Adnexal Mass (Tumors)

Overview

What is an adnexal mass?

An adnexal (ad-nek-suhl) mass is a growth that develops around the uterus, usually in your ovaries, fallopian tubes and neighboring connective tissues. Some adnexal tumors are fluid-filled, while others are solid. They can appear at any age, and most of them go away on their own within a few months. They’re called adnexal tumors because they appear in the adnexa of the uterus. The term “adnexa” refers to the ovaries, fallopian tubes and ligaments that secure the female reproductive organs.

What’s the difference between uterine polyps and adnexal tumors?

Uterine polyps form inside the uterine lining, while adnexal tumors usually form in the ovaries, fallopian tubes or connective tissues surrounding the uterus. Both conditions can cause similar symptoms, such as irregular menstrual periods.

Who do adnexal tumors affect?

Adnexal tumors affect women of all ages, but they most commonly occur during the childbearing years.

How common are adnexal tumors?

In the United States, approximately 5% to 10% of women will develop an adnexal mass at some point in their lifetime.

Does having an adnexal mass mean cancer?

No. Most adnexal tumors are benign (noncancerous). But a small percentage of 15% to 20% are malignant (cancerous). In general, postmenopausal people are at a higher risk for malignant adnexal tumors compared to premenopausal people.

Symptoms and Causes

What are the symptoms of adnexal mass?

Adnexal mass symptoms may include:

In many cases, people with adnexal tumors don’t experience any symptoms.

What causes adnexal tumors?

Adnexal masses can be caused by numerous gynecologic and non-gynecologic factors. Most commonly, the tumors originate from the female reproductive system. But they can also originate in the urinary or digestive systems.

Gynecologic adnexal tumors

Most adnexal masses are caused by problems with the female reproductive system. The most common causes include:

  • Ovarian cysts. These fluid-filled cysts form on your ovaries. They’re generally painless — most people never develop symptoms. Ovarian cysts are extremely common.
  • Noncancerous ovarian tumors. When abnormal cells grow and multiply in the ovaries, they become solid masses, with occasional cystic components. Benign (noncancerous) tumors typically don’t spread to nearby tissues or other parts of your body.
  • Ovarian cancer. When an ovarian tumor is malignant (cancerous), it can grow and spread to other areas of the body. Ovarian cancer is one of the most common types of cancer in women.
  • Ectopic pregnancy. If a fertilized egg doesn’t make it all the way to the uterus, it can implant somewhere else instead, such as the fallopian tube. When this happens, it’s called an ectopic pregnancy, and it cannot be carried all the way to term. If the egg keeps growing outside of your uterus, it can cause internal bleeding and severe pain. Left untreated, ectopic pregnancies can be fatal for the pregnant person.
  • Broad ligament leiomyoma. A leiomyoma may be located adjacent to the ovary and fallopian tube and be mistaken for an adnexal mass.
  • Hydrosalpinx. When the fallopian tube fills with fluid, it's called a hydrosalpinx. These typically don't cause symptoms but can result in pelvic pain or infertility.
  • Tubo ovarian abscess. The genital tract can be infected by an infection, which can lead to inflammation of the fallopian tube, ovary, and sometimes surrounding structures, including the bowel or bladder.

Non-gynecologic adnexal tumors

These masses usually originate in the urinary or gastrointestinal systems. Common types include adnexal tumors of the colon and appendix. It’s also possible for breast cancer and colon cancer to metastasize (spread) to the pelvis, resulting in adnexal tumors.

Diagnosis and Tests

How are adnexal tumors diagnosed?

Adnexal tumors are most often detected during routine examinations. They may also be discovered during pelvic examinations or ultrasounds. Once you receive a diagnosis, your healthcare provider can run additional lab and imaging tests to determine what caused the adnexal mass. In some cases, you may be asked to take a pregnancy test to rule out ectopic pregnancy.

Management and Treatment

Do adnexal masses need to be removed?

Not always. In many cases, adnexal masses aren’t harmful and will eventually resolve on their own. However, if they cause uncomfortable symptoms, then surgical removal may be recommended. If intense pain or fevers are experienced, you should contact your health care provider immediately to assess for ovarian torsion, which is a surgical emergency.

How is an adnexal mass treated?

Treatment depends on the specific case. If the adnexal mass is benign and isn’t causing any pain, then your healthcare provider will likely monitor the situation with periodic imaging tests. However, if the tumor grows, if you have increased pain, internal bleeding, or if it is cancerous, surgery will be recommended.

Prevention

Can adnexal tumors be prevented?

There is currently no way to prevent adnexal tumors. However, with early detection, you can reduce your risk for associated complications. If you’re diagnosed with an adnexal tumor, it’s important to see your healthcare provider for frequent follow-ups. Medications can sometimes be offered to decrease the risk of recurrent ovarian cysts.

Outlook / Prognosis

What can I expect if I have an adnexal mass?

If you have an adnexal mass, your healthcare provider will work with you to design a personalized treatment plan. Oftentimes, adnexal tumors go away on their own. Your provider will likely monitor the tumor with frequent imaging tests to make sure it doesn’t grow. If your adnexal mass causes painful symptoms, or if it’s cancerous, your healthcare provider will recommend surgical removal.

Are adnexal tumors fatal?

The majority of adnexal tumors aren’t dangerous, and they may even go away on their own over time. In rare instances, the tumor may be cancerous. In these cases, adnexal masses could be life-limiting. If you have increased pain or fever, it is important to be evaluated to assess for ovarian torsion.

When should I seek urgent intervention?

The majority of adnexal masses are not urgent, but if you experience intense pain, fevers, or dizziness then you should seek urgent medical evaluation to assess for ectopic pregnancy, adnexal torsion, tubo-ovarian abscess or a ruptured ovarian cyst.

Living With

When should I see my healthcare provider?

If you’ve been diagnosed with an adnexal tumor, you should see your healthcare provider for frequent follow-ups. During these visits, they will check to see if the tumor has grown. Additionally, you should call your provider any time you develop painful or uncomfortable symptoms.

A note from Cleveland Clinic

Most adnexal masses are noncancerous and resolve themselves in a few months. In some cases, however, an adnexal tumor can cause pelvic pain, bloating, difficulty urinating and other problems. As with most conditions, early detection is key. Your healthcare provider can tell you if you need treatment.

Last reviewed by a Cleveland Clinic medical professional on 11/03/2021.

References

  • Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. (https://pubmed.ncbi.nlm.nih.gov/27175840/) Am Fam Physician. 2016 Apr 15;93(8):676-81. PMID: 27175840. Accessed 10/27/21.
  • Carvalho JP, Moretti-Marques R, Filho ALDS. Adnexal mass: diagnosis and management. (https://pubmed.ncbi.nlm.nih.gov/32736396/) Rev Bras Ginecol Obstet. 2020 Jul;42(7):438-443. doi: 10.1055/s-0040-1715547. Epub 2020 Jul 31. PMID: 32736396. Accessed 10/27/21.
  • Stein EB, Roseland ME, Shampain KL, Wasnik AP, Maturen KE. Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update. (https://pubmed.ncbi.nlm.nih.gov/33079254/) Abdom Radiol (NY). 2021 May;46(5):2127-2139 . doi: 10.1007/s00261-020-02812-z. Epub 2020 Oct 20. PMID: 33079254. Accessed 10/27/21.

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