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American Family Physician Apr 2016Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or... (Review)
Review
Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. Pelvic examination has low sensitivity for detecting an adnexal mass; negative pelvic examination findings in a symptomatic woman should not deter further workup. Ectopic pregnancy must be ruled out in women of reproductive age. A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. CA 125 levels are elevated in conditions other than ovarian cancer. Because substantial overlap in CA 125 levels between pre- and postmenopausal women may occur, this level alone is not recommended for differentiating between a benign and a malignant adnexal mass. Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. Large mass size, complexity, projections, septation, irregularity, or bilaterality may indicate cancer. If disease is suspected outside of the ovary, computed tomography may be indicated; magnetic resonance imaging may better show malignant characteristics in the ovary. Serial ultrasonography and periodic measurement of CA 125 levels may help in differentiating between benign or potentially malignant adnexal masses. If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated.
Topics: Adnexal Diseases; CA-125 Antigen; Chorionic Gonadotropin, beta Subunit, Human; Diagnosis, Differential; Endometriosis; Female; Gynecological Examination; Humans; Leiomyoma; Magnetic Resonance Imaging; Ovarian Cysts; Ovarian Diseases; Ovarian Neoplasms; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Pregnancy; Pregnancy, Ectopic; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Uterine Neoplasms
PubMed: 27175840
DOI: No ID Found -
Reproductive Biology and Endocrinology... Dec 2018Recurrent implantation failure (RIF) refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos. The definition... (Review)
Review
Recurrent implantation failure (RIF) refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos. The definition should also take advanced maternal age and embryo stage into consideration. The failure of embryo implantation can be a consequence of uterine, male, or embryo factors, or the specific type of IVF protocol. These cases should be investigated to determine the most likely etiologies of the condition, as this is a complex problem with several variables. There are multiple risk factors for recurrent implantation failure including advanced maternal age, smoking status of both parents, elevated body mass index, and stress levels. Immunological factors such as cytokine levels and presence of specific autoantibodies should be examined, as well as any infectious organisms in the uterus leading to chronic endometritis. Uterine pathologies such as polyps and myomas as well as congenital anatomical anomalies should be ruled out. Sperm analysis, pre-implantation genetic screening and endometrial receptivity should be considered and evaluated, and IVF protocols should be tailored to specific patients or patient populations. Treatment approaches should be directed toward individual patient cases. In addition, we suggest considering a new initial step in approach to patients with RIF, individualized planned activities to activate the brain's reward system in attempt to improve immunological balance in the body.
Topics: Embryo Implantation; Embryo Transfer; Endometritis; Female; Fertilization in Vitro; Humans; Infertility, Female; Preimplantation Diagnosis; Recurrence; Risk Factors; Treatment Failure
PubMed: 30518389
DOI: 10.1186/s12958-018-0414-2 -
Chinese Clinical Oncology Oct 2020Early detection and characterization of ovarian lesions is of utmost importance for adequate management. Ovarian cancer accounts for 3.3% of all cancers in women... (Review)
Review
Early detection and characterization of ovarian lesions is of utmost importance for adequate management. Ovarian cancer accounts for 3.3% of all cancers in women worldwide but has only a 5% of female cancer deaths because of low survival rates. The majority of ovarian lesions are benign and have spontaneous resolution. The adequate discrimination between benign and malignant lesions is the most important starting point for a correct and optimal management. Ultrasound is the method of choice up until now for adequate assessment of adnexal abnormalities, no other method has proven superior. Along time, there has been many classification systems that aim standardization of adnexal masses The Gynecology Imaging Reporting and Data System (GI-RADS), published in 2019. The International Ovarian Tumor Analysis (IOTA) group standardized in 2013 the approach of adnexal pathology descriptions by ultrasound with the limitation of needing pathologic reports for complete assessment. The Ovarian Adnexal Reporting and Data System (O-RADS) is a lexicon designed in 2018 to standardize definitions of characteristics by ultrasound. This system offers an interpretation method to decrease ambiguity and recommends management guides according to its classification.
Topics: Adnexal Diseases; Diagnostic Imaging; Female; Humans
PubMed: 33161725
DOI: 10.21037/cco-20-37 -
Diagnostic and Interventional Imaging Oct 2019Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an... (Review)
Review
Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an adnexal lesion. In the cases of classic simple cysts, hemorrhagic cysts, endometriomas, dermoids and obviously malignant lesions, ultrasound may be sufficient for management recommendations. In cases where there is an isolated adnexal lesion, without peritoneal disease or serum CA-125 elevation, and in lesions considered indeterminate on ultrasound, MR imaging with incorporation of the ADNEx MR score can increase the specificity for the diagnosis of benignity or malignancy. This article will review the imaging evaluation of adnexal lesions and how to incorporate the ADNEx MR score to help guide clinical management.
Topics: Adnexa Uteri; Adnexal Diseases; CA-125 Antigen; Contrast Media; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Ultrasonography
PubMed: 30177450
DOI: 10.1016/j.diii.2018.06.003 -
Avicenna Journal of Medicine 2017Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these... (Review)
Review
Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.
PubMed: 29119081
DOI: 10.4103/ajm.AJM_22_17 -
American Family Physician May 1998Adnexal masses are frequently found in both symptomatic and asymptomatic women. In premenopausal women, physiologic follicular cysts and corpus luteum cysts are the most... (Review)
Review
Adnexal masses are frequently found in both symptomatic and asymptomatic women. In premenopausal women, physiologic follicular cysts and corpus luteum cysts are the most common adnexal masses, but the possibility of ectopic pregnancy must always be considered. Other masses in this age group include endometriomas, polycystic ovaries, tubo-ovarian abscesses and benign neoplasms. Malignant neoplasms are uncommon in younger women but become more frequent with increasing age. In postmenopausal women with adnexal masses, both primary and secondary neoplasms must be considered, along with leiomyomas, ovarian fibromas and other lesions such as diverticular abscesses. Information from the history, physical examination, ultrasound evaluation and selected laboratory tests will enable the physician to find the most likely cause of an adnexal mass. Measurement of serum CA-125 is a useful test for ovarian malignancy in postmenopausal women with pelvic masses. Asymptomatic premenopausal patients with simple ovarian cysts less than 10 cm in diameter can be observed or placed on suppressive therapy with oral contraceptives. Postmenopausal women with simple cysts less than 3 cm in diameter may also be followed, provided the serum CA-125 level is not elevated and the patient has no signs or symptoms suggestive of malignancy.
Topics: Adnexal Diseases; Algorithms; CA-125 Antigen; Decision Trees; Diagnosis, Differential; Female; Humans; Ovarian Cysts; Patient Education as Topic; Postmenopause; Pregnancy; Pregnancy Complications; Premenopause; Teaching Materials; Ultrasonography
PubMed: 9614415
DOI: No ID Found -
American Family Physician Oct 2009Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of... (Review)
Review
Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Family physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.
Topics: Adnexal Diseases; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Physical Examination; Prognosis
PubMed: 19835343
DOI: No ID Found -
American Family Physician Apr 2012Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically;... (Review)
Review
Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has human immunodeficiency virus infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.
Topics: Administration, Oral; Anti-Bacterial Agents; Biopsy; Chlamydia trachomatis; Diagnostic Imaging; Drug Therapy, Combination; Endometrium; Female; Gynecological Examination; Hospitalization; Humans; Infusions, Parenteral; Male; Mass Screening; Medical History Taking; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pelvic Inflammatory Disease; Pregnancy; Risk Factors; Sexual Partners
PubMed: 22534388
DOI: No ID Found