Ovarian cysts, cancer, and other adnexal masses: Clinical

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Ovarian cysts, cancer, and other adnexal masses: Clinical

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A 65-year-old woman comes to the clinic for a routine health examination. The patient feels generally well and has no complaints. Medical history is notable for gastroesophageal reflux disease managed with pantoprazole. Family history is unremarkable. Vitals are within normal limits. Physical examination is normal. The patient is interested in being tested for CA-125 because a friend who was recently diagnosed with ovarian cancer was found positive for this marker. Which of the following is the most appropriate recommendation for this patient?  


Adnexal masses can affect the ovary or the fallopian tube. They can develop in females of all ages, and can be discovered incidentally during a pelvic ultrasound, or when they cause symptoms like pain or pressure on the affected side.

When encountering an adnexal mass the first step is to assess whether or not it’s a medical emergency, and, if it’s not, whether the mass is benign or malignant.

Medical emergencies are adnexal masses that cause severe and abrupt pain, along with other symptoms like nausea, vomiting, fever, or vaginal bleeding.

In addition, any kind of pelvic pain or bleeding in a pregnant female during her first trimester is considered a medical emergency - so the first step is to get a pregnancy test.

If the pregnancy test is negative, the likely causes are ovarian torsion, a ruptured ovarian cyst, and a tubo-ovarian abscess.

In ovarian torsion, the ovary twists around the suspensory ligament, which suspends the ovary and contains the ovarian blood vessels within it.

Risk factors include an ovarian mass - like a cyst or cancer, and an ovary greater than 5 centimeters in diameter.

In both cases, twisting the vessel cuts of the blood supply to the ovary - causing ovarian ischemia.

An ultrasound may show that one ovary is larger than the other one, because of edema and blood pooling up in the ovarian veins, and the affected ovary might look like a twisted mass.

A Doppler ultrasound shows decreased or absent blood flow within the ovary, and the “whirlpool sign” may be present, which is when blood flow inside the ovarian vessels seems to flow in a spiral around a central axis.


Ovarian cysts and cancer are some of the major adnexal masses. An adnexal mass is an abnormal growth in the tissues surrounding the uterus and ovaries. An ovarian cyst is any fluid-filled sac that develops in the ovary. Most ovarian cysts do not cause any symptoms unless they either break open or cause the ovary to twist and become ischemic (ovarian torsion). Ovarian cancer refers to a malignancy that begins in the ovaries, commonly affecting women above 60 years of age.

Other adnexal masses may include tubo-ovarian abscesses, teratomas (tumors containing various types of tissue, such as hair, teeth, and bone), and ectopic pregnancy (in pregnant women).


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