Adnexal Mass

What is an Adnexal mass?

An adnexal mass is a lesion arising from the uterine adnexa, most commonly the ovary or fallopian tube. The adnexal region includes the ovaries, fallopian tubes, and supporting ligaments. Adnexal masses may be physiologic (for example, related to ovulation) or pathologic. In reproductive-age individuals, benign causes predominate, whereas malignancy risk increases with age and certain clinical risk factors. The clinical significance of an adnexal mass depends on symptoms, growth pattern, and imaging characteristics.

What causes Adnexal masses?

In reproductive-age individuals, most adnexal masses represent functional ovarian cysts that arise during normal ovulatory cycles. These include follicular cysts that fail to regress and corpus luteum cysts that may hemorrhage. Endometriomas develop from ectopic endometrial tissue that bleeds cyclically within the ovary. Other benign cystic structures include inclusion cysts and paratubal cysts.

Infectious processes such as pelvic inflammatory disease can progress to a tubo-ovarian abscess. An ectopic pregnancy located in the fallopian tube can also present as an adnexal mass and carries a risk of rupture. In postmenopausal individuals or those with a personal or family history of breast or ovarian cancer, neoplastic etiologies require careful consideration. Many high-grade serous carcinomas are thought to originate from the fallopian tube epithelium.

What are the signs and symptoms of an Adnexal mass?

Clinical presentation varies with size, etiology, and acuity. Gradual enlargement may cause pelvic pressure, bloating, or urinary frequency due to mass effect. Acute severe pelvic pain with nausea suggests ovarian torsion, particularly if the onset is sudden. Cyclical pelvic pain associated with dysmenorrhea supports endometriosis as a possible cause. On examination, clinicians may identify adnexal tenderness, a palpable mass, or decreased mobility, suggesting inflammation or adhesions. Fixed or irregular masses warrant further evaluation because they may indicate invasive or complex pathology.

How is the cause of an Adnexal mass diagnosed?

Evaluation begins with a focused history that addresses menstrual patterns, fertility treatments, pregnancy risk (urine/serum β-hCG), and family cancer history, followed by a pelvic examination assessing mass size, mobility, and tenderness. Transvaginal ultrasound is the first-line imaging modality and distinguishes cystic from solid components while assessing septations, papillary projections, and internal vascularity. Doppler flow assessment can support suspicion of torsion or neoplasm in appropriate clinical settings.

Serum CA-125 may assist with risk stratification, particularly in postmenopausal individuals or when imaging features are concerning. Risk models such as the ROMA or ADNEX systems integrate imaging findings with biomarkers to refine estimates of malignancy risk. MRI or CT can further characterize indeterminate or large masses and support staging and operative planning. Diagnostic laparoscopy is considered when torsion is suspected or when imaging cannot adequately exclude malignancy.

How is an Adnexal mass treated?

Management depends on symptoms, imaging findings, reproductive goals, and estimated malignancy risk. Small, simple cysts with benign features may be managed expectantly with interval ultrasound monitoring. Surgical intervention is indicated for persistent, enlarging, symptomatic, or suspicious masses. Acute complications such as torsion, rupture, or tubo-ovarian abscess require urgent assessment and often operative management. Antibiotic therapy accompanies drainage in cases of abscess. Procedures may include cystectomy, detorsion, or oophorectomy, tailored to fertility preservation when appropriate. Suspected malignancy warrants referral to gynecologic oncology for staging and definitive management.

What are the most important facts to know about Adnexal masses?

• An adnexal mass arises from the ovary, fallopian tube, or adjacent supporting structures and may be physiologic or pathologic.
• Functional cysts are common in reproductive-age individuals, whereas malignancy risk increases with age and specific risk factors.
• Acute severe pain raises concern for torsion or rupture and requires urgent evaluation.
• Transvaginal ultrasound is the primary diagnostic tool, with serum markers and risk models supporting malignancy assessment.
• Management ranges from observation of simple cysts to surgical treatment for persistent, symptomatic, or suspicious lesions.