Comprehensive review of adnexal masses in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20232742Keywords:
Adnexal mass, CA-125, Ectopic pregnancy, Ovarian malignancy, Ovarian tumour, RMI, Tubo-ovarian mass, Tumour markersAbstract
Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups.
Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages.
Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively.
Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy.
References
Prince S. A prospective study of adnexal masses with its evaluation by risk of malignancy index among patients attending tertiary care hospital. Int J Res Rev. 2020;7(12):194-9.
Biggs WS, Marks ST. Diagnosis and management of adnexal masses. Am Fam Phys. 2016;93(8).
Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv. 2006;61(7):463-70.
Yacobozzi M, Nguyen D, Rakita D. Adnexal masses in pregnancy. Semin Ultrasound CT MR. 2012;33(1):55-64.
Valentin L, Jurkovic D, Van Calster B, Testa A, Van Holsbeke C, Bourne T, et al. Adding a single CA 125 measurement to ultrasound imaging performed by an experienced examiner does not improve preoperative discrimination between benign and malignant adnexal masses. Ultrasound Obstet Gynecol. 2009;34(3):345-54.
Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007;109(2):221-7.
Edmonds DK, Lees C, Bourne T. Dewhurst’s Textbook of Obstetrics and Gynaecology. 9th edn. John Wiley and Sons Ltd.; 2018.
American College of Obstetricians and Gynecologists. Practice bulletin no. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016;128(5):e210-26.
Yazbek J, Raju SK, Nagi JB, Holland TK, Hillaby K, Jurkovik D. Effect of quality of gynaecological ultrasonography on management of patients with suspected ovarian cancer: a randomised controlled trial. Lancet Oncol. 2008;92:124-31.
Modesitt SC. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynaecol. 2003;102(3):594-9.
Spanos W. Preoperative hormonal therapy of cystic adnexal masses. Am J Obstet Gynaecol. 1973;116(4):551-6.
Alacazar JL, Merce LT, Laparte C, Jurado M, Garcia GL. A new scoring system to differentiate benign from malignant adenexal masses. Am J Obstet Gynaecol. 2003;188(3):685-92.
Kayastha S. Study of ovarian tumors in Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2009;11(3):200.
Pilli GS, Suneeta K, Dhaded A, Yenni V. Ovarian tumours: a study of 282 cases. J Indian Med Assoc. 2002;100(7):423-4.
Gupta N, Bisht D, Agarwal AK, Sharma VK. Retrospective and prospective study of ovarian tumours and tumour-like lesions. Indian J Pathol Microbiol. 2007;50(3):525-7.
Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol. 2011;155(2):119-24.
Cannistra SA. Cancer of the Ovary. N Engl J Med. 2004;351(24):2519-29.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.
Abbas AM, Zahran KM, NA, Kamel HS. A new scoring model for characterization of adnexal masses based on two-dimensional gray-scale and colour Doppler sonographic features. Facts Views Vis Obgyn. 2014;6(2):68-74.
