Evaluation and Management of Adnexal Masses

Committee on Practice Bulletins—Gynecology in collaboration with Ramez Eskander, MD; Michael Berman, MD; and Lisa Keder, MD, MPH. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Background Differential Diagnosis A pelvic mass can have gynecologic or nongynecologic origins (Box 1). Consideration of the location of a pelvic mass in conjunction with patient age and reproductive status can help narrow the differential diagnosis. Adnexal masses of gynecologic origin may be benign or malignant ovarian lesions; tubal or paratubal processes such as hydrosalpinges or ectopic pregnancy; and uterine abnormalities such as leiomyomas or müllerian abnormalities. Nongynecologic causes of pelvic masses are less common and may be related to a variety of other organ systems, including gastrointestinal and urologic sources. Cases of metastatic cancer, especially those from the breast, colon, or stomach, may first present as adnexal masses.