Adnexal masses in pregnancy: an updated review on diagnosis and treatment

2020 ◽  
pp. 030089162090914 ◽  
Author(s):  
Valentina D’Ambrosio ◽  
Roberto Brunelli ◽  
Lucia Musacchio ◽  
Valentina Del Negro ◽  
Flaminia Vena ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Treatment Options ◽  
Benign Tumors ◽  
Patient Counseling ◽  
Adnexal Masses ◽  
Ultrasound Findings ◽  
Pelvic Masses ◽  
Complementary Examination ◽  
Asymptomatic Women ◽  
In Pregnancy

Adnexal masses are not common in pregnancy. They are often discovered incidentally during routine ultrasound examinations. In general, 24%–40% of the cases are benign tumors; up to 8% are malignant tumors. Adnexal masses are usually asymptomatic, but sometimes can be responsible for abdominal or pelvic pain. Transvaginal and transabdominal ultrasound is essential to define the morphology of pelvic masses and to distinguish between benign and malignant cases. Magnetic resonance imaging can be a complementary examination when ultrasound findings are equivocal and a useful additional examination to better define tissue planes and relations with other organs. Patient counseling can be challenging because there is no clear consensus on the management of adnexal masses during pregnancy. Treatment options consist of observational management (in case of asymptomatic women with reassuring instrumental findings) or surgery (via laparoscopy or laparotomy). Surgery can be offered as a primary tool when cancer is suspected or when acute complications such as ovarian torsion occur.

scholarly journals Approach to Gynecological Adnexal Masses

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laurie-Rose Dubé
Keyword(s):  
Reproductive Tract ◽  
Ovarian Neoplasm ◽  
Female Reproductive Tract ◽  
Reproductive Hormone ◽  
Adnexal Masses ◽  
Ultrasound Findings ◽  
Pelvic Masses ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Ovarian Abscess

Gynecological pelvic masses are a common occurrence in women of all ages. The differential diagnosis is extensive and includes masses of all anatomical components of the female reproductive tract. This simple and refined approach leads the reader through the process of narrowing said differential. A thorough history and physical examination are essential steps that can hint to the appropriate investigations such as reproductive hormone levels, serum cancer biomarkers and imaging. Emphasis is put on ultrasound findings, helping differentiate not only diagnoses, but also the benign or malignant character of the mass. It also highlights the Risk of Malignancy Index I, commonly used in clinical practice to assess the risk of malignancy of a mass. Beyond the initial approach, some diagnoses and their management are discussed, from the very common functional cyst to the worrisome ovarian neoplasm, and mentioning more peculiar findings like tubo-ovarian abscess and leiomyoma.

scholarly journals Ovarian Masses-Applicable IOTA ADNEX Model versus Morphological Findings for Accurate Diagnosis and Treatment

2021 ◽  
Vol 11 (22) ◽  
pp. 10789
Author(s):  
Tudor Butureanu ◽  
Demetra Socolov ◽  
Daniela Roxana Matasariu ◽  
Alexandra Ursache ◽  
Ana-Maria Apetrei ◽  
...  
Keyword(s):  
At Risk ◽  
Surgical Treatment ◽  
Ovarian Tumor ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Adnexal Masses ◽  
Borderline Tumors ◽  
Benign Ovarian Tumor ◽  
Significant Difference ◽  
Ovarian Masses

A common problem in gynecological practice is the differential diagnosis of the ovarian masses. The clinician must apply the IOTA (International Ovarian Tumor Analysis) ADNEX (Assessment of Different Neoplasia in the Adnexa) model criteria to evaluate the risk of benign, borderline or malignant tumors. The aim of this study was to verify if the IOTA ADNEX model is a practical tool to be used before surgery and if there is a significant difference between IOTA ADNEX criteria and histological findings. A prospective single center study was performed between January 2017 and December 2019 in Obstetrics and Gynecology Hospital “Cuza-Voda”, Iasi, Romania. The study included 230 patients between 17 and 74 years old diagnosed with persistent adnexal masses. We applied the IOTA ADNEX model protocol predicting the risk of benign, borderline or malignant masses. The golden standard remains the histological diagnosis of the surgically removed mass. The patients that had been diagnosed using ultrasonography with persistent adnexal masses between 30 and 291 mm were operated on in our clinic. In our study. the majority of patients had benign ovarian tumor mass, these being 223 (96.96%) patients, from whom, according to IOTA ADNEX protocol, the correspondence was: 91.8–99.7% at risk of benign tumors, 0.3–4.5% at risk of borderline tumors and 0.3–8.2% at risk of malignant masses. Unexpected findings were obtained from the malignant group that included five patients (2.17%) with the following correspondence: 96.1–99% at risk of benign tumors, 0.6–2.4% at risk of borderline tumors and 1–3.9% at risk of malignant masses. After applying the IOTA ADNEX model criteria, the patients with a suspicion of malignant disease were correctly guided towards surgical treatment in an oncological center. In our hospital, surgical treatment was only proposed to those patients with high suspicion of benign masses.

scholarly journals Which Parameters could be Useful for Predicting Malignancy in Solid Adnexal Masses?

2009 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Juan Luis Alcázar ◽  
Pedro Royo ◽  
Laura Pineda
Keyword(s):  
Blood Flow ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Menopausal Status ◽  
Ca 125 ◽  
Benign Tumors ◽  
Adnexal Masses

Abstract To determine which clinical, biochemical and other sonographic parameters could be useful to predict malignancy in sonographically solid adnexal masses. Methods Clinical (age, menopausal status, complaints and physical examination), biochemical (serum CA-125 levels) and other sonographic features (tumor volume, ascites, bilaterality, blood flow location and velocimetric pattern) from 163 women diagnosed as having a solid adnexal mass on B-mode gray-scale ultrasound were reviewed for this retrospective study. All patients had undergone surgery and mass removal. Definitive histologic diagnosis was available in all cases. All parameters were compared to final histological diagnosis (benign or malignant) in univariate statistical analysis. Then a stepwise forward logistic regression analysis was performed to identify those features that independently predict malignancy. Results A total of 173 masses were analyzed. Patients mean age was 52.4 years (range: 15 to 84 years) 117 masses were malignant and 56 were benign. After univariate analysis all parameters showed statistical differences between benign and malignant tumors. After logistic regression analysis only central blood flow (odd ratio: 64.2, 95% CI: 17.07 to 242.03) and presence of ascites (odd ratio: 32.77, 95% CI: 5.38 to 199.72) were identified as independent predictors of malignancy. The presence of one of these two features correlated to malignancy in 98.6% of cases. The absence of both was found in 82.1% of benign tumors. Conclusions The presence or absence of ascites or central blood flow may be helpful for discriminating benign from malignant solid adnexal masses.

scholarly journals Ovarian cyst mimicking acute appendicitis in pregnancy: A case report

2021 ◽  
Vol 8 (3) ◽  
pp. 431-433
Author(s):  
Vijay Verma ◽  
Supriya ◽  
Ravi Verma
Keyword(s):  
Acute Appendicitis ◽  
Ovarian Cyst ◽  
Surgical Intervention ◽  
Ovarian Cysts ◽  
Adnexal Masses ◽  
Emergency Intervention ◽  
Large Ovarian Cyst ◽  
Asymptomatic Women ◽  
Ovarian Masses ◽  
In Pregnancy

Ovarian cysts, also known as ovarian masses or adnexal masses are fluid filled sacs or pockets in an ovary or on its surface. These are found incidentally in asymptomatic women. Ovarian cysts are considered large in size when they are over 5 cm and giant when they are over 15 cm. Acute appendicitis is the most common surgical problem encountered during pregnancy. Pregnancy is associated with various anatomic and physiologic changes that may disguise and delay the diagnosis of acute appendicitis. Antibiotic treatment does not always improve the outcome and emergency intervention is required. Early diagnosis and surgical intervention is mandatory for the eventful outcome of pregnancy. Here we present a case of a primigravida patient with a large ovarian cyst mimicking acute appendicitis.

Preoperative Evaluation of the ADNEX Model for the Prediction of the Ovarian Cancer Risk of Adnexal Masses at Siriraj Hospital

2021 ◽  
pp. 1-7
Author(s):  
Vitcha Poonyakanok ◽  
Prasong Tanmahasamut ◽  
Atthapon Jaishuen ◽  
Thanyarat Wongwananuruk ◽  
Chutimon Asumpinwong ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Characteristic Curve ◽  
Preoperative Evaluation ◽  
Survival Rates ◽  
Benign Tumors ◽  
Diagnostic Study ◽  
Ovarian Cancer Risk ◽  
Cutoff Value ◽  
Adnexal Masses ◽  
Siriraj Hospital

Introduction: Distinguishing benign adnexal masses from malignant tumors plays an important role in preoperative planning and improving patients’ survival rates. The International Ovarian Tumor Analysis (IOTA) group developed a model termed the Assessment of Different NEoplasias in the adneXa (ADNEX). Objective: Our objective was to evaluate the performance of the ADNEX model in distinguishing between benign and malignant tumors at a cutoff value of 10%. Methods: This was a prospective diagnostic study. 357 patients with an adnexal mass who were scheduled for surgery at Siriraj Hospital were included from May 1, 2018, to May 30, 2019. All patients were undergoing ultrasonography, and serum CA125 was measured. Data were calculated by the ADNEX model via an IOTA ADNEX calculator. Results: Of the 357 patients, 296 had benign tumors and 61 had malignant tumors. The area under the receiver operating characteristic curve for using the ADNEX model was 0.975 (95% confidence interval, 0.953–0.988). At a 10% cutoff, the sensitivity was 98.4% and specificity was 87.2%. The best cutoff value was at 16.6% in our population. Conclusions: The performance of the ADNEX model in differentiating benign and malignant tumors was excellent.

scholarly journals Predicting Malignancy in Entirely Solid-appearing Adnexal Masses on Gray-Scale Ultrasound Based on Additional Ultrasound Findings, Clinical Complaints and Biochemical Parameters: A Retrospective Study

2013 ◽  
Vol 7 (1) ◽  
pp. 80-85
Author(s):  
Juan Luis Alcázar ◽  
Laura Pineda ◽  
Jesús Utrilla-Layna
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Retrospective Study ◽  
Logistic Regression Analysis ◽  
Biochemical Parameters ◽  
Malignant Tumors ◽  
Ca 125 ◽  
Gray Scale ◽  
Adnexal Masses ◽  
Ultrasound Findings

ABSTRACT Purpose To determine which clinical, biochemical and other sonographic parameters could be useful to predict malignancy in sonographically solid adnexal masses. Materials and methods Clinical, biochemical and other sonographic features from 227 women diagnosed as having an entirely solid adnexal mass on B-mode gray-scale ultrasound were reviewed for this retrospective study. All patients had undergone surgery and mass removal. Definitive histologic diagnosis was available in all cases. All parameters were compared to final histological diagnosis (benign or malignant) in univariate statistical analysis. Then a stepwise forward logistic regression analysis was performed to identify those features that independently predict malignancy. Results A total of 227 masses were analyzed. Patients’ mean age was 52.9 years (range: 15-84 years). A total of 150 masses were malignant and 77 were benign. In 52 cases carcinomatosis was observed on ultrasound scan and all theses cases were malignant. In the remaining 175 cases, univariate analysis showed statistical differences between benign and malignant tumors all parameters except tumor's volume. After logistic regression analysis tumor contour, acoustic shadowing, amount of color and CA 125 were identified as independent predictors of malignancy. Using a logistic model 94.4% of malignant tumors and 85.7% of benign tumors would be correctly identified. Conclusion The presence of carcinomatosis is invariably associated to malignancy. In absence of carcinomatosis, irregular tumor contour, absence of acoustic shadowing, moderate or abundant blood flow and a high CA 125 are associated to malignancy. How to cite this article Utrilla-Layna J, Olartecoechea B, Aubá M, Ruiz-Zambrana A, Pineda L, Alcázar JL. Predicting Malignancy in Entirely Solid-appearing Adnexal Masses on Gray-Scale Ultrasound Based on Additional Ultrasound Findings, Clinical Complaints and Biochemical Parameters: A Retrospective Study. Donald School J Ultrasound Obstet Gynecol 2013;7(1):80-85.

The probability of indolent versus aggressive histology based on renal tumor size: Implications for surveillance and treatment.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 704-704
Author(s):  
Bimal Bhindi ◽  
Robert Houston Thompson ◽  
Christine M. Lohse ◽  
Ross Mason ◽  
Igor Frank ◽  
...  
Keyword(s):  
Decision Making ◽  
Tumor Size ◽  
Clear Cell ◽  
Renal Tumor ◽  
Malignant Tumors ◽  
Benign Tumors ◽  
Low Grade ◽  
Patient Counseling ◽  
Aggressive Histology ◽  
Aggressive Tumors

704 Background: While the probability of benign versus malignant histology based on renal tumor size has been described, this alone does not sufficiently inform decision-making in the modern era since indolent malignant tumors can be surveilled. Thus, we sought to characterize the probability of indolent versus aggressive histology based on radiographic tumor size. Methods: We evaluated patients who underwent radical or partial nephrectomy at Mayo Clinic for a pT1-2, pNx/0, M0 solid renal tumor between 1990-2010. Pathology was reviewed by one genitourinary pathologist. Benign tumors, low grade (1-2) clear cell and papillary renal cell carcinoma (RCC), and any chromophobe, clear cell papillary, mucinous tubular and spindle cell, SDH-B deficient, and tubulocystic RCC were considered indolent. All other histologies were considered aggressive, as were any malignancies with necrosis or sarcomatoid differentiation. Cancer-specific survival (CSS) was estimated using the Kaplan Meier method. Logistic regression models were used to estimate the probability of malignant and aggressive histology based on tumor size. Sex-stratified analyses were also performed. Results: Of the 2650 patients included, there were 1773 patients with indolent tumors (303 benign; 1470 malignant) and 877 with aggressive tumors. Ten-year CSS was 96% for indolent malignant tumors and 82% for aggressive tumors. The predicted probabilities of any malignant histology and aggressive malignant histology increased with tumor size (Table; 1-7cm point estimates shown). For example, a 3 cm tumor had an 87% probability of malignancy and a 27% probability of being aggressive. For any given tumor size, men had a greater probability of aggressive histology than women. Conclusions: We present tumor size-based estimates of the probability of aggressive histology for renal masses. This information should be useful for patient counseling and treatment decision-making. [Table: see text]

Inclusion of CA-125 Does Not Improve Mathematical Models Developed to Distinguish Between Benign and Malignant Adnexal Tumors

2007 ◽  
Vol 25 (27) ◽  
pp. 4194-4200 ◽  
Author(s):  
Dirk Timmerman ◽  
Ben Van Calster ◽  
Davor Jurkovic ◽  
Lil Valentin ◽  
Antonia C. Testa ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Malignant Tumors ◽  
Color Doppler ◽  
Characteristic Curve ◽  
Premenopausal Women ◽  
Color Doppler Imaging ◽  
Doppler Imaging ◽  
Ca 125 ◽  
Benign Tumors ◽  
Adnexal Masses

Purpose To test the value of serum CA-125 measurements alone or as part of a multimodal strategy to distinguish between malignant and benign ovarian tumors before surgery based on a large prospective multicenter study (International Ovarian Tumor Analysis). Patients and Methods Patients with at least one persistent ovarian mass preoperatively underwent transvaginal ultrasonography using gray scale imaging to assess tumor morphology and color Doppler imaging to obtain indices of blood flow. Results Data from 809 patients recruited from nine centers were included in the analysis; 567 patients (70%) had benign tumors and 242 (30%) had malignant tumors—of these 152 were primary invasive (62.8%), 52 were borderline malignant (21.5%), and 38 were metastatic (15.7%). A logistic regression model including CA-125 (M2) resulted in an area under the receiver operating characteristic curve (AUC) of 0.934 and did not outperform a published (M1) without serum CA-125 information (AUC, 0.936). Specifically designed new models including CA-125 for premenopausal women (M3) and for postmenopausal women (M4) did not perform significantly better than the model without CA-125 (M1; AUC, 0.891 v AUC, 0.911 and AUC, 0.975 v AUC, 0.949, respectively). In postmenopausal patients, serum CA-125 alone (AUC, 0.920) and the risk of malignancy index (AUC, 0.924) performed very well. Results were very similar when the models were prospectively tested on a group of 345 new patients with adnexal masses of whom 126 had malignant tumors (37%). Conclusion Adding information on CA-125 to clinical information and ultrasound information does not improve discrimination of mathematical models between benign and malignant adnexal masses.

Treatment of Bacterial Vaginosis

1994 ◽  
Vol 28 (4) ◽  
pp. 483-487 ◽  
Author(s):  
John R. Schlicht
Keyword(s):  
Bacterial Vaginosis ◽  
Data Extraction ◽  
Treatment Options ◽  
Oral Antibiotic ◽  
Minimal Risk ◽  
Medline Search ◽  
Vaginal Cream ◽  
Study Selection ◽  
Asymptomatic Women ◽  
In Pregnancy

OBJECTIVE: The purposeof this articleis to review the treatment options for bacterial vaginosis, including the newer topical antibiotics, metronidazole gel and clindamycin cream. The article also examines the controversies over whether bacterial vaginosis is a sexually transmined disease and whether asymptomatic women should be treated. DATA SOURCE: A MEDLINE search was conducted to identify pertinent literature, including review articles. STUDY SELECTION: Emphasiswas placed on those clinical trials using metronidazole gel or clindamycin cream. Studies addressing the complications of bacterial vaginosis in pregnancy, the risk of treatment in pregnancy, and the method of transmission of the disease also were reviewed. DATA EXTRACTION: Clinical studies evaluating clindamycin cream and metronidazole gel were scarce; therefore, data from all available trials were reviewed. The objectives, methodology, and results from other studies werer eviewed; thoseaddressing complications of the disease and risksand benefits of treatment wereincluded. DATA SYNTHESIS: There is evidence both for and against bacterial vaginosis being a sexually transmined disease. Potential complications of the disease may warrant treatment of certain asymptomatic women, especially during pregnancy. Treatment options include oral or vaginal metronidazole or clindamycin, all of which provide high cure rates. Vaginal antibiotics result in minimal risk to the fetus in pregnant patients. CONCLUSIONS: Complications of bacterial vaginosis maybe associated with significant morbidity, especially among pregnant women. Treatment of asymptomatic women with the disease is controversial, but may be justified in certain high-risk populations. The topical agents, clindamycin vaginal cream 2% and metronidazole vaginal gel 0.75% provide a safe, effective, but expensive alternative to oral antibiotic regimens for the treatment of bacterial vaginosis.

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