Cystic Lesion Near the Uterus on Ultrasound

Q: Hi, I’m Sarah, forty-two years old. I’ve missed about two months period. I went to the doctor and the ultrasonography was done. Pelvic ultrasonography report says: Urinary bladder has normal wall thickness with 445 cc urine. Uterus with 59*47*57 mm diameter is relatively normal in size, shape and echo texture. No mass lesion is noted. There is well-defined normal-appearing endometrial 14 mm stripe. There is more than 50 mm heterogeneous cystic component in right adnexa. Left ovary shows normal shape, size and echo pattern. Post micturition residue is about 15 cc. Thanks.
- By Sarah



The first thing which needs to be detected is- from where has this adnexal lesion originated? What is the tissue of origin of this mass?

Then we can know the nature of the mass. We can predict its behavior and decide the treatment.

Uterine Adnexa

Adnexa, as you may know, is the region (or area) on the side of the uterus. It include all structures present on the side of the uterus; namely the ovary, the tube, ligament and connective tissues.

Any mass present here may arise from the ovary, tube, or uterus itself. It may also be some metastatic (spread of cancer from its origin site to other places in the body) mass from any other organ of the body, such as the breast or stomach.

Possible causes

Functional or physiological cyst

The commonest adnexal mass in your age group is a functional cyst produced from the ovary. These are cystic (fluid filled) swelling formed in the ovary. Formation of such cyst around 40-50 years of age is common and considered normal.

They usually give no symptom at all and disappear on their own after some time. They are nothing but a consequence of hormonal fluctuations around this age.

However, a functional cyst may occasionally grow in size and occupy the adnexal space. It may cause irregularities in periods.

These cysts are treated by hormones. Rarely, the doctor may have to drain them or remove then surgically.

Ovarian cystadenofibroma

These are non- cancerous growths from the ovary again. You may consider them as non- aggressive tumors.

They occupy adnexal space as the grow. The lesion is heterogeneous- solid and cystic (fluid filled) in appearance.

Cystadenofibroma are slow to grow. The diagnosis is confirmed on biopsy.

Ectopic pregnancy

Since you have missed periods, the possibility of pregnancy has to be ruled out. Your doctor may have already tested for it.

Rarely, the fertilized egg does not get implanted in the uterus. It may get fixed in the tube or elsewhere. After such abnormal implantation, it may grow to produce some adnexal swelling.

Tubo-ovarian abscess

The adnexal lesion may be a collection of pus (abscess). Such swellings are separated by septa, giving it a heterogeneous appearance.

Such an abscess would usually be present after an infection. Did you have any infection in the tube, uterus or elsewhere in the past?

Also, when you have an abscess in your body, you are likely to have other constitutional symptoms like, fever, malaise, etc.

Neoplasm from any reproductive organ

The possibility of any cancerous growth from the ovary, uterus, or the tube needs to be ruled out. This would be done after taking a biopsy from the lesion.

Such neoplasm are,though, rare in your age group.

Diagnosing an adnexal mass

You have already undergone a pelvic exam and an ultrasound.

Your doctor may treat you first for the possibility of functional cysts. If you don’t respond, you may require a biopsy.

Meanwhile, be watchful for any other symptom like:

  • Discharge from vagina
  • Any spotting
  • Pain in the lower abdomen
  • Any lymph node enlargement
  • Fatigue or weakness

If you note any such symptom, it would be beneficial to report it to your doctor.

You may read here about a similar case.

Take Care,

Buddy M.D.

2 thoughts on “Heterogenous Mass in Uterine Adnexa

  1. Marilou Montilla

    Q: Hi, I’m Marilou


    There is a well-delineated, fluid-attenuating (-2 HU) mass in the right pelvic cavity measuring 5 cm in diameter, with an imperceptibly thin wall. Eccentrically located within it is a 4 x 6 mm hyperdensity (+680 HU). Contiguous and posterior to the said mass is a 2.5-mm focus with attenuation of +18 HU.

    Collectively, both masses are lateral to the urinary bladder and supero-anterior to the adjacent uterus. They are well-delineated from the contiguous bowel loops. No perilesional standing, nodularity and extraluminal fluid.

    The opacified small bowels and unopacified colonic segments are not unusual. No undue destention and narrowing, mucosal and filling defects appreciated.

    Aorto-iliac vessels are within normal caliber. No lymphadenopathy and ascites noted.

    > Heterogeneous (and possibly lobulated) cystic mass with internal calcific focus in the right adnexa could be ovarian in etiology; teratoma / dermoid cyst is primarily considered; negative for frank invasion of the adjacent bowels, urinary bladder and uterus.
    > The smaller, more dense cystic mass could also be the right ovary, with an exophytic ovarian cyst (larger focus); correlate with ultrasound findings.

    My Doctor says we need to remove my left and right ovary and also my uterus. But in my CT scan result which is stated above says the my right ovary have a problem. Is it ok not to remove my uterus and left ovary?

    -thank you by Marilou

    1. Buddy M.D. Post author

      A little more information is required before we make any comment.
      Firstly what’s your age.
      Secondly, did your doctor take a biopsy from the lesion? If yes, what was the test report?

      Take Care,
      Buddy M.D.


Ask the Doctor

Click Here to Get Medical Advice for Free.

Specialist Doctors answer your question in 24 Hours.

Leave a Comment:

2 + = 5