Incidental Adnexal Masses Research Articles

Retrospective Evaluation of Incidental Adnexal Masses Encountered During Cesarean Section

Retrospective Evaluation of Incidental Adnexal Masses Encountered During Cesarean Section

Adnexal Masses: Clinical Application of Multiparametric MR Imaging & O-RADS MRI

초음파에서 우연히 접하는 자궁부속기 병변은 양성 병변이 더 흔하지만, 일부는 악성도가 애매한 병변으로 간주되어 추가적인 평가를 위해 다중매개변수 MRI가 필요하다. 고식적 MRI를 통해 해부학적 모양을 살피고, 지방, 출혈, 섬유성 조직, 고형성 조직 등 병변의 구성성분을 파악하여 많은 양성 종괴들을 정확하게 진단할 수 있다. 또한 추가적인 확산강조영상과 역동적 조영증강 기법의 관류영상으로 양성과 악성의 감별 진단 정확도를 높일 수 있다. 최근 자궁부속기 종괴의 악성 위험도를 평가하고, 각 위험도 군에 대한 적절한 조치를 권고하는데 있어 표준화된 의사소통이 가능하도록 하기 위해 난소-자궁부속기 MRI 보고 및 자료시스템(ovarian-adnexal reporting and data system MRI; 이하 O-RADS MRI)이 발표되었다. 본 종설에서는 자궁부속기 종괴의 악성도 예측 및 감별 진단을 위한 다중매개변수 MRI의 임상 적용과 O-RADS MRI에 대하여 기술하고자 한다.

Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update.

Incidental adnexal masses are commonly encountered at ultrasound, computed tomography, and magnetic resonance imaging. Since many of these lesions are surgically resected and ultimately found to be benign, patients may be exposed to personal and economic costs related to unnecessary oophorectomy. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. Multiple consensus guidelines in radiology have been published to assist in characterization of these masses as benign, indeterminate, or likely malignant. In the last two years, several new and updated stratification systems for assessment of incidental adnexal masses have been published. The purpose of this article is to offer a concise review of four recent publications: ACR 2020 update on the management of incidental adnexal findings on CT and MRI, SRU 2019 consensus update on simple adnexal cysts, O-RADS ultrasound risk stratification system (2020), and O-RADS MRI risk stratification system (2020).

Evaluation of Adnexal Masses with Gray Scale Ultrasonography and Color Doppler Flow Imaging in the First Trimester of Pregnancy

Sonography is common use in early pregnancy has led to the exposure of incidental adnexal masses more often. Assessment of grayscale and color Doppler sonography outcomes is as precise when based on static images. To determine the evaluation of adnexal masses with grayscale ultrasonography and color Doppler flow imaging in first trimester of pregnancy. This Cross Sectional study was conducted at the Department of Radiology, Jinnah Hospital, Lahore, Pakistan. The study was conducted from July to Dec 2019. The patients were selected by nonprobability convenience sampling. All pregnant patients were undergoing abdominal ultrasonography to detect the adnexal masses. The data was collected by the questionnaire. Overall 68 individuals involved in this study out of which 29(96.7%) are benign diseases on the left side of patients and malignant are only 1(3.3%). Patients having benign diseases of right-sided are 33(86.8%) and malignant are 5(13.2%). Benign diseases are 62(91.2%) out of which 43 patients had cystic, 15 are mixed and 4 are solid components. Malignant diseases are found only 6 patients out of which 3 are mixed and 3 are solid components. Majority of the adnexal masses identified in pregnancy is benign and will resolve suddenly. Doppler sonography has severe limitations in the differentiation of benign from malignant adnexal disease on the basis of low-impedance flow.

Asymptomatic adnexal mass in postmenopausal women

The widespread use of vaginal ultrasound as an integral part of the gynecologic clinical examination in many countries has led to the unexpected finding of adnexal mass. The implications of the finding of an adnexal mass in an asymptomatic postmenopausal woman can be serious if it is malignant and is not excised, because ovarian cancer has an indolent course and when it becomes symptomatic it is often fatal. The aim of the present review is to discuss the evaluation and management of incidental adnexal masses in postmenopausal women. Despite careful evaluation with ultrasound and biomarkers, a small number of patients will remain without a conclusive diagnosis. It is our opinion, based on empirical evidence discussed here, that conservative therapy with observation can be safely applied in the majority of these patients.

2979 Laparoscopic Removal of Parasitic Leiomyomas

Video Objective The objective of this video is to describe the presentation, diagnosis and surgical approach to parasitic leiomyoma. We describe a case report of a postmenopausal patient who presented with incidental adnexal masses, underwent a diagnostic laparoscopy and was ultimately diagnosed with parasitic leiomyoma. We discuss the differential diagnosis, symptomatology, origin and epidemiology of this rare diagnosis. Setting A university tertiary care hospital. Interventions This is a case report of a patient with an incidentally diagnosed adnexal mass that was found to have parasitic leiomyoma. Conclusion Parasitic leiomyoma is an unusual variant of fibroid presentation. There are several hypotheses regarding their development, most importantly following morcellation after laparoscopic myomectomy. Others include the possibility of pedunculated fibroids that detach from the uterus and latch onto nearby viscera. This case illustrates the incidental finding of a parasitic leiomyoma, appropriate workup and differential diagnosis. We also elaborate on the surgical technique for removal of parasitic leiomyomas. We conclude that parasitic leiomyoma should be on the differential diagnosis for adnexal masses.

An observational study on diagnosis and management of adnexal masses in pregnancy

Background: Adnexal masses are seen in 1 in 80 to 1 in 8,000 pregnancies. However, with an increased use of ultrasonography in pregnancy, there is a significant rise in the incidence of adnexal masses in pregnancy. Objective: The study was undertaken to analyse the incidence, histological types, complications, and management of adnexal masses in pregnancy. Materials and Methods: This is an observational study of 44 cases of adnexal masses in pregnancy, performed in the Department of Obstetrics and Gynaecology LTMMC and LTMGH, Mumbai, a tertiary reference centre, during the years 2014 to 2016. Results: The incidence of adnexal masses in pregnancy was 0.2% in this study with dermoid and mucinous cyst adenoma being the most common histological types. Torsion was the most common complication seen in the study. Only 11 (25%) cases were managed conservatively. Thirty-one cases underwent exploratory laparotomy and two were managed laparoscopically. There was no significant detrimental effect on pregnancy as 79.5% of pregnancies continued until term without any complications. Conclusion: Adnexal masses in pregnancy can be effectively managed in pregnancy. Both laparotomy and laparoscopy are safe, if used judiciously.

Analysis of adnexal mass managed during cesarean section.

Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be made regarding clinical management. The objective of this study was to outline and discuss the clinical features, management and outcomes of adnexal masses that were encountered during a cesarean section (CS) at a university affiliated hospital in China. The medical records of the patients with an adnexal mass observed during a CS were retrospectively collected at Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China, from January 1991 to December 2011. The incidence of adnexal masses was 16.40 per 1000 CSs. The most common pathologic diagnosis was benign ovarian tumor, the 2nd was ovarian endometrioma and the 3rd was theca lutein cyst. Thirteen cases of ovarian malignancies were diagnosed during a CS. Only 388 cases (29.78%) were detected by an ultrasonography (USG) examination before a CS. Eight cases required emergency CS due to abdominal pain; all other patients were clinically asymptomatic. The reasons for abdominal pain included torsion (n = 5), rupture (n = 2) and ovarian enlargement (n = 1). In 13 cases with ovarian endometrioma, cysts ruptured during a CS without any clinical manifestation. No maternal and fetal complications related to surgery were observed. Preconception care and routine prenatal care, including USG examination, may optimize the detection and management of an adnexal mass. The presumptive ovarian endometrioma detected before pregnancy could be the indication for surgery due to the possibility of spontaneous hemoperitoneum. Theca lutein cysts might be huge and exist throughout the whole pregnancy period. Expectant management is reasonable for an adnexal mass that emerged during pregnancy without suspicion of malignancy. Abdominal pain might be a clue for cyst torsion or rupture.

A study of incidental adnexal masses during caesarean section and its management

A study of incidental adnexal masses during caesarean section and its management

257 - Single-Incision Laparoscopic Ovarian Cystectomy in a 26 Weeks Pregnancy Patient with 17 cm Cyst

Background: The incidence of adnexal masses in pregnancy is estimated to be 1% to 4%. Surgical intervention is required, in particular in the setting of potential malignancy, ovarian torsion, or mass adversely affecting the pregnancy. Single-Incision Laparoscopic surgery (SILS) averts the potential morbidity of multiple trocar insertions including less bleeding and pain, as well as better cosmetic outcome and tissue retrieval.

Sezaryen Sırasında Saptanan İnsidental Adneksiyal Kitleler

Sezaryen Sırasında Saptanan İnsidental Adneksiyal Kitleler

Management of a borderline ovarian tumor in a pregnant woman in a rural hospital: a case report

Borderline ovarian tumors (BOTs) are neoplasms with benign and malignant characteristics, affecting young women in childbearing age. Finding incidental adnexal mass in pregnancy is more common with the use of ultrasound, incidence is about 2% to 10% of pregnancies. A great majority of adnexal masses excised during pregnancy are in fact BOTs. Treatment varies depending of gestational age: before 24 gestational week is usually conservative and surgical staging. Radical management is reserved to patients with suspected malignancy and satisfied parity. A 38-years-old woman presented to external consultation in a rural hospital with 36 gestational weeks of her fourth pregnancy, without antenatal control and asymptomatic. Obstetric ultrasound reported: right ovarian tumor with cystic and solid areas. Laboratory data were normal. She underwent elective cesarean and exploratory laparotomy, surgical findings were: a term female baby with no obstetric complications and a right ovarian tumor with trans-operatory report of mucinous epithelial cells with atypia, suggestive of ovarian borderline tumor. Based on this, a hysterectomy with bilateral oophorectomy was performed. No complications were reported. Post-operatory evolution was normal. Definitive histopathological study reported a borderline ovarian tumor.

Incidental adnexal masses: the role of imaging in the management of the patient

Adnexal masses are a relatively common finding and are usually benign. When an adnexal mass is detected incidentally on cross-sectional imaging, it is important to ensure that the patient follows the most appropriate pathway and ultrasound will be the most appropriate intial imaging in most cases. Ultrasound can triage patients into three categories: 1. appropriately reassured that there are benign characteristics; 2. followed up for reassurance in likely benign cases; 3. Referred for further tests if there is a suspicion of possible malignancy. There are two helpful guidelines can be used when an adnexal mass is detected at ultrasound, either the IOTA simple rules or the Society of Radiologists in Ultrasound statement on managing asymptomatic ovarian cysts. In cases that are highly likely to be cancer, the next step includes referral to a cancer centre and staging with CT. In cases of a sonographically indeterminate adnexal mass, characterisation with MRI can further differentiate likely benign masses from malignant masses with a high specificity.

Laparoendoscopic Single-Site Surgery for Management of Adnexal Masses in Pregnancy: Case Series

The incidence of adnexal masses in pregnancy is estimated to be 1% to 4%. In select cases, surgical intervention is required. Recent studies have demonstrated that laparoscopy during pregnancy is safe and confers many advantages over laparotomy. Herein we present a series of nine cases collected prospectively that demonstrate the feasibility, safety, and putative benefits of laparoendoscopic single-site surgery for treatment of adnexal masses in pregnant women.

Management of incidental adnexal masses on caesarean section.

Background:The reported incidence of adnexal masses during pregnancy vary from 1 in 81 pregnancies to 1 in 8000 pregnancies. There is still a debate on management of incidental adnexal masses during the caesarean section concerning the risk of this additional procedure on postoperative morbidity and mortality. The aim of our study was to investigate the management of incidental adnexal masses which were observed during caesarean section in a tertiary health care centre.Materials and Methods:The medical records of the patients who had incidental adnexal masses during caesarean section at Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Department of Obstetrics and Gynecology from January 2006 to September 2011 were evaluated retrospectively. The data was processed with the SPSS 16.0 statistical software.Results:The number of total live births was 17341 and 6624 of them were done by caesarean section (31%). There were 38 cases of incidental adnexal masses which were discovered at caesarean section. The most common pathologic diagnosis of the masses were paraovarian–paratubal cysts with the rate of 23.7% (n=9). Cystectomy procedure during caesarean section did not alter the morbidity of the patient.Conclusions:In conclusion for detecting adnexal masses during pregnancy follow-up of growth rate of adnexal mass will be a useful reference during the observation period if ideally all pregnant women have a first-trimester ultrasound examination with regular adnexa check-up.

Diagnosis and Management of Adnexal Masses in Pregnancy

Widespread use of ultrasound in early pregnancy has led to the detection of incidental adnexal masses more frequently. This article reviews the diagnosis and management options for adnexal masses in pregnancy. The availability of high-resolution ultrasound has made observation to be a viable option in some cases. However, for those masses suspicious of malignancy, at risk of torsion, rupture, or clinically symptomatic, surgical treatment is warranted. Laparoscopy has been successfully used in pregnancy and is safe in experienced and trained hands in properly equipped units.

The management of incidental adnexal masses during cesarean section

The management of incidental adnexal masses during cesarean section

Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening

Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening

Co-Existing Tubal Ectopic Pregnancy and Endometroid Adenocarcinoma of the Ovary, Masquerading as a Twin Ectopic Pregnancy: Management of Ectopic Pregnancy with Incidental Adnexal Mass

Co-Existing Tubal Ectopic Pregnancy and Endometroid Adenocarcinoma of the Ovary, Masquerading as a Twin Ectopic Pregnancy: Management of Ectopic Pregnancy with Incidental Adnexal Mass

Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening

To determine the prevalence, work-up, and outcomes of indeterminate adnexal masses identified at low-dose unenhanced computed tomography (CT) in asymptomatic women age 50 and older undergoing colonography screening. This study was institutional review board approved and HIPAA compliant. Informed consent was waived. The fate of indeterminate adnexal lesions identified at unenhanced CT in 2869 consecutive women (mean age, 57.2 years; age range, 50-97 years) undergoing colonography screening between April 2004 and December 2008 was evaluated. One hundred eighteen women (mean age, 56.2 years), representing 4.1% of the screening cohort, had an indeterminate adnexal mass (108 unilateral, 10 bilateral; mean size, 4.1 cm) at prospective CT interpretation. A total of 80 women underwent some combination of further imaging evaluation (n = 76) (transvaginal ultrasonography [n = 71], pelvic magnetic resonance imaging [n = 7], contrast material-enhanced CT [n = 7]) and/or surgery (n = 26). Mean serum CA-125 level in 33 women was 12.8 U/mL; levels were normal (<35 U/mL) in 32 (97%) cases (range, 3-26 U/mL) and mildly elevated (41 U/mL) in one case. Final pathologic findings of surgically excised lesions were cystadenoma or cystadenofibroma (n = 14; 11 serous, three mucinous); nonneoplastic cysts (n = 5; two endometriomas); mature teratoma (n = 3); hydrosalpinx (n = 2); fibroma (n = 1); and benign Brenner tumor (n = 1). Three additional teratomas were diagnosed at index CT only. No ovarian cancers were prospectively identified, although four cases of ovarian cancer developed subsequent to a negative adnexal finding at CT examination during a 15-44-month interval among the remaining 2751 women. Incidental indeterminate adnexal lesions were relatively common at unenhanced CT (4.1%), but subsequent work-up revealed no ovarian cancers. Furthermore, a normal finding at CT was not protective against short-term development of ovarian cancer. More sophisticated risk factor assessment is needed to identify women at higher risk.