Masses

DIFFERENTIAL DIAGNOSES

■ Endometriosis/adenomyosis

■ Ovarian neoplasm

■ Tubo-ovarian abscess (TOA)

■ Also, congenital anomalies, other carcinomas/sarcomas

HISTORIES SUGGESTIVE OF DIAGNOSES

In different contexts, pelvic masses are more likely to carry different diagnoses. The following are contexts and the likely diagnosis:

Context in Which Pelvic Mass Is Found

Likely Diagnosis

Painless abnormal uterine bleeding

Leiomyoma

Amenorrhea

Pregnancy, ovarian cysts

Dysmenorrhea

Endometriosis

Reproductive age

Pregnancy, ovarian cysts, leiomyoma, TOA, ovarian neoplasm

Postmenopausal

Neoplasm

History of pelvic inflammatory disease (PID)

Signs/symptoms of systemic illness— TOA, adhesions

History of surgery/endometriosis

Adhesions

Leiomyomas are the most common causes of undiagnosed pelvic masses.

Pregnancy tests should be given to all women of reproductive age.

ECC is endocervical curettage—scraping of the endocervical canal with subsequent cytological examination.

DIAGNOSTIC TESTS FOR VARIOUS CAUSES OF PELVIC MASSES

Pregnancy: Pregnancy test

Ovarian cysts: Physical exam (+ ultrasound (US) if needed for confirmation)

Leiomyoma: Physical exam (+ US, hysteroscopy if needed for confirmation) Ovarian neoplasm: US, computed tomography (CT) scan, CA-125 level, surgical exploration, high level of suspicion due to age, family history Endometrial neoplasm: ECC, D&C Endometriosis/adenomyosis: Laparotomy/scopy

Tubo-ovation abscess: History of PID, tender mass, KUB x-ray (showing ileus)

BENIGN OVARIAN MASSES

FUNCTIONAL OVARIAN CYSTS

KUB x-ray is x-ray of the kidneys, ureters, and bladder (portions of the intestines are also visualized).

Follicular cysts are usually asymptomatic.

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