Adnexal mass

Question 1

When should you observe vs do surgical intervention for an ovarian mass

Answer 1

Simple ovarian cyst <10cm, observe using serial TVUS

Surgery for any of the following:
1. complex internal architecture
2. solid mass
3. bilateral masses
4. suspicious findings on exam or US
5. elevated tumor markers
6. presence of ascites
7. symptomatic mass or torsion

Question 2

Pregnant pt with adnexal mass, management:

Answer 2

1. A simple unilateral cyst may be observed
2. Complex cyst in 1st trimester should be re-evaluated at 17-18 weeks
3. Operation is safe after 18 weeks or in 2nd trimester

Question 3

What are factors favoring malignancy in ovarian mass