Adnexal Mass

1. Differential Diagnosis of Adnexal Mass
   1. Ovary
      1. Functional cyst or Corpus Luteal Cyst
      2. Theca lutein cyst
      3. Benign ovarian tumor (teratoma, cyst adenoma)
      4. Ovarian Torsion
      5. Ovarian hyperstimulation syndrome
      6. Ovarian Cancer
   2. Fallopian Tube
      1. Tuboovarian abscess in PID
      2. Hydrosalpinx
      3. Ectopic Pregnancy
      4. Malignancy
   3. Uterus
      1. Leiomyomata or Uterine Fibroids (pedunculated)
      2. Endometriosis
   4. Gastrointestinal Tract
      1. Stool-filled bowel
      2. Diverticulitis
      3. Appendicitis or appendiceal abscess
      4. Inflammatory Bowel Disease
      5. Small Bowel leiomyoma
      6. Colon Cancer
      7. Krukenberg Tumor (metastasis to ovary)
   5. Urinary Tract
      1. Bladder distention
      2. Urachal cyst
2. Evaluation: Indications for Gynecology Referral in Prepubescent girls
   1. Refer all Adnexal Masses
3. Evaluation: Indications for Gynecology Referral in Premenopausal women
   1. Positive urine Pregnancy Test
      1. Evaluate for Ectopic Pregnancy (serial Quantitative hCG and pelvic Ultrasound)
   2. Ultrasound with complex cyst or solid mass (suspicious findings)
      1. See Pelvic Ultrasound Ovarian Mass Findings
   3. Ultrasound with mass >10 cm
   4. Serial Ultrasounds (every 4-6 weeks) with mass that persists >12 weeks
   5. CA-125 is not recommended in evaluation of premenopausal women
      1. However if obtained, a CA-125>200 U/ml should prompt referral in this group
4. Evaluation: Indications for Gynecology Referral in Postmenopausal women
   1. Ultrasound with complex cyst or solid mass (suspicious findings)
      1. See Pelvic Ultrasound Ovarian Mass Findings
   2. Ultrasound with mass >10 cm
   3. Serial Ultrasounds (every 4-6 weeks) with mass that persists >12 weeks
   4. CA-125 >35 U/ml
5. Imaging
   1. See Pelvic Ultrasound Ovarian Mass Findings
6. References
   1. Chambers in Noble (2001) Primary Care, p. 385
   2. Webb (2004) Radiol Clin North Am 42(2):329
   3. Barney (2008) Med Clin North Am 92(5): 1143-61
   4. Givens (2009) Am Fam Physician 80(8): 815-22