Adnexal masses

Question 1

DDX for adnexal mass

Answer 1

Gyn
Benign: endometrioma, simple cyst, TOA, teratoma, serous or mucinous cystadenoma
Malignant: Epithelial carcinoma, germ cell tumor, metastatic disease, sex cord or stromal tumor

Nongynecologic
Diverticular abscess
Appendiceal abscess
Bladder or ureteral diverticulum

Question 2

Ultrasound findings that suggest malignancy

Answer 2

Size greater than 10 cm
Papillary or solid components
Irregularity
Presence of ascites
High color Doppler flow

Question 3

Characteristics of benign masses

Answer 3

Simple appearance (thin, smooth walls)
Absence of solid components, septations, internal blood flow

Question 4

Non-malignant condition is causing elevation of CA 125

Answer 4

Uterineleiomyoma
Endometriosis
PID
Ascites of any etiology
SLE
IBD

Elevated and only 50% of stage one epithelial ovarian cancer

Question 5

What is the most common type of ovarian malignancy in children and adolescents

Answer 5

Germ cell tumors

Question 6

What is the recommended follow up for a hemorrhagic cyst between five and 10 cm in pre-menopausal patient?

Dermoid <10 cm

Answer 6

8 to 12 weeks

8-12 weeks then annually

Question 7

What is the recommended follow up for a simple cyst and a post menopausal patient?

Answer 7

<3 cm none

3-10 cm: 1 yr then annually for 5 yrs

Question 8

Endometrioma in postmenopausal pt

Answer 8

Higher risk of transformation to malignancy

MRI