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Chapter-25 Management of Adnexal Cystic Masses

BOOK TITLE: Ovarian Cancer: Comprehensive and Contemporary Management

Author
1. Rajaram Shalini
2. Agarwal Rachna
ISBN
9788184485394
DOI
10.5005/jp/books/10583_25
Edition
1/e
Publishing Year
2009
Pages
16
Author Affiliations
1. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, shalini.rajaram@labnetworx.com, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, shalini_rajaram@rediffmail.com, Guru Teg Bahadur Hospital and University College of Medical Sciences, New Delhi, India, University College of Medical Sciences and GTB Hospital, Delhi, University College of Medical Sciences and Guru Tegbahadur Hospital, Delhi 110095, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India; Asia Oceania Research Organization on Genital Infections and Neoplasia (AOGIN), India, New Delhi, University College of Medical, Sciences and Guru Teg Bahadur Hospital, New Delhi, India, All India Institute of Medical Sciences,
2. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, rachna_anila@yahoo.co.in, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
Chapter keywords

Abstract

The adnexal mass is most frequently of the ovaries because of its propensity for neoplasia. It encompasses wide spectrum of disorders and numerous therapies may be appropriate. Although the majority of adnexal masses are due to benign processes, the primary goal of the diagnostic evaluation is the exclusion of malignancy. Once a mass has been detected and evaluated by imaging and serum tumor markers, the physician is faced with the dilemma of how best to manage an individual patient. The questions to be answered are which patients can be safely followed, which should be operated on immediately and which can be evaluated laparoscopic ally. The patient’s age is a crucial factor in determining the probable etiology of an adnexal mass as well its management. The differential diagnosis of the adnexal mass is complex so ovarian masses at various ages have been discussed in detail under the following categories: Fetal and newborn ovarian cysts, Reproductive age and Postmenopausal women. Workup of adnexal masses includes a complete history and physical examination which is essential in the diagnosis of adnexal masses. Various imaging modalities described in literature and especially ultrasound based morphological scoring systems have been enumerated to aid in the workup of an adnexal mass. More information can be obtained with Color Doppler ultrasound waveform analysis. The role of 3D Ultrasound and value of vascularity index, called Power Doppler Index (PDI) for evaluation of these masses has also been highlighted. Interestingly the accuracy of Computerized Tomography, Magnetic Resonance Imaging and combination of various imaging modalities along with PET have been compared as diagnostic tools for diagnosis of the adnexal masses. Management algorithm of adnexal cystic mass in the premenopausal and postmenopausal age has been described based on current evidence. The recommendations for operative laparoscopy and its controversies have been enumerated. To conclude the chapter is a comprehensive summary of diagnostic evaluation and management of adnexal masses at various ages based on evidence from literature.

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