical removal of the primary tumor with or without regional lymph nodes is the treatment of choice; however, perioperative radio- or chemotherapy should be considered in the event of aggressive behavior. […] The use of radiotherapy may also be beneficial in treating lymph node metastases, which are common among patients with MATS. […] The role of radiation therapy remains unclear; recent guidelines recommend considering radiotherapy in the treatment of extraocular sebaceous carcinoma as an adjuvant treatment for lymph node metastases or recurrent disease, or as monotherapy for patients who cannot be operated on or who present with unresectable tumors.

• #20 Treatment of Malignant Adnexal Tumors of the Skin: A 12-Year Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8870474/

  The death rate was 67% among patients with porocarcinoma and regional lymph node involvement. […] Recent data do not substantiate the use of radiotherapy, as mucinous carcinoma does not tend to respond to radiation treatment. […] Immunotherapy may also be applied as a treatment of other adnexal malignancies. […] Currently, new treatment strategies are being developed; a phase II trial study is being conducted to access the efficacy of the talimogene laherparepvec and nivolumab in therapy of malignant sweat gland tumors, sebaceous carcinoma, and trichilemmal carcinoma.

• #21 Treatment of Malignant Adnexal Tumors of the Skin: A 12-Year Perspective

  https://www.mdpi.com/2072-6694/14/4/998

  Surgical resection is the standard of care for malignant adnexal cancers of the skin. The efficacy of radiotherapy and targeted therapies is still undetermined in both adjuvant and palliative settings. […] Surgical removal of the primary tumor with or without regional lymph nodes is the treatment of choice; however, perioperative treatment may be considered. The role and efficacy of radiotherapy in the treatment of skin adnexal malignancies are not yet fully defined. Some authors suggest that adjuvant radiotherapy may be considered in locally advanced and regional disease. […] The aim of this study was to evaluate treatment outcomes and assess the efficacy of combined therapy in patients with cutaneous adnexal tumors treated at a tertiary skin cancer center. […] The use of radiotherapy may also be beneficial in treating lymph node metastases, which are common among patients with MATS.

• #21 Treatment of Malignant Adnexal Tumors of the Skin: A 12-Year Perspective

  https://www.mdpi.com/2072-6694/14/4/998

  The role of radiotherapy remains unclear; recent guidelines recommend considering radiotherapy in the treatment of extraocular sebaceous carcinoma as an adjuvant treatment for lymph node metastases or recurrent disease, or as monotherapy for patients who cannot be operated on or who present with unresectable tumors. […] The efficacy of radiotherapy in adnexal tumors requires further investigation. However, we proved that radiotherapy can be beneficial—especially among patients with sebaceous, trichilemmal, and pilomatrix carcinomas, or malignant proliferating pilar tumors.

• #22 Adnexal Tumors | Causes, Symptoms, & Treatment Guide

  https://fitwellhub.pk/symptoms-of-adnexal-tumor/

  The type and stage of the adnexal tumor determine the following treatment options. […] Adnexal tumors are primarily removed through surgery. Depending on the tumors nature and size, a minimally invasive procedure or a more complex surgery may be required. […] To kill the cancerous cells chemotherapy (the use of drugs) is used. It is often used for malignant tumors or the areas where cancer has spread. […] To target and kill cancerous cells high-energy rays are used and called radiation therapy. It is used rarely in adnexal tumor cases. […] Medications are used in the effective management of adnexal tumors, especially in relieving symptoms and preventing recurrence. […] Pain relievers are used to manage the anxiety and pain associated with adnexal tumors. To prevent tumor growth and balance hormone levels hormonal therapy. Chemotherapy drugs are used to treat malignant tumors.

• #23 Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation

  https://www.mdpi.com/1422-0067/22/10/5077

  The recommended first-line chemotherapy consists of a 5-fluorouracil-based regimen and capecitabine, and second-line agents included doxorubicin, platins, cyclophosphamide, vincristine, and bleomycin. […] The therapeutic approach includes surgical excision. The sentinel lymph node mapping is not indicated in primary cutaneous secretory carcinoma.

• #24 Chemotherapy of Rare Skin Adnexal Tumors: A Review of Literature | Anticancer Research

  https://ar.iiarjournals.org/content/34/10/5263

  Adjuvant radiation can be useful in high-risk cases (tumors larger than 5 cm, positive surgical margins of 1 cm, moderately- to poorly-differentiated histology with lymphovascular invasion). […] All authors agree that the role of chemotherapy in the treatment of SATs remains unclear. In fact, SATs are considered relatively chemoresistant, although some responses to single-agent or combined chemotherapy have been reported. […] The association of two or three chemotherapeutic agents has led to some responses in metastatic disease, although these therapy schedules are characterized by short-term duration and great toxicity. […] Our suggestion is that these chemoresistant tumors can benefit only from a targeted-therapy. […] Considering the differential diagnosis between a primary SAT and a secondary neoplasm, skin metastasis of breast cancer is very difficult, hence we suggest the utilization of all available immunohistochemical markers, additionally to clinical and radiological evaluations. […] Yet, due to the sharing of some molecular alterations in breast cancer and SATs, we suggest that using the same chemotherapeutic agents and the same target therapy for metastatic SAT could be effective, considering also the high rate of chemoresistance of these types of neoplasms.

• #25 Recurrent female adnexal tumor of probable Wolffian origin treated with debulking surgery, imatinib and paclitaxel/carboplatin combination chemotherapy: A case report

  https://www.spandidos-publications.com/10.3892/ol.2017.5874

  The role of adjuvant chemotherapy or radiation therapy in the treatment of FATWO remains controversial. […] For recurrent and metastatic FATWO, molecular-targeted therapy, such as the use of tyrosine kinase inhibitors, may be a potential treatment option. […] Despite insufficient previous studies investigating the effect of imatinib mesylate on FATWO tumors, this targeted molecular therapy was administered in this case of recurrent KIT-positive FATWO for 6 months and follow-up was performed at 6-month intervals. […] A number of chemotherapy regimens, including cisplatin/cyclophosphamide, etoposide/ifosfamide/carboplatin, cisplatin/paclitaxel, carboplatin/paclitaxel with leuprolide, and irinotecan alone, have been used to treat recurrent and metastatic FATWO. […] However, only paclitaxel used in combination with cisplatin induced temporary stabilization of the disease.

• #26

  https://atlantagynonc.com/conditions/pelvic-masses

  The treatment for a pelvic mass is to remove it during surgery. The type of surgery we recommend depends on your age, whether you want to have children in the future, your medical history, and how complex the mass is. […] For patients whose ovaries are no longer making hormones and who no longer have periods, we may recommend removing both ovaries and tubes and the uterus, even if only one ovary is involved in the mass. […] In the United States, most women stop having periods in their early 50s. Though the ovaries are making some hormones in this age group, we recommend removing the uterus (with the cervix) and possibly both ovaries and tubes to prevent the need for future surgeries and the development of cancer. […] Before age 40, the ovaries are making significant amounts of hormones that regulate a woman’s periods and allow for pregnancy. In this age group, we usually recommend removing only the ovary involved with the mass unless it is found to be cancer or in certain other situations.

• #27 Standard Treatment Guidelines For Adnexal Mass

  https://speciality.medicaldialogues.in/standard-treatment-guidelines-for-adnexal-mass

  (a) Conservative Management: Simple cyst in premenopausal woman: 2/3rd of these regress over 2-3 menstrual cycles. Therefore a Wait and See policy is recommended for 8-10 wks. […] (b) Surgical Management is recommended for the following: A cyst with significant pain and other features suggestive of rupture/torsion […] Surgery for Benign ovarian cyst: Ovarian cystectomy or Oophorectomy if the cyst cannot be removed separately from ovaries. […] Surgery where Malignancy is suspected: Staging laparotomy has to be performed followed by histopathology and appropriate referrals for chemotherapy. […] Special Situations: 1. Mass with borderline histology […] 2. Young women Germ cell tumours […] 3. Adnexal masses in pregnancy: mostly cystic, resolve

• #28 Case Report: Management of an Early Third Trimester Large Adnexal Mass in a Singleton Pregnancy

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-8-190.php?jid=ogcr

  Adnexal masses are increasingly being diagnosed in pregnancy. They are typically either managed expectantly or surgically in the early second trimester; however, limited reports on interventions for management in the third trimester. […] PCD of a simple cyst is a treatment option for women with significant symptoms in the third trimester. […] Management of adnexal masses in pregnancy is founded on balancing the risks of intervention for the pregnancy and the risks of complications from a mass managed expectantly. […] If surgical management is indicated, masses are typically excised via laparoscopy or laparotomy, ideally between 16 and 20 6/7 weeks gestation to minimize risks of spontaneous abortion in the first trimester and preterm labor in the third trimester. […] PCD may be a less invasive alternative treatment option for persistent adnexal masses in pregnancy. […] This case demonstrates that, with thorough patient counseling and through shared decision making, PCD offers a viable treatment option for patients with rapidly enlarging adnexal masses and significant symptoms late in gestation.

• #29 Azthena logo with the word Azthena

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

  Since most adnexal masses are non-cancerous, prognosis is often very good after appropriate treatment. Surgical removal of the tumor offers a complete cure for the majority of patients. […] Depending on the type of adnexal tumor, medical or surgical treatment options are offered.

• #30 Adnexal tumors and masses – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adnexal-tumors/care-at-mayo-clinic/mac-20355056

  Mayo Clinic doctors have extensive experience diagnosing and treating adnexal tumors and masses, including those that are cancerous (malignant adnexal tumors) and those that aren’t cancerous (benign adnexal tumors). […] Mayo Clinic doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals. […] Mayo Clinic doctors have extensive experience diagnosing and treating adnexal tumors and masses. These experts draw on their experience to create a personalized treatment plan that delivers exactly the care you need.

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

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

  Consider opportunistic salpingectomy as risk reduced surgery for ovarian cancer during benign operation. […] The therapeutic approach must include the differential diagnosis of malignancy and the hormonal and reproductive aspects of the patient. […] Whenever possible, a minimally invasive procedure focused on preserving the ovaries is recommended. […] Most ovarian carcinomas occur in women over 50 years of age. It is recommended that ovarian cysts in postmenopausal women should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan. […] 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.

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