Approach to adnexal masses Quiz: Ace Your Exams
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A 60-year-old woman presents to the clinic with a 3-month history of worsening pelvic pressure and bloating. Her last menstrual period was 10 years ago, and she has not had postmenopausal bleeding. She has no nausea or vomiting, but does note recent constipation. Her past medical history is notable for hypothyroidism, and her medications include levothyroxine, a daily multivitamin, and a calcium supplement. Family history is significant for a maternal aunt with breast cancer at age 68. Temperature is 36.5°C (97.7°F), pulse is 72/min, respirations are 18/min, blood pressure is 120/80 mmHg, and body mass index is 34 kg/m2. The abdominal exam reveals mild distension, but no tenderness to palpation. A large pelvic mass is palpable on bimanual exam. A pelvic ultrasound shows a 12 cm multiloculated cystic structure in the left adnexa, with thick septal walls that lack internal vascularity. The mass has no mural nodules, papillary projections, or solid components. The uterus is small, and the endometrial thickness is 6 mm (slightly thicker than what is usually seen in postmenopausal women). Which of the following is the most appropriate next step in the evaluation?
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