ADNEXAL MASS

An adnexal mass refers to any mass occupying the region of the uterine appendages (adnexa). Major concern is the ovarian neoplasm (malignancy).

COMMON ADNEXAL MASSES: -

OVARIAN: -

• Ovarian neoplasm
• Ovarian cyst
• Endometriosis
• Tubo Ovarian mass.

UTERINE: -

• Myoma
• Tubal pathology
• Ectopic Pregnancy
• Hydrosalpinx
• Tubal neoplasms

GASTROINTESTINAL: -

• Diverticulitis
• Appendicular mass(right)

GENITOURINARY: - Pelvic kidney.

EVALUATION OF AN ADNEXAL MASS: -

1. Clinical— (Bimanual pelvic) Examination for its size, shape, consistency, mobility and tenderness.
2. Transvaginal ultrasonography—Whether the cyst is simple or complex, internal echoes, nodularity. Doppler ultrasound to study blood flow and to measure R1 and P1.
3. Computed tomography (CT)—Contrast tomography can differentiate loop of bowel, dermoid cyst, myomas.
4. Magnetic resonance imaging (MRI) is also helpful and it has no risk of ionizing radiation.
5. Positron emission tomography (PET) is more sensitive in detecting metastatic disease.
6. Tumor markers—Numerous tumor markers have

been studied for the detection and follow-up of ovarian malignancy namely CA–125, CA–15-3, TAG-72, CA–19-9.

MANAGEMENT OF AN ADNEXAL MASS

Whenever any adnexal mass is diagnosed the management will depend mainly on —

(i) Nature of the mass.

(ii) Age of the woman.

Ovarian cysts in postmenopausal women—Should be assessed for the risk of malignancy clinically and also using CA–125 and transvaginal sonography

(TVS). Important points on TVS for scoring are: Multinodular cyst, presence of a solid areas, metastases, ascites and bilateral lesions. According to RMI (Risk of Malignancy Index) the women are triaged into Low risk: RMI < 25. Moderate Risk: RMI 25-250 and High Risk: RMI > 250.

Actual Management: Conservative: - management is ideal for a simple, unilateral unilocular ovarian cyst, < 8 cm with low RMI (<25) and normal serum CA–125. Such women are followed up with TVS at an interval of 4 months. 50 percent of such cysts resolve spontaneously.

HOMOEOPATHIC MANAGEMENT OF ADENEXAL MASSES: -

Adenexal masses management with homoeopathic medicine is a holistic approach that treats the main cause behind the problem. Homoeopathic medicines are very safe to use among women of all age groups without any side effects.

The medicines which may be used are: -

1. Lachesis: - Homoeopathic medicine for Adenexal masses in the left ovary. Swelling and pain in left ovary that gets better during menses, and Menstrual bleeding that is blackish in colour are the symptoms that indicate the need for this remedy.
2. Lycopodium: - Homoeopathic medicine for Adenexal masses in right ovary. Burning or boring pains may be felt in the ovary. Irregular periods, profuse or Prolonged periods, pain during intercourse and abdominal bloating are the main symptoms.
3. Colocynthis: - For Adenexal masses that are painful. The pain varies in character ranging from cramping, stitching to tensive. Burning sensation in ovaries that gets better upon bending over double and a sensitive Ovarian region that seems hard and swollen.
4. Apis Mel: - For masses that cause pain during intercourse. A stinging, sharp, cutting, pain from the ovary radiating down the thigh, soreness and tenderness over the Ovarian region, heaviness in the Ovarian region and pain in ovaries during menstruation are the symptoms.
5. Pulsatilla:- For masses with scanty menstrual bleeding. A tendency of delayed menstruation, menstrual colic, chilliness, vomiting, heavy pressure in the abdomen and lower back, a pressure in the bladder and rectum are the symptoms.