Clinicopathological spectrum of gynecological pelvic masses: a cross-sectional study

Shobha S. Pillai


Background: Pelvic mass lesions are a commonly encountered entity in gynecological practice. These masses may be uterine or adnexal, benign or malignant. Clinicians have to be aware of their differential diagnosis to triage the patients and ensure optimum therapeutic approach. The objectives of this study were to study the diverse clinical spectrum of gynecological pelvic masses and to correlate the preoperative diagnosis based on clinical examination and ultrasonography with intraoperative surgical findings and histopathological examination.

Methods: This was a cross sectional observational study on 114 patients with a diagnosis of pelvic mass who underwent laparotomy. All the patients were evaluated by a complete history, general abdominal and pelvic examination, followed by ultrasonography. These preoperative findings were then correlated with surgical findings and histopathological diagnosis.

Results: 48% 0f the patients were in the age group of 41-50 years. The most common presenting complaint was lower abdominal/ pelvic pain seen in 78% of the patients. Uterine masses mostly presented as abdominal pain, abdominopelvic mass, menstrual complaints whereas ovarian masses presented with vague G. I symptoms or were asymptomatic. 37% of all masses were leiomyomas. There were 16 uterine malignancies and 14 ovarian cancer cases. Preoperative USG correlated well with histopathological diagnosis.

Conclusions: A methodical approach consisting of a proper history, clinical examination, imaging studies and correct interpretation of diagnostic procedures is necessary for the triage and optimum management of gynecologic pelvic masses.


Adnexal masses, Gynecological pelvic masses, Histopathological diagnosis, Ovarian masses, Ultrasonography, Uterine masses

Full Text:



Russell DJ. The female pelvic mass: Diagnosis and management. Med Clin North Am. 1995;79:1481-93.

Moore RG, Bast RC. How do you distinguish a malignant pelvic mass from a benign pelvic mass? Imaging, biomarkers, or none of the above. J Clin Oncol. 2007;25:4159-61.

Engelen MJ, Kos HE, Willemse PH, Aalders JG, de Vries EG, Schaapveld M, et al. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer. 2006;106:589-98.

Giede KC, Kieser K, Dodge J, Rosen B. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol. 2005;99:447-61.

Varras M. Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early detection of ovarian cancer. Clin Exp Obstet Gynecol. 2003;31(2):85-98.

Ljubic A, Bozanovic T, Vilendecic Z. Sonographic evaluation of benign pelvic masses. Donald School Basic Textbook of Ultrasound in Obstetrics and Gynecology; 2014:372.

Stein SM, Laifer-Narin S, Johnson MB, Roman LD, Muderspach LI, Tyszka JM, et al. Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler, and spectral Doppler sonography. Am J Roentgenol. 1995;164:381-6.

Padilla L, Radosevich DM, Milad MP. Limitations of the pelvic examination for evaluation of the female pelvic organs. Int J Gynaecol Obstet. 2005;88:84-8.

Tripathi P, Singh D, Bagul M. Ultrasonography study of gynecological pelvic masses. Int Res J Clin Med. 2016;1(4):1-6.

Eze JC, Ugwu AC, Ohagwu CC. The value of ultrasonography in the diagnosis of leiomyomas in Southeast Nigeria. J Asian Scient Res. 2013;3(2):151-6.

Kinkel K, Hricak H, Lu Y. US characterization of ovarian masses: a meta-analysis. Radiol. 2000;217:803.

Liu J, Xu Y, Wang J. ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol. 2007;62:328-34.

Jacobs I, Oram D, Fairbanks J. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990;97(10):922-9.

Moore RG, McMeekin DS, Brown AK. A novel multiple marker bioassay utilizing HE4 and CA-125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2009;112:40-6.

ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007;110:201-4.