eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Adnexal Tumors: Workup

Author: Margrit M Juretzka, MD, MS, Assistant Professor of Gynecologic Oncology, Stanford University Hospital and Clinics
Coauthor(s): Nelson Teng, MD, PhD, Associate Professor, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Stanford School of Medicine
Contributor Information and Disclosures

Updated: Oct 16, 2008

Workup

Laboratory Studies

Possible lab tests in the evaluation of adnexal mass include serum markers, Papanicolaou test, CBC count, urinalysis (U/A), stool for blood, and electrolytes.

  • CA-125 is a marker that is elevated in approximately 80% of women with ovarian cancer with sensitivities of 50% in women with stage I disease and 90% in patients with advanced disease,22 However, it can be elevated in many other conditions, including gynecologic etiologies such as endometriosis, uterine fibroids, and pregnancy, and nongynecologic conditions such as gastroenteritis, pancreatitis, cirrhosis, and congestive heart failure.16,17,18 As such, the specificity of CA-125 is limited and is not recommended for routine screening purposes in the general population.15
  • Urine or serum beta human chorionic gonadotropin (ß-hCG) should be obtained in women of reproductive age to rule out pregnancy and pregnancy-related etiologies of adnexal masses.
  • Other serum markers such as AFP and LDH can be helpful when a germ cell tumor is suspected.
  • A Papanicolaou test should be considered in women undergoing a gynecologic surgery.
    • This test should be used to help rule out any unknown cervical pathology.
    • In extremely rare situations, this test may reveal the presence of an adnexal malignancy.
  • A CBC count helps evaluate for presence of inflammation and anemia.
    • An infected mass such as a tubo-ovarian abscess results in an increased WBC count with an associated left shift.
    • Adnexal masses rarely cause anemia, but because they often require surgical removal, this information should be known.
  • U/A results are generally normal in the presence of an adnexal mass.
    • Bladder pathology may present with symptoms of an adnexal mass and may be discovered based on U/A results.
    • Appendicitis can present similar to an adnexal mass but is often associated with WBCs in the U/A findings.
  • Results from testing stool for blood should be negative for adnexal masses but may be positive in those women with colonic pathology.
  • Serum electrolytes should not be altered by an adnexal mass; however, symptoms associated with masses, such as nausea and vomiting, can cause alterations that must be known before anesthesia and surgery are considered.
  • Measuring other hormone levels is generally of limited value in the evaluation of adnexal masses. Obtaining estrogen and progesterone levels may be helpful in women suggested to have functional tumors, such as germ cell tumors, or if a girl younger than 12 years is being evaluated.

Imaging Studies

  • The most commonly performed test to evaluate an adnexal mass is transabdominal or transvaginal ultrasonography.5,6,7,23
    • This test helps demonstrate the presence of the mass and its location (eg, ovarian, uterine, bowel). It also provides the mass size, consistency, and internal architecture. Scoring systems, such as that suggested by DePriest and associates, can then be used to determine the likelihood of a malignant component.24
    • Hysterosonography (ultrasonography with the presence of fluid in the uterine cavity) may be used to help distinguish between uterine masses and those arising from other pelvic structures.
    • Color Doppler ultrasonographies can be used to evaluate the resistive index of the mass vessels, which, when low, has been indicative of a malignancy.
  • Pelvic radiographs are generally not helpful in the evaluation of adnexal masses. A dermoid cyst generally contains areas of calcification that may be picked up on a plain radiograph.
  • CT scans are most useful for assessing the remainder of the abdomen and pelvis when metastatic disease is suspected. Incidental adnexal masses are sometimes found when CT is performed for evaluation of other conditions. As with ultrasonography, CT scan can help identify the size, location, and relationship to other organs. CT scan is less effective than ultrasonography for determining the internal architecture of these masses.
  • MRI scans can help characterize adnexal mass characteristics in select cases when ultrasonographic findings are limited.4

Diagnostic Procedures

In limited settings, aspiration of the mass can be performed. However, this approach must be reserved for those women in whom an extremely low chance of a malignant mass exists and/or when surgical intervention is contraindicated.

More on Adnexal Tumors

Overview: Adnexal Tumors
Workup: Adnexal Tumors
Treatment: Adnexal Tumors
Follow-up: Adnexal Tumors
References
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References

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Further Reading

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Keywords

adnexal mass, pelvic mass, ovarian mass, pelvic masses, ovarian masses, ovarian cysts, ovarian neoplasms, fallopian tube masses, fallopian tube neoplasms, follicular cyst, endometriosis, ovarian cancer, functional cysts, nonfunctional cysts, germ cell tumor, adult cystic teratoma, dermoid cyst

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Contributor Information and Disclosures

Author

Margrit M Juretzka, MD, MS, Assistant Professor of Gynecologic Oncology, Stanford University Hospital and Clinics
Margrit M Juretzka, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Coauthor(s)

Nelson Teng, MD, PhD, Associate Professor, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Stanford School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

John J Kavanagh Jr, MD, Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas College of Medicine
John J Kavanagh Jr, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Society of Gynecologist Oncologists, Southern Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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