DIAGNOSIS AND MANAGEMENT OF THE ADNEXAL MASS

Adnexal masses are frequently found in both symptomatic and asymptomat ic women. In premenopausal women, physiologic follicular cysts and cor pus luteum cysts are the most common adnexal masses, but the possibili ty of ectopic pregnancy must always be considered. Other masses in thi s age group include endometriomas, polycystic ovaries, tubo-ovarian la n abscesses and benign neoplasms. Malignant neoplasms are uncommon in younger women but become more frequent with increasing age. In postmen opausal women with adnexal masses, both primary and secondary neoplasm s must be considered, along with leiomyomas, ovarian fibromas and othe r lesions such as diverticular abscesses. Information from the history , physical examination, ultrasound evaluation and selected laboratory tests will enable the physician to find the most likely cause of an ad nexal mass. Measurement of serum CA-125 is a useful test for ovarian m alignancy in postmenopausal women with pelvic masses. Asymptomatic pre menopausal patients with simple ovarian cysts less than IO cm in diame ter can be observed or placed on suppressive therapy with oral contrac eptives. Postmenopausal women with simple cysts less than 3 cm in diam eter may also be followed, provided the serum CA-125 level is not elev ated and the patient has no signs or symptoms suggestive malignancy.