Adnexal Mass Tumors: Symptoms, Types, Causes and Treatment

Adnexal mass tumors are a common yet complex challenge in gynecology, affecting women and girls across all age groups. These masses arise in the adnexa of the uterus—primarily the ovaries and fallopian tubes—but can also involve surrounding structures. While many adnexal masses are benign and symptomless, others may cause distressing symptoms or raise concerns about cancer, especially since ovarian malignancies often present with vague signs. Understanding the symptoms, types, causes, and modern approaches to treatment is crucial for timely diagnosis and effective management. This article provides a comprehensive, evidence-based overview, synthesizing the latest research and consensus recommendations.

Symptoms of Adnexal Mass Tumors

The symptoms of adnexal mass tumors can range from mild and nonspecific to severe and acute. Many women may not notice any symptoms until the mass becomes large or complications arise. Recognizing the symptom patterns is essential for early detection, especially given the overlap with other pelvic or abdominal conditions.

Symptom	Description	Prevalence/Notes	Sources
Abdominal Pain	Discomfort or sharp pain in abdomen	Most common symptom (25–45%)	1 4 5 12
Abdominal Distension	Swelling or bloating	More frequent in malignancy, 12–20%	1 2 4 10
Menstrual Changes	Irregularity, menorrhagia, dysmenorrhea	20–40%, esp. in reproductive age	1 4 5
Urinary/GI Symptoms	Urgency, frequency, satiety, eating difficulties	Less common, often with malignancy	2 11

Table 1: Key Symptoms

Understanding Symptom Patterns

Abdominal and Pelvic Pain

• Abdominal pain is the leading symptom, especially in children, adolescents, and reproductive-age women. It may be acute (as in torsion or rupture) or chronic (as in benign cysts or slow-growing tumors) 1 4 5 12.
• In younger children, pain can be the first and sometimes only sign, while in adults, it often coexists with other symptoms.

Menstrual and Reproductive Symptoms

• Menstrual irregularities such as menorrhagia (heavy bleeding) and dysmenorrhea (painful periods) are frequent, particularly with benign ovarian cysts and endometriosis 1 4.
• Bleeding per vagina can signal an ectopic pregnancy or a hormonally active tumor 5.

Abdominal Distension and Bloating

• Abdominal bloating and increased size are more often reported in malignant cases, sometimes accompanied by early satiety and unintentional weight loss 2 10.
• Persistent or progressive distension should raise suspicion for malignancy.

Urinary and Gastrointestinal Symptoms

• Urinary urgency, frequency, or incontinence and gastrointestinal complaints like early satiety or difficulty eating may occur when large masses compress nearby organs 2 11.
• These symptoms are particularly concerning if they persist for weeks or worsen over time.

Incidental Detection

• A significant number of adnexal masses are discovered unintentionally during imaging for unrelated issues, especially in asymptomatic women 1 3.

Types of Adnexal Mass Tumors

Adnexal masses represent a diverse group of lesions, from harmless cysts to aggressive cancers. Classification depends on the site of origin, histological type, and malignancy risk.

Type	Features/Origin	Malignancy Risk	Sources
Ovarian Cysts	Functional, endometriotic, etc.	Mostly benign	8 12 13
Benign Tumors	Serous/mucinous cystadenoma, dermoid	Low	8 12 13
Borderline Tumors	Intermediate behavior	0.9–7% in some cohorts	8 12
Malignant Tumors	Epithelial, germ cell, stromal	5–25%, age-dependent	8 10 12 17
Tubal/Paratubal Masses	Paratubal cysts, ectopic pregnancy	Variable	5 12 13
Non-Gynecologic	GI tract, abscesses	Rare	2 3

Table 2: Types of Adnexal Masses

Ovarian Masses

• Functional cysts (e.g., follicular, corpus luteal): Most common in reproductive years, usually resolve spontaneously.
• Benign neoplasms: Serous or mucinous cystadenomas and dermoid cysts (mature teratomas) are frequent and have low malignant potential 8 12 13.
• Endometriomas: Cysts arising from endometriosis, often associated with pain and menstrual symptoms.

Borderline and Malignant Tumors

• Borderline tumors: Exhibit features between benign and malignant; they account for 0.9–7% of pediatric and adolescent masses 8 12.
• Malignant tumors:
  • Epithelial ovarian cancers (serous cystadenocarcinoma) are most common in adults and older women 10 13.
  • Germ cell tumors (e.g., dysgerminoma, yolk sac tumor): More prevalent in children and young women; often present with large, rapidly growing masses 8 12 17.
  • Sex cord stromal tumors: Rare, but may present with hormonal symptoms 8.
  • Metastatic tumors: Uncommon, but crucial to recognize due to poor prognosis 9.

Tubal, Paratubal, and Nongynecologic Masses

• Tubal/Paratubal masses: Include benign hydrosalpinx, paratubal cysts, and ectopic pregnancies, the latter being a life-threatening emergency in reproductive-age women 5 12 13.
• Nongynecologic masses: Gastrointestinal tumors or abscesses, though rare, should be considered in the differential diagnosis 2 3.

Causes of Adnexal Mass Tumors

Understanding the underlying causes of adnexal masses helps guide diagnosis, management, and counseling. The etiology varies by age, hormonal status, and associated risk factors.

Cause Category	Examples	Typical Age Group	Sources
Physiologic	Follicular, corpus luteal cysts	Reproductive age	12 13
Neoplastic	Benign, borderline, malignant	All ages, type-dependent	8 12 13 17
Inflammatory/Infectious	Tubo-ovarian abscess, PID	Reproductive age, sexually active	13
Pregnancy-related	Ectopic pregnancy	Reproductive age	5 13
Endometriosis	Endometrioma	Reproductive age	13
Nongynecologic	GI tract, appendiceal mass	Variable	2 3

Table 3: Causes of Adnexal Masses

Physiologic and Functional Cysts

• Follicular and corpus luteal cysts arise from normal ovulatory cycles and are especially common in menstruating women. Most resolve without intervention 12 13.
• These cysts are rare in prepubertal girls and postmenopausal women.

Neoplasms

• Benign neoplasms (e.g., cystadenomas, dermoid cysts): Result from abnormal cellular proliferation, typically with no cancer risk 8 12 13.
• Malignant tumors: May develop due to genetic predisposition (e.g., BRCA mutations), age, or unknown factors. Risk increases with age, peaking in postmenopausal women 8 10 13 17.

Inflammatory Causes

• Tubo-ovarian abscesses and other infections are more common in sexually active women, often linked to pelvic inflammatory disease (PID) 13.
• Symptoms include pain, fever, and sometimes gastrointestinal disturbance.

Pregnancy-Related Masses

• Ectopic pregnancy is a critical cause of adnexal mass in reproductive-age women and must always be considered in acute presentations 5 13.
• Presents with pain, bleeding, and positive pregnancy test.

Endometriosis

• Endometriomas are cysts formed by the growth of endometrial tissue in the ovary, leading to chronic pain and infertility 13.

Nongynecologic Etiologies

• Masses from adjacent organs, such as the gastrointestinal tract or appendix, may mimic adnexal masses and should be included in the differential diagnosis 2 3.

Treatment of Adnexal Mass Tumors

Treatment strategies for adnexal masses are individualized, based on patient age, symptom severity, mass characteristics, and risk of malignancy. The recent shift towards conservative management of benign-appearing masses reflects an effort to reduce unnecessary surgeries while ensuring prompt intervention for malignancy.

Treatment	Indication/Approach	Key Considerations	Sources
Observation	Small, simple, benign-appearing	Serial imaging, low malignancy risk	15 16 18
Surgery	Suspicious/large/malignant masses	Laparoscopy vs. laparotomy, fertility preservation	14 16 18
Medical Therapy	Infection, endometriosis	Antibiotics, hormonal agents	13 18
Referral	High-risk or indeterminate cases	Gynecologic oncologist	2 10 16

Table 4: Treatment Options

Observation and Conservative Management

• Most simple, benign-appearing cysts in premenopausal women are suitable for observation, with periodic ultrasound and clinical review. The risk of acute complications or malignancy is low (<1%) with this approach 15 16.
• Spontaneous resolution occurs in up to 20% within two years 15.
• Conservative management is not advised in postmenopausal women with complex or persistent masses, or when symptoms worsen 16 18.

Surgical Intervention

• Indicated for: Large (>6–10 cm), complex, symptomatic, or persistent masses; suspected malignancy; acute complications (e.g., torsion, rupture) 2 10 14 16 18.
• Laparoscopy is the preferred approach for most benign and some borderline tumors, as it is minimally invasive and supports fertility preservation 14 18.
• Laparotomy may be required for larger, suspicious, or malignant masses to ensure proper staging and treatment 14 18.
• Fertility-sparing surgery is prioritized in children and adolescents, with gynecologist involvement reducing the rate of unnecessary oophorectomies 12 17.

Medical Management

• Antibiotics are first-line for tubo-ovarian abscesses and pelvic infections 13.
• Hormonal therapy may be used for endometriosis-associated cysts to control symptoms 13.

Specialist Referral

• Referral to a gynecologic oncologist is warranted for:
  • Postmenopausal women with an adnexal mass
  • Evidence of metastasis or ascites
  • Masses with high-risk features on imaging
  • Persistent or growing masses despite observation 2 10 16.

Improving Diagnosis and Management

• Advanced imaging (transvaginal ultrasound, MRI) and risk assessment models (e.g., RMI, ADNEX) help stratify malignancy risk and guide management 6 7 9 10 11.
• Decision-making is enhanced by multidisciplinary input and adherence to consensus guidelines 16.

Conclusion

Adnexal mass tumors are a diverse group of gynecologic conditions, with presentations ranging from silent to life-threatening. Early recognition and accurate risk stratification are crucial for optimal outcomes. Here are the key points to remember:

• Symptoms are often nonspecific, with abdominal pain, menstrual changes, and bloating being most common.
• Types of masses range from benign cysts to malignant tumors, with risk and histology varying by age.
• Common causes include physiologic cysts, neoplasms, infection, pregnancy, and endometriosis.
• Treatment is tailored to the individual's age, risk, and symptoms, with observation favored for benign-appearing masses and surgical intervention for suspicious or symptomatic lesions.
• Conservative management is safe for most benign masses, while specialist referral is critical for high-risk cases.
• Multidisciplinary and evidence-based approaches are essential for improved patient care and outcomes.

By understanding the spectrum of adnexal mass tumors, healthcare providers can ensure timely diagnosis, appropriate treatment, and better quality of life for affected individuals.