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

Reply:

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.

Medical Advice (Q&As) on “Heterogenous Mass in Uterine Adnexa

  1. Marilou Montilla

    Hi, my CT Findings are:

    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 distention and narrowing, mucosal and filling defects appreciated.

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

    Remarks:

    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 my CT scan result, which is stated above, says that my right ovary has a problem. Is it OK not to remove my uterus and left ovary?

    Reply
    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?

      Reply
  2. Rishika

    I have 4.9*5cm tubo-ovarian mass in right side. I’m 26 year unmarried girl. I have pain in right abdomen and bleeding continuous till 2 months. Can it be treated with medication or need any invasive treatment?

    Reply
    1. Buddy M.D. Post author

      We need to first decide what this tubo-ovarian mass is. Your doctor may like to investigate further to reach make a diagnosis.

      This mass may be due to endometriosis or it may be an abscess. Treatment would depend upon what is causing this mass.

      Reply
        1. Buddy M.D. Post author

          Your doctor may first treat you by giving medicines. These pills are likely to be hormones.

          If you don’t respond, a laparoscopy may be done, during which biopsy may be taken from the adnexal tissue. On the basis of the biopsy report, further treatment may be decided.

          Reply
  3. Poonam

    Medical History:

    (1) 20 Oct 1980: Date of birth.
    (2) 25 Nov 2003: Marriage.
    (3) Dec. 2004: Pregnancy test positive.
    (4) Feb 2005: miscarriage of 3 months.
    (5) Jan 2006: Second pregnancy test positive, followed by severe pain in abdomen. Then, came to know about having ectopic pregnancy that results in left fallopian tube rupture and get treated by OPERATION.
    (6) 26 Nov. 2008: Endometriosis in right side in 2008. Treatment gave no positive response. Get treated by OPERATION.
    (7) Aug 2011: Ovarian Cyst formation in right side in. Get treated.
    (8) July 2013: Again, ovarian cyst formation in right side. Get treated.
    (9) May 2014: Tubular cystic lesion lateral to right ovary. Well defined lesion in right adnexa abutting the serosal surface. Gartner duct cyst (long existence).

    Reply
    1. Buddy M.D. Post author

      This tubular cyst needs to be investigated further. We need to know the nature of the cyst, whether it is due to some infection, pregnancy or some other cause. An ultrasound guided biopsy may be required. Also, a blood work, including HCG levels, needs to be carried out.

      After the diagnosis is made, your doctor will treat the cyst. After that, you may go for a IVF baby, if wanted.

      Reply
  4. Renu

    I have been operated on 1/10/14 for the removal of uterus due to excessive bleeding by hysterectomy. After some time, the pain started. So CT scan was done on 19/2/2014. In that it was found that annular thickening of wall of rectum and sigmoid colon with heterogeneous enhancement and mucosal irregularity with perifocal fat stranding in pelvic cavity, with inflammatory soft tissue thickening measuring 40*38mm with few ares of central liquefaction (favoring phlegmon). Again the CT scan is done on 5/6/2014. The report shows evidence of large lobulated cystic mass measuring 104*70mm, extending from left adnexa-pelvis to lower abdomen with enhancing internal thin septations without any enhancing nodular components. Not only this, but there is well defined rounded heterogeneously enhancing lesion measuring 18*15mm with internal necrotic area seen along left external illiac vessels, possibility of necrotic lymph node. What does this mean? What is the treatment for this?

    Reply
    1. Buddy M.D. Post author

      Could you let us know your current symptoms?

      Do you have pain in your belly, any discharge from vagina, back pain, gastric problem, etc.?

      This information is essential for us to have a better insight in to your problem.

      Reply
      1. renu

        Yes, I have pain in my lower abdomen, gastric problems, after CT scan I frequently go to washroom, but urine does not come easily. With stool, some white substance come. I feel very weak, sometime chest pain, then there is always pain which is unbearable, as if some thing is biting on my back. Also, I always have high fever.

        Reply
        1. Buddy M.D. Post author

          You may be having some kind of a tubo-ovarian mass in your adnexa. Sounds like the mass is infected and contains plenty of products of inflammation.

          A big infected mass, lying in your uterine adnexa may produce fibrosis to affect the nearby colon and rectum in the back, urinary bladder and urethra in front. So, it is possible to have both, gastric and urinary problems.

          You need to be investigated further. Your doctor may suggest investigating you laparoscopically, to diagnose the nature of this mass seen on CT.

          Since the mass sounds to be infected, it is advisable to be prompt in getting treated. Infection in the pelvic cavity spread quickly to involve other organs.

          Reply
          1. renu

            What kind of treatment or test has to be done to find that this mass is tumor or not?

          2. Buddy M.D. Post author

            You may put your value and check the result at our lab checker.

            CA 125, or cancer antigen is suggestive, though not diagnostic, of malignancy. A normal value would mean that the mass is most likely not malignant.

  5. Merlinda

    I have suffered itchiness in my vagina. My ultrasound results shows
    -The endometrium is thin and hyperechoic with intact endomyometrial interface
    -The right ovary is lateral to the uterus and contains follicles
    – Posterior to the uterus is a cystic structure measuring 6.6 x 6.2 x 4.5cm biloculated, thin walled (0.2cm) with thin septation (0.1cm) suggestive of an ovarian new growth with benign sonologic features
    – There is no free fluid in the cul-de-sac
    What does it mean, is this an emergency? Do I have to undergo surgery as soon as possible? I am 55 years old and I am afraid of this. Please advice.

    Reply
    1. Buddy M.D. Post author

      It is advisable to go ahead with investigations. You may need to undergo a laparoscopy. This is essential. Your doctor may suggest taking a biopsy tissue.

      Though the mass behind your uterus appears to be non malignant, it has to be attended soon. This mass may rupture, bleed or twist and present as an emergency.

      It is essential to know what this mass is. It may be from the ovary or the fallopian tube. Read above in detail.

      Reply
  6. Anonymous

    Hello sir, I am 36 yrs married with no issue, my PT is positive and pelvic ultrasonography result shows; thick- walled mass with solid and cystic components in the left adnexa. It has thick septae within it. Measures 3.4cm* 4.4cm. The right adnexa and pouch of Douglas are free. The uterus is normal- sized, with smooth margins and homogeneous echoes. The mid line endometrial plate echo is in intact. Please, what doest it mean, is it dangerous.

    Reply
    1. Buddy M.D. Post author

      A little more information is required from your side.

      Let us know your symptoms, why did you go for the ultrasound? Are you getting normal periods?

      Reply
  7. uroosa

    Adenexa A3.9 multiply 2.5 cm cyst seen in right adenaxa /single/thin septation with no soft tissues component .
    2. fluid seen in cul-de-sac
    3. conclusion small right adenaxl cyst
    I have adnexal cyst. I am 23 year old and I have married in 9 Oct 2013 after marriage one month later some problems started to me and after checkup doctor said that a large cyst is present and it is operated and it is safely removed in left side but after few days later the right side cyst is seen and after ultrasound these details are shown by a doctor which are mentioned. When I use a medicine, it will create a stomach pain or some type of allergy. So I want to know how to remove the cyst by treatment. I am very afraid of these thing and I want to know. Please help me now. I feel little pain in right side. Sometimes I will start or some time it well disappear and I feel the right side heavy. What can I do?

    Reply
    1. Buddy M.D. Post author

      What are your symptoms, any menstrual disturbance? Let us know so that we have a better insight into your problem.

      This is likely to be a functional cyst. You may read above in detail about it. You need to visit a gynecologist for the purpose. Medical treatment with hormonal pills may be started for 3 to 4 months.

      Reply
  8. Monika

    Hi, I have a pain in lower abdomen, feel like carrying heavy load on my stomach. Got my ultrasound done. It says left adenexa shows complex cystic lesion measures 4 *4.9cm volume 39cc. Conclusion of ultrasound shows complex left tubo-ovarian mass lesion. Please advice what all this means and what to be done.

    Reply
    1. Buddy M.D. Post author

      Let us know your age and whether you are having normal and regular menses.

      A tubo-ovarian mass can be an abscess, secondary to some infection. It may be a cyst formed in the ovary.

      Did your doctor take a biopsy from the lesion?

      You need to get it investigated further. It is essential to know what exactly that mass is. Only then, the treatment modality can be decided.

      Reply
      1. Anonymous

        I am 42 years old. I had my period on 23, this was diagnosed on 28, 4-5 months back I had period problem. Used to have blotting, then I consulted gyne. After the medicine, I started having periods normally which lasted 3 days. This time when my periods started I had acute pain. I had gall bladder 13mm stone. Thought that it was due to that BT pain persist for 4-5 days. Moreover used to feel like carrying loads on my tummy. Doctor has given me azithral 500 mg. But I have lot of itching. What should I do, is it serious?

        Reply
        1. Buddy M.D. Post author

          There are signs that you are having some infection in your pelvic area.

          You need antibiotic treatment. Azithral is likely to work.

          You may also start using candid-V cream for the vagina. This medicine has to be inserted into the canal with an applicator provided with the cream.

          Let us know about the results.

          Reply
          1. Anonymous

            Hi, after using azithral for a week I had sudden pain in my left knee. Now, not able to move my knee at all. Met orthopedic. He said it is the effect of infection getting spread. Also the itching in my whole body is continuing really worried now what is happening. Ortho gave me augmentin for a week. He said condition is serious and told me complete bed rest. Should I take my condition serious, doc please help me out as I’m getting confused. Am I seriously ill or is it normal?

          2. Buddy M.D. Post author

            Are you getting high fevers, chills or acute pain in the knee? What problem did you have to begin with? Was it a throat infection? Let us know for a better picture of your problem.

            You may be having some other problem in your knee. Continue taking the antibiotics and stay in touch with your doctor. You may ask him about getting an X-ray knee joint done.

  9. Monika

    Hi, after using azithral for a week I had sudden pain in my left knee. Now, not able to move my knee at all. Met orthopedic. He said it is the effect of infection getting spread. Also the itching in my whole body is continuing really worried now what is happening. Ortho gave me augmentin for a week. He said condition is serious and told me complete bed rest. Should I take my condition serious, doc please help me out as I’m getting confused. Am I seriously ill or is it normal? Again got my ultrasound done it says lesion seen in left ovary measures 13.9*13.6mm and 25.8* 23.6mm. Cyst with solid area of 14.4mm is seen within left ovary hemorrhagic/infection. No free fluid is seen in pod. Really confused.

    Reply
    1. Buddy M.D. Post author

      Read your above written comment and reply.

      Are you getting normal menses? What led you to get a U/S abdomen done?

      Reply
      1. Monika

        Doc, I had started having pain during my cycle on 23. After which I got my ultrasound and was recommended azithral. When I stopped azithral knee pain started coz of which ortho recommended augmentin 650mg. Then thought of getting second opinion met another gyne as I have got my Hgb test which says ESR 110 gyne urgently suggested ultrasound IVRS whose report I shared with you above and my dosage from 650 mg was increased to 1000 mg. Problem is I’m not getting proper answer from anybody what is happening in today date I can move my left leg only if I take painkiller. What ultrasound says whose result I have shared with you nobody is making me understood. On top of it, they are saying after a week I will get my CBC ESR again and if ESR is high they think only think that May be it is t.b. I showed my report to previous gyne who recommended azithral she says cyst problem may be there. Actually writing to you is because I want to know as ordinary person what is happening with me as started thinking are doctors here think I am a practicing vegetable on which they are practicing. May be this May be that not telling me actual what it is it, so please help me doc I really wait for your reply.

        Reply
        1. Buddy M.D. Post author

          See, you clearly have some infection in your pelvic region. This is the your primary problem.

          It is difficult to say what infection it is.

          Your doctors are trying regular medications in high doses first. If you don’t respond, may be they consider taking a biopsy to know the exact infection.

          T.B. is a possibility and would get revealed only after investigations.

          The cyst in the ovary is a secondary problem, can wait for the time being till your infection gets treated. It is also possible that the cyst is due to the infection in your pelvis, that is, it is an infective focus.

          You require urgent treatment for your pelvic infection.

          Reply
  10. Yeye

    Hi. I just want to ask the meaning of the result of my ultrasound report gynecology. Cervix 2.82 x 2.71cm, Uterus 5.5 x 4.24x 4.05cm anteverted, Endometrium thickness 0.84cm Hypoechoic with linear midline endometrial echo, Endometrial-myometrial junction is regular with increased basal echoes. Right-2.74×1.85×1.24cm FOLLICLES-small follicles.Left-3.14×3.05×2.52cm FOLLICLES-thick walled cystic focus 2.14cm (+) ring of fire. OTHER FINDINGS-CUL-DE-SAC-minimal fluid.REMARKS: NORMAL-SIZED ANTEVERTED UTERUS, EARLY SECRETORY ENDOMETRIUM, NORMAL -SIZED OVARIES WITH CORPUS LUTUEM IN THE LEFT. What does this result mean? I’m worried.

    Reply
  11. Md. shahidul

    My mother is 60+. Ultrasound report showed a large pelvic cyst. SOL in lower abdomen measuring 126mm x 97 mm x 84mm posterior to urinary bladder with thick echogenic margin. Low echoes within cyst. Please consult me is it cancerous cyst or not.

    Reply
  12. Haris

    Respected Doctor,
    I have serious concern as my wife of 36 age has been reported as stated below by ultrasound results. I am really worried if it might be dangerous or cancerous ? Or is it cure able without surgery by medications only? I really need you urgent kind advice and support. Beside in her CBC, her platelet count is also decreasing. Please help me.
    NEW TRANSVAGINAL ULTRASOUND
    • Uterus : is anteverted. No significant changes in the anterior
    intramural fibroid.
    • Endometrium: with thickness of about 11 mm.
    • Both ovaries: Homogenous echopattem, no mass or cyst.
    • Right ovary measure 3.9 x 3.3 em.
    • Left ovary measure 2.5 x 2.2 em.
    • Right adnexa show hypoechoic area about 4.6 x 3.1 em. with mild
    fluid seen around and some vascularity-for clinical correlation to
    exclude ? mass in the right adnexa ? ectopic pregnancy 1 organized
    blood I other.

    BETA- HCG- QUALITATIVE (PREGNANCY TEST) NEGATIVE

    OLD TRANSVAGINAL ULTRASOUND
    • Uterus : is anteverted. No significant changes in the anterior
    intramural fibroid.
    • Endometrium: with thickness of about 11 mm.
    • Both ovaries: Homogenous echopattem, no mass or cyst.
    • Right ovary measure 3.9 x 3.3 em.
    • Left ovary measure 2.5 x 2.2 em.
    • Right adnexa show hypoechoic area about 4.6 x 3.1 em. with mild
    fluid seen around and some vascularity … for clinical correlation to
    exclude? mass in the right adnexa ? ectopic pregnancy 1 organized
    blood I other .

    Thanks & regard,
    Haris
    haris_shaik@yahoo.com

    Reply
    1. Buddy M.D. Post author

      There’s nothing to worry. The mass in the adnexa is unlikely to be malignant. However, it needs to be investigated further.

      There is some mass lying by the side of the uterus, called adnexal mass. This mass may have arose from the ovary/ tube or lymph nodes lying there. We need to investigate this further.

      Your doctor may suggest you to go for a diagnostic laproscopy, may be with biopsy from the mass, to conclude a diagnosis.

      Such masses are likely to arise in conditions where there is some hormonal disturbance. Let us know her symptoms. Is she having normal menses, any pain, vomiting or any other problem?

      As for the platelet count, use our lab tool to check her platelet count. You’ll also know the conditions associated with the low value.

      Reply
  13. Nikki

    I have a cystic mass within the left adnexa and it measures 4.3 x 3.5 cm in size. They advise it’s pushing against the bladder. Is that a large mass or not?

    Reply


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