A patient may report a symptomatic pelvic mass, or it may be discovered as part of a pelvic examination or ultrasound done for other reasons. A pelvic mass can be associated with the uterus, ovaries, or nongynecologic organs. The first step in evaluation is to review the patient's age, history, and risk factors. For example, an ovarian cyst is more likely to be a functional cyst in a younger woman, but it has a higher potential to be ovarian cancer in postmenopausal women. Additional historical details include menopausal status, menstrual history, family history, STI risk, symptoms of hyperandrogen-ism, and dysmenorrhea.

Pelvic examination is not sensitive or specific for diagnosis of a pelvic mass, especially as body mass index (BMI) increases (Myers et al., 2006). However, pelvic examination can provide other information helpful in the diagnosis, such as location of the mass, mobility of the mass, cervical motion tenderness, pelvic tenderness, and vaginal discharge. Initial evaluation of a pelvic mass should include a pelvic ultrasound, which can be transabdominal or transvaginal, depending on the size and location of the mass. Premenopausal women should be tested to exclude pregnancy. Doppler ultrasound, cyst morphology, and CA-125 testing are useful in ruling out ovarian cancer in a postmenopausal woman with an adnexal mass. Table 25-2 lists the differential diagnosis and common features of pelvic masses.

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