A pelvic mass can be found during a routine gynecological exam. A pelvic mass can be non-cancerous or cancerous.EtiologyPelvic masses can originate from gynecological organs (cervix, uterus, uterine adnexa) or from other pelvic organs (intestine, bladder, ureters, muscles, bones).
The type of mass tends to vary between age groups:In infants, maternal hormones produced during pregnancy can stimulate the development of adnexal cysts that can be seen during the first few months of life. This effect is rare.
By the time of puberty, menstrual blood can accumulate and form a vaginal mass (hematocolpo) as the outflow is blocked. The cause is usually the presence of an imperforate hymen; other causes include congenital malformations of the uterus, cervix, or vagina.
In women of childbearing age, pregnancy is the most common cause of uniform enlargement of the uterus, which sometimes may not be suspected. Another common cause is fibroids, which can develop outside the uterus.
Frequently found adnexal masses include Graafian follicles (usually 5-8 cm in diameter) that develop normally but do not release the egg (called functional ovarian cysts). These cysts often regress spontaneously within a few months.
Adnexal masses may result from ectopic pregnancy, ovarian cancer, fallopian tube carcinoma, benign disease (eg, benign cystic teratomas), or hydrosalping. Endometriosis can have single or multiple locations anywhere in the pelvis, usually on the ovaries.
In postmenopausal women, pelvic masses are more frequently neoplastic in nature. Many benign ovarian masses (eg, endometriomas, myomas) are sensitive to ovarian hormone secretion, which becomes less common after menopause.
AssessmentAnamnesisIt is necessary to collect a thorough medical and gynecological anamnesis.Other findings may suggest a cause for the pelvic mass:Presence of vaginal bleeding and pelvic pain: an ectopic pregnancy or, rarely, gestational trophoblastic disease
Dysmenorrhea: endometriosis or uterine fibroidsIn young girls, precocious puberty: presence of a masculinizing or feminizing ovarian tumorIn women, virilization: a masculinizing ovarian tumorMenometrorrhagia or postmenopausal bleeding: increased risk of a malignant tumor, sometimes feminizing (not the most common cause)
ExaminationDuring physical examination, signs of non-gynecologic disease (eg, gastrointestinal, endocrine) and the presence of ascites should be looked for. It is necessary to carry out a complete gynecological examination.
Being able to distinguish a mass of uterine origin from that of adnexal origin can be difficult. Endometriomas are usually adnexal masses. Advanced endometriosis can manifest as fixed masses without cul-de-sacs.
Adnexal tumors, benign tumors (eg, benign cystic teratomas), and adnexal masses from ectopic pregnancy are often motile. Hydrosalping are usually fluctuating, painful on palpation, low-mobile, and sometimes bilateral.