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Female Pelvic Mass

By

David H. Barad

, MD, MS, Center for Human Reproduction

Last full review/revision Feb 2022| Content last modified Feb 2022
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Topic Resources

The female pelvic cavity contains the upper female reproductive tract (cervix, uterus, ovaries, fallopian tubes); the adnexa refers to the ovaries, fallopian tubes, and surrounding connective tissues. The pelvic cavity also contains the intestines, bladder, and lower ureters. A pelvic mass may originate from any of these structures.

Etiology of Pelvic Mass

Pelvic masses may originate from the upper female reproductive tract (cervix, uterus, fallopian tubes, ovaries) or from other pelvic structures (intestines, bladder, ureters).

Type of mass in the female reproductive tract tends to vary by age group:

Evaluation of Pelvic Mass

History

General medical and complete obstetric and gynecologic histories are obtained.

Symptoms or findings may suggest a cause for the pelvic mass:

Examination

During the general examination, the examiner should look for signs of nongynecologic (eg, gastrointestinal, urologic, endocrine) disorders and for ascites. If malignancy is suspected, evaluation for groin or supraclavicular lymphadenopathy is indicated.

A complete gynecologic examination is done. Distinguishing uterine from adnexal masses may be difficult. If ectopic pregnancy is suspected, excess pressure during examination is avoided to prevent rupture. Advanced endometriosis can manifest as nonmobile cul-de-sac masses. Cervical motion tenderness occurs in pelvic infection (and appendicitis). Nonmobile masses may be inflammatory (eg, due to endometrioma, hydrosalpinx, or tubo-ovarian abscess) or malignant. Hydrosalpinges are usually fluctuant, tender, nonmobile, and sometimes bilateral.

In early pregnancy or in young girls, pelvic organ masses may be palpable in the abdomen because the space in the pelvis is too small to contain a large mass.

Testing

If women of reproductive age have a pelvic mass, a pregnancy test should be done regardless of menstrual or sexual history. If a pregnancy test is positive, ultrasonography Ultrasonography Ideally, women who are planning to become pregnant should see a physician before conception; then they can learn about pregnancy risks and ways to reduce risks. As part of preconception care... read more or another imaging test is not always necessary; imaging is necessary when pelvic pain or vaginal bleeding is present.

If a suspected mass is not detected during examination or the cause cannot be determined, an imaging test is done. Usually, pelvic ultrasonography is done first.

In women of reproductive age, simple, thin-walled cystic adnexal masses that are 3 to 10 cm (usually follicular cysts) do not require further investigation unless they persist for> 3 menstrual cycles or are accompanied by moderate to severe pain (1 Evaluation references The female pelvic cavity contains the upper female reproductive tract (cervix, uterus, ovaries, fallopian tubes); the adnexa refers to the ovaries, fallopian tubes, and surrounding connective... read more Evaluation references ).

The International Ovarian Tumor Analysis (IOTA) group developed the Simple Rules to preoperatively assess risk of cancer in women who have ovarian or other adnexal tumors that are thought to require surgery. Classification is based on the presence or absence of 10 ultrasound features and has a higher sensitivity and specificity than other classification scores. In 2016, the IOTA Simple Rules were updated to include a risk calculation tool (SRrisk), which can be used on mobile devices (2 Evaluation references The female pelvic cavity contains the upper female reproductive tract (cervix, uterus, ovaries, fallopian tubes); the adnexa refers to the ovaries, fallopian tubes, and surrounding connective... read more Evaluation references ).

If ultrasonography does not clearly delineate size, location, and consistency of the mass, another imaging test may do so. MRI is typically used for further evaluation of the mass; CT is useful for evaluating suspected metastases.

Radiographic characteristics that suggest cancer include a solid component (particularly those with a blood supply), thick septations, surface excrescences, ascites, and additional intraabdominal masses. Suspected adnexal masses are evaluated with surgical exploration because biopsy may spread malignant cells. Tumor markers may help in the diagnosis of specific tumors Tumor Immunodiagnosis Tumor-associated antigens (TAAs) can help diagnose various tumors and sometimes determine the response to therapy or recurrence. An ideal tumor marker would Be released only from tumor tissue... read more . Suspected uterine masses may be evaluated with endometrial biopsy and/or surgical exploration.

Evaluation references

Key Points

  • Type of mass in the female reproductive tract tends to vary by age group.

  • In women of reproductive age, the most common cause of symmetric uterine enlargement is pregnancy; other common causes of pelvic masses are uterine fibroids and functional ovarian cysts.

  • In postmenopausal women, masses are more likely to be cancerous.

  • In women of reproductive age, do a pregnancy test.

  • If clinical evaluation is inconclusive, do an imaging test; usually, pelvic ultrasonography is done first.

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