ABSTRACT
This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.
ABSTRACT
Ovarian cancer is the leading cause of death from gynaecological malignancy in developed countries. Synchronous endometrioid endometrial and ovarian cancer in patients appears with different clinical characteristics compared to patients with isolated endometrial cancer. A 34-year-old woman with lower abdominal pain of 1â year duration presented at the emergency department. On gynaecological examination, she had a left and midline pelvic mass. A transvaginal ultrasound showed it to be a complex hypervascularised mass, with cystic and solid components on left adnexal region. Ectopic pregnancy and pelvic inflammatory disease were excluded. Serum levels of tumour marker CA125 and ROMA were increased. The MR showed a complex mass, suggestive of primary fallopian tube or ovarian tumour. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection and subcolonic omentectomy. Histopathology revealed a synchronous endometrioid endometrial and ovarian cancer.
