ADNEXAL MASS

A condition requiring closer

attention

Dr.Nur sayeeda
Assistant professor
Obstretics &Gynaecology
Dhaka Medical college
 Defination
• Anatomicaly the adnexae encompases the
region whithin the pelvis that includes the
ovaries,fellopian tubes round ligaments &
structures arising from embryologigal rests so-
Any mass occuping this region is Adnexal
mass or tubo-ovarian mass
Etiology of adnexal mass
it may be-

a. physiologic- follicular cyst

lutual cyst
b.infectious- hydrosulphinx
pyosulphinx T-o mass,appendicular lump,diverticulities.
C.Non neoplastic-
ectopic pregnancy
pedunculated myoma,pelvic
kidney,endometioma,PCO

D.Neoplastic-ovarian
tumour-benign
malignant
 Clinical presentation of adnexal mass

.Acute onset of lower abdominal pain

.Chronic ,intermittent pain
.Dysmenorrhia,menstrual disturbance
.Non-specific symptoms- anorexia,nausia
loss of weight etc
.Bladder symptoms-
.No symptoms -
 Diagnosis of adnexal mass
• A.History-
Age-. young age- germ cell tumour
. Following menarche –
follicular&corpus luteal cyst
. Reproductive age group-
PCO,endometriosis,ectopic ,T-O mass

. After menopause-malignancy
 Diagnosis-continue
• Pain-due to distension of ovarian
capsule&compression of adjacent structure
a.Location
b.radiation
c.quality
d.time of onset
. Menstrual disturbance-
. Others-
 B.Physical Examination
• a.General examination-including lyphnode palpation
&breast examination
• b.Bimanual examination-
size,shape,consistency,mobility,tenderness.
• C.Recto-Vaginal examination-

a complex mass in cul-de-sac

+nodularity+tander utero-sacral ligament>Endomtiosis in
pre-menopausal women but malignancy in post-
menopausal women
 c.Ultrasound evaluation
• a.Complexity-
• b.contour-smooth/excrescences
• c.Presence of internal septa/papillae
• d.Ascities

Colour flow doppler scanning-to study blood

flow,to measure R1,P1.
 Labaratory test
• Complete blood picture-
• M-T ,VDRL,TPHA etc-
• Serum B- HCG-
• Serum tumour marker –alfa-fetoprotein ↑ -
endodermal sinus tumour
lactic dehydrogenase ↑-
dysgermina
B-HCG↑- non gestational chorionic carcinoma
Serum CA -125-
 Serum CA -125
• Normal value –less than 35u/ml
It may increase in some benign condition(upto-
100u/ml)-Liomyoma,non malignant ovarian
tumour,liver disease,
adenomyosis,endometriosis,pregnancy,PID etc.
Malignant conditions are –Serous epithelial
ovarian carcinoma,breast,colon,lung &
pancreatic cancer.
In premenopausal women the
common adnexal mass are-
Ovarian cyst
Tubal pregnancy
Benign &malignant tumour
Endometrioma
PCO
T-O mass
In post-menopausal women those are-

Cancer
Fibroid
Fibroma
Diverticular abscess
 Managementment of Adnexal mass

• Depends upon- Age

• Result of the work-up
• In pre menousal women-
Management of adnexal mass in post
menopausal women
Thank you