Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Review Article

Adnexal Masses in Premenopausal Reproductive Age Women

Author(s): Henny Liwan* and Steve Hong

Volume 15, Issue 1, 2019

Page: [32 - 40] Pages: 9

DOI: 10.2174/1573404813666171016154803

Price: $65

Abstract

Background: Adnexal masses in premenopausal women are common reason for referral to OB-GYN. The etiologies vary from non-gynecologic to gynecologic. Once the mass is determined to be gynecologic in its origin, the gynecologist needs to predict if the mass is more likely to be benign or malignant which could lead to a diagnostic dilemma.

Objective: This article reviews different histologic type of ovarian tumors, its epidemiology, clinical presentation, imaging appearance and ovarian tumor markers. Familiarity with these patterns will help the clinician narrow the differential diagnosis thus facilitating further management.

Results: The incidence of malignancy increases with age. Vast majority of adnexal masses that are ovarian in etiology, 90.5% are benign. The first line imaging is usually a pelvic ultrasound. There are imaging characteristics that could assist in categorizing a mass as more likely to be benign or suspicious for malignancy. Furthermore, there are tumor markers that are approved by FDA to be used as tools to evaluate adnexal masses.

Conclusion: Adnexal masses in the reproductive age group demonstrate the greatest histologic variance that is mostly benign. Clinical judgement is important to predict if a mass is likely to be benign or malignant based on risk factors, imaging appearances, and tumor markers. If suspicion of malignancy is high, referral to a gynecologic oncologist is warranted as this may improve patient’s survival.

Keywords: Adnexal mass, tumor markers, premenopausal, reproductive, diagnostic dilemma, ovarian tumor.

Graphical Abstract

[1]
Royal College of Obstetrics and Gynaecologists: Management of Suspected Ovarian Masses in Premenopausal Women; 162; Novembers. 2011.
[2]
Timmerman D, Van Calster B, Testa AC, et al. Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol 2010; 36: 226-34.
[3]
Van Nagell JR, Miller RW. Evaluation and management of ultrasonographically detected ovarian tumors in asymptomatic women. Obstet Gynecol 2016; 127(5): 848-58.
[4]
Hermans AJ, Kluivers KB, Janssen LM, et al. Adnexal masses in children, adolescents and women of reproductive age in the Netherlands: A nationwide population-based cohort study. Gynecol Oncol 2016; 143(1): 93-7.
[5]
Moore RG, McMeekin DS, Brown AK, et al. A Novel multiple marker bioassay utilizing HE4 and CA 125 for the prediction of ovarian cancer in patients with pelvic mass. Gynecol Oncol 2009; 112(1): 40-6.
[6]
Piovano E. Cavallero C1, Fuso L, et al Diagnostic accuracy and cost-effectiveness of different strategies to triage adnexal masses: A prospective study. Ultrasound Obstet Gynecol 2017; 50(3): 395-403.
[7]
Davidson SA. Management of the adnexal mass Danforth’s Obstetrics and Gynecology, 10th Edition. 2008. 62: 1061-72.
[8]
Bennett JA, Oliva E. Pathology of the adnexal mass. Clin Obstet Gynecol 2015; 58(1): 3-27.
[9]
Brown J, Frumovitz M. Mucinous tumors of the ovary: Current thoughts on diagnosis and management. Curr Oncol Rep 2014; 16(6): 389.
[10]
Ahmed R, Din HU, Hashmi SN, Muhammad I. Sarcoma-like mural nodule in a borderline mucinous tumour of ovary. J Coll Physicians Surg Pak 2016; 26(5): 435-7.
[11]
Liggins CA, Ma LT, Schlumbrecht MP. Sertoli-Leydig cell tumor of the ovary: A diagnostic dilemma. Gynecol Oncol Rep 2016; 15: 16-9.
[12]
Pirschner F, Bastos PM, Contarato GL, Bimbato ACBL, Filho AC. Gorlin syndrome and bilateral ovarian fibroma. Int J Surg Case Rep 2012; 3(9): 477-80.
[13]
Lee KR, Scully RE. Mucinous tumors of the ovary: A clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with ‘pseudomyxoma peritonei’. Am J Surg Pathol 2000; 24: 1447.
[14]
Borah T, Mahanta RK, Bora BD, Saikia S. Brenner tumor of ovary: An incidental finding. J Midlife Health 2011; 2(1): 40-1.
[15]
Palmeiro MM, Cunha TM, Loureiro AL, Esteves G. A rare benign ovarian tumour. BMJ Case Rep 2016; 2016 pii: bcr2015214101.
[16]
Burnik Papler T, Frković Grazio S, Kobal B. Sertoli-Leydig cell tumor with retiform areas and overgrowth of rhabdomyosarcomatous elements: Case report and literature review. J Ovarian Res 2016; 9: 46.
[17]
Baek J. Synchronous occurrence of mature cystic teratoma of the fallopian tube and ovary: A case report. Oncol Lett 2016; 12: 911-4.
[18]
Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: Tumor types and imaging characteristics. Radiographics 2001; 21: 475-90.
[19]
Gupta A, Gupta P, Manaktala U, Khurana N. Clinical, radiological, and histopathological analysis of paraovarian cysts. J Midlife Health 2016; 7(2): 78-82.
[20]
American College of Obstetrics and Gynecology: Committee Opinion: The Role of the Obstetrician Gynecologist in the Early Detection of Epithelial Ovarian Cancer; no. 477, March. 2011.
[21]
Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975-2013. Bethesda, (MD): National Cancer Institute 2016.
[22]
American College of Obstetrics and Gynecology: Practice Bulletin Evaluation and Management of Adnexal Masses; 174, November. 2016.
[23]
Li A. New Biomarkers for ovarian cancer: OVA1 and ROMA in diagnosis, selective use of these new tests may lead to better outcomes for women with adnexal masses or epithelial ovarian cancer. Contemporary Obstetrics and Gynecology & Women’s health. April 1, 2012.
[24]
US Food and Drug Administration. FDA clears a test for ovarian cancer: test can help identify potential malignancies, guide surgical decisions. Silver Springs, MD: FDA 2009.
[25]
Smorgick N, Maymon R. Assesment of adnexal masses using ultrasound: A practical review. Int J Womens Health 2014; 6: 857-63.
[26]
Pavlik EJ, Ueland FR, Miller RW, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol 2013; 122: 210-7.
[27]
Timmerman D, Testa AC, Bourne T, et al. Logstistic Regression model to distinguish between the benign and malignant adnexal mass before surgery: A multicenter study by the international ovarian tumor analysis group. J Clin Oncol 2005; 23: 8794-801.
[28]
Lynda Roman, Laila Muderspach, et al. Pelvic examination, tumor marker level, and gray-scale and Doppler sonography in the prediction of pelvic cancer. Obstet Gynecol 1997; 89(4): 493-500.
[29]
van Nagell JR, DePriest PD. Management of adnexal masses in postmenopausal women. Am J Obstet Gynecol 2005; 193(1): 30-5.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy