An adnexal mass, or adnexal cyst, is a growth that occurs in or near the organs attached to the uterus in women. This is what is called the adnexa region and includes the fallopian tubes, ovaries, uterus, and the connecting tissues.
Women of all ages may develop an adnexal mass, especially in the ovaries. They are often discovered due to uncomfortable symptoms like pain in the pelvic region or difficulty with urination. Other times, the doctor may discover them accidentally during a physical exam, surgery, ultrasonography, a CT (computed tomography) scan, or MRI (magnetic resonance imaging).
An adnexal mass is often benign or non-cancerous; however, they can sometimes be malignant. They are frequently filled with fluid, and doctors will be concerned if they are also solid. Most adnexal masses won’t require treatment and often go away within a few menstrual cycles.
In this article, we will guide you through everything you need to know about an adnexal cyst. We will inform you about the prevalence of adnexal cysts, as well as the symptoms, causes, diagnostic method, and treatment for this growth.
As you read on, you will also learn about the connection between pregnancy and adnexal mass.
Let’s get started…
Prevalence of Adnexal Cyst or Mass
Usually, an adnexal mass or cyst affects the adnexa, but when it is metastatic in nature, it may originate somewhere else, such as in the breast or stomach.
An adnexal cyst can be found in women of all ages. A malignant adnexal cyst may develop in females as young as 15, but more often, the mass is a functional cyst that will likely disappear on its own without treatment.
Women aged 40 and above with an adnexal cyst or mass have a greater chance of developing ovarian cancer.
Symptoms of Adnexal Cyst and Mass Growth
Some women with the condition will not experience adnexal cyst symptoms while being unaware an adnexal mass growth is even present. It is through a routine pelvic exam that an adnexal mass is typically discovered.
In some cases, adnexal cyst symptoms will occur, but this depends largely on the size of the mass. It is important to consult your doctor if you experience any of the following adnexal cyst symptoms, since they may also be present in other conditions and further investigation is likely required.
- Pain or pressure in the pelvic region
- Abdominal distension
- Constipation and gastrointestinal disorders
- Bleeding at the site of the cyst or mass
- Back pain
- Irregular periods in women experiencing pre-menopause
- Difficulty with urination
- Frequent urination
Causes of Adnexal Cyst and Mass Growth
There are a variety of different adnexal cysts and masses. Some fluid-filled growths arise in the woman’s ovaries; others have both solid and liquid matter (called septated) and are especially dangerous.
There is also what is called a complex adnexal cyst or mass, which will evolve from an ovarian adnexal mass or cyst. A complex adnexal mass or cyst can be further classified into categories of dermoid cysts, endometriomas, and low malignant tumors.
There are thought to be hundreds of adnexal mass causes. Adnexal cyst symptoms are often similar between the potential causes, especially endometriomas, ectopic pregnancy, and ovarian cancer. That being said, an adnexal mass differential diagnosis will be made based on the unique cause.
The following are some of the most common:
Ectopic pregnancy occurs when a fertilized egg doesn’t make it to the uterus. Instead, the egg implants in the fallopian tube, and therefore the pregnancy is unable to grow to term.
When the egg continues to grow in the fallopian tube, it will lead to a rupture, severe abdominal or pelvic pain, and heavy internal bleeding. An untreated ectopic pregnancy can be fatal for women.
Ovarian Cancer and Other Cancers
Ovarian and fallopian tube cancers commonly form a tumor in women that can grow and spread to areas other areas of the body. Common ovarian cancer symptoms include back pain, constipation, heartburn, indigestion, fatigue, irregular periods, difficulty urinating, abdominal or pelvic distension, and painful sex.
Breast and gastrointestinal tract cancers may spread to the adnexal region as well.
Ovarian cysts will also cause adnexal cysts. These liquid-filled sacs will develop on the ovaries; however, ovarian cysts are often painless and don’t produce symptoms.
When it contains tissue from the endometrium or uterine lining, this type of ovarian cyst is called an endometrioma. This will produce abnormal uterine bleeding and worsening pain from menstruation. This process can lead to endometriosis—a painful disorder of the endometrium.
Benign Ovarian Tumors
An ovarian tumor is solid, whereas a cyst is filled with fluid. However, when the cells inside the tumor are not cancerous, it is a benign tumor. As such, it won’t invade or spread to other parts of the body. It may not even produce symptoms.
Common benign ovarian tumors that may produce an adnexal cyst or mass include dermoid cysts, fibromas, and cystadenomas.
Small follicles lead to the development of an enlarged polycystic ovary. It is common in women with polycystic ovarian syndrome. Symptoms will include multiple cysts, irregular periods, high testosterone levels, and excessive hair growth.
This is a collection of pus in the ovaries and tubes due to pelvic inflammatory disease (PID). Symptoms will include fever, abdominal pain, and vaginal discharge. PID can be sexually transmitted, and can also lead to infertility. A tubo-ovarian abscess is considered an acute infection; therefore, immediate attention is necessary.
This is a benign condition in which fluid becomes trapped inside a fallopian tube. Pain and reduced fertility rates may result.
Adnexal Cyst and Mass in Pregnancy
To avoid complications, it is ideal to discover an adnexal mass and treat it before a woman gets pregnant. That being said, adnexal masses are sometimes exposed in pregnancy during a routine pelvic exam or ultrasound.
Since most adnexal cysts or masses are not harmful and resolve without treatment, many doctors choose to simply monitor the mass very closely during pregnancy. Women will only require surgery if a complication occurs, the mass is so large that it will likely cause an issue with the pregnancy, or the doctor suspects the adnexal cyst or mass is malignant and therefore may be cancerous.
A clinical review published in OBG Management in 2007 found that about 10% of adnexal masses discovered during pregnancy are considered malignant. However, since the cancer is in often its early stages, this is good news for the mother.
If the malignant tumor is discovered during pregnancy, the doctor will only interfere with a pregnancy if it is no longer safe for the mother.
How to Treat Adnexal Cyst and Mass
When an adnexal mass or cyst is small and no symptoms are present, treatment may not be required. That being said, your doctor may want to monitor the situation with regular ultrasounds and pelvic exams. In the U.S., a pelvic ultrasonography is considered the most used imaging modality for detecting an adnexal mass.
Surgery is needed when the mass begins to grow, the cyst becomes solid, or the patient develops adnexal cyst symptoms. Adnexal masses that exceed eight centimeters (cm) to 10 cm in size should be managed with a type of abdominal surgery called a laparotomy.
After it is removed, the adnexal cyst or mass will be examined to determine whether the cells within it are cancerous. If cancerous, further treatment may be needed to ensure all the cancer has been removed from the body.
Diagnosing Adnexal Cyst and Mass
A physical pelvic exam will help the doctor diagnose an adnexal cyst or mass. The doctor will feel the woman’s ovaries, uterus, vagina, bladder, and rectum, and make note of a lump or anything else unusual. The doctor will also retrieve information about the woman’s medical history, symptoms, and a possible family history of cancer or adnexal cysts.
An ultrasonography is done after the physical exam. This pelvic ultrasound will confirm if a cyst or mass is near or in the adnexa region. After being diagnosed, the doctor will decide if the adnexal cyst or mass is cause for emergency. Often, it is not an emergency, and this is when the doctor will look to discover the cause of the cyst or mass.
A MRI or CT scan may be used to determine the underlying cause of an adnexal cyst or mass. A pregnancy test may also be given to rule out an ectopic pregnancy.
Final Thoughts on Adnexal Cyst and Mass
An adnexal mass or cyst is often non-cancerous and will resolve without treatment. That being said, when uncomfortable symptoms are experienced, a pelvic exam and ultrasonography may be needed to determine the cause of the adnexal cyst or mass.
Adnexal cyst symptoms are similar to those of many of the potential causes of this condition, including ectopic pregnancy or ovarian cancer. When treated before it spreads outside the ovary, the five-year survival rate of ovarian cancer is considered 92%.
When a liquid-filled cyst becomes solid, surgery may help manage an adnexal cyst or mass. If cancerous, further treatment may be necessary to ensure all cancer has been eliminated from the body.
Article Sources (+)
Brown, D., et al., “Adnexal Mass: US Characterization and reporting,” Radiology, January 7, 2010, doi: 10.1148/radiol.09090552.
Ghezzi, F., et al., “Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses,” Gynecological Surgery, April 3, 2008, doi: 10.1111/j.1471-0528.2008.01775.x.
Givens, V., et al., “Diagnosis and Management of Adnexal Masses,” American Family Physician, Oct. 2008; 80(8): 815-820; https://www.aafp.org/afp/2009/1015/p815.html.