Adnexal Cyst – Causes of Mass in Adnexa and Ovary
A mass or a cyst in the adnexa of the uterus is a common presentation in women of all age groups.
What Is Uterine Adnexa?
Adnexa refers to adjoining anatomical parts of the uterus. It includes the fallopian tubes and ovaries as well as associated vessels, ligaments, and connective tissue.
Any lump or mass found within adnexa of uterus is abnormal and needs to be evaluated. Such a mass usually originates from ovary or fallopian tube. However, it may arise from various other structures such as the bowels, the peritoneal lining covering the viscera, the ligaments holding the uterus in place or the adjoining lymph nodes.
Adnexal masses may be benign or cancerous.
Cystic or Solid Lesions
A lesion is called cystic if it’s a closed sac-like structure that contains a liquid, gaseous, or semisolid substance in it. Alternatively, it may be solid and full of cells. In general, solid lesions have more chances of being malignant.
Diagnosing the mass involves detecting its site of origin and its nature. Causes vary in premenopausal and postmenopausal women. In arriving at the probable diagnosis, the age of the patient, the history, the findings on physical examination and the results of radiologic and lab reports are studied.
Causes of Adnexal Mass in Premenopausal Women
Physiological Ovarian Cysts
These may be either follicular cysts or corpus luteum cysts. They comprise the most common type of adnexal masses in this age group.
Follicular cysts- Normally, each month the ovary sheds an egg into fallopian tube. Sometimes, the egg is not shed and remains in the ovary. Later it forms a cyst around itself. This cyst may grow big enough to give an adnexal mass.
Corpus luteum cysts- Sometimes the egg gets shed but leaves behind its covering which forms a cystic swelling.
A condition where the fertilized egg is implanted somewhere else than the uterus. The site of implantation is usually the fallopian tubes. In this case, pregnancy tests would be positive. Menstrual cycle and other symptoms of pregnancy are absent.
Sometimes endometrial tissue (lining of the uterus) enters the ovary by retrograde flow. There, it forms a cystic structure called chocolate cyst. This structure secretes during periods just like normal endometrium, slowly forming a swelling in adnexal region.
They typically increase during periods. They are painful and may get ruptured to produce severe pain.
As explained earlier, normally each month an egg sheds out of ovary into the fallopian tube. In polycystic ovaries, this does not happen. The egg remains in the ovary itself to form a small cyst. Slowly many such cysts get formed.
On ultrasonography, multiple cysts are seen in the ovary. Patient usually has problem conceiving.
There may be some infection in the tube or the ovary. Later an abscess is formed which presents as an adnexal mass. The patient also has fever.
Fluid filled dilatation of one or both the fallopian tubes is called hydrosalpinx. This occurs secondary to some pelvic infection or trauma. The condition is often asymptomatic. However, some women complain of lower abdominal pain.
Hydrosalpinx may cause infertility.
These are tumor like growths in the uterus. They are smooth, rounded and almost always benign, that is, non-cancerous. Patient may have heavy and prolonged bleeding during menses.
Malignant neoplasms are extremely rare in this age, however they still need to be ruled out.
Causes of Adnexal Mass in Post Menopausal Women
Primary and secondary neoplasms such as ovarian carcinoma and metastatic disease from uterus, breast or gastrointestinal tract need to be ruled out in this age group. Serum markers called CA-125 is done, which may indicate the presence of malignancy.
Ovarian fibroma are common in peri and post menopausal patients. The presenting symptom may be abdominal pain. The diagnosis is made on ultrasound that shows a solid lesion.
With time, small pouches may get formed that erupt from the weak muscular walls of the large intestine. These pouches are called diverticula. In course of time, they may get irritated, swollen or infected to give symptoms.
Causes in a Newborn Baby Girl
In newborns, a small functional cysts (less than 1 to 2 cm) may get formed due to the influence of maternal hormones. They may regress during the first few months of life on their own.
This depends upon the size of the cyst and its associated symptoms. In case of small cysts, one may not need any medical intervention. Small physiologic cysts usually disappear on their own in due course of time.
For bigger cysts, medical intervention is required, depending upon the disorder.
Two types of surgeries are available for ovarian cysts:
- Exploratory laparotomy
- Pelvic laparoscopy to remove the cyst or the ovary
It is important to know the type of tissue in the cystic mass. Ruling out malignancy is also important.
The ultimate diagnostic tool is histological examination. The primary goals of diagnostic evaluation are to confirm that the adnexal mass is ovarian and to determine whether it’s benign or malignant. A laproscopic biopsy may be taken followed by histological exam.