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Pelvic Mass

By

David H. Barad

, MD, MS, Center for Human Reproduction

Last full review/revision Mar 2020| Content last modified Mar 2020
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Topic Resources

Etiology of Pelvic Mass

Pelvic masses may originate from gynecologic organs (cervix, uterus, uterine adnexa) or from other pelvic organs (intestine, bladder, ureters, skeletal muscle, bone).

Type of mass tends to vary by age group:

Evaluation of Pelvic Mass

History

Examination

During the general examination, the examiner should look for signs of nongynecologic (eg, gastrointestinal, endocrine) disorders and for ascites. A complete gynecologic examination is done.

Distinguishing uterine from adnexal masses may be difficult. Endometriomas are usually adnexal masses. Advanced endometriosis can manifest as nonmobile cul-de-sac masses. Adnexal cancers, benign tumors (eg, benign cystic teratomas), and adnexal masses due to ectopic pregnancy are often mobile. Hydrosalpinges are usually fluctuant, tender, nonmobile, and sometimes bilateral.

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

Testing

In women of reproductive age, a pregnancy test should be done regardless of stated history. If the 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 ectopic pregnancy is suspected.

If the presence or origin (gynecologic versus nongynecologic) of a mass cannot be determined clinically, an imaging test can usually do so. Usually, pelvic ultrasonography is done first.

In women of reproductive age, simple, thin-walled cystic adnexal masses that are 5 to 8 cm (usually graafian follicular cysts) do not require further investigation unless they persist for > 3 menstrual cycles or are accompanied by moderate to severe pain.

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 iPhones or Android devices (1 Evaluation reference A pelvic mass may be detected during routine gynecologic examination. A pelvic mass may be noncancerous or cancerous. Pelvic masses may originate from gynecologic organs (cervix, uterus, uterine... read more Evaluation reference ).

If ultrasonography does not clearly delineate size, location, and consistency of the mass, another imaging test (eg, CT, MRI) may do so.

Ovarian masses with radiographic characteristics of cancer, such as a solid component, surface excrescences, and irregular shape (which also suggest cancer), require needle aspiration or biopsy. 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 .

Evaluation reference

Key Points

  • Type of pelvic mass 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 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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