Adnexa,
by definition, are accessory or adjoining anatomical
parts, such as ovaries and fallopian tubes in relation
to the uterus. So, dermoid cyst on the right adnexa
would indicate a dermoid cyst on the right ovary. The
normal functioning ovary produces a follicular cyst also
called the functional cyst every other month or so. In
most cases, these functional cysts are self-limiting and
disappear of their own accord within the duration of a
normal menstrual cycle. Rarely, they persist or become
enlarged. In such cases, they are a sign of a
pathological condition.
The
clinical presentation of right adnexa
dermoid cyst is often asymptomatic. The dermoids are
generally detected at the time of a pelvic examination
or at the time of a radiologic examination for another
diagnosis, or at the time of a surgical
procedure. Symptoms, if any, may include urinary
frequency, pelvic or abdominal pressure, dull pain, and
change in bowel habits due to the pressure of the mass
on the intestines. Sometimes patients present with
adnexal torsion or twisting of the ovary with acute
abdominal pain, requiring emergency surgical
intervention.
Right
adnexal
masses, by and large are benign processes. But adnexal masses having following
characteristics need to be thoroughly checked for
malignancy:
- Those
that have a complex internal
structure
- Those
that have solid
components
- Those
that are associated with
pain
- Masses
in prepubescent or postmenopausal
women
- Large
cysts
- In
menstruating women, those which persist beyond the
normal menstrual cycle.
About 10%
of adnexal masses are malignant. In
the past, doctors relied on pelvic examination to
diagnose an adnexal
dermoid. With the advent of newer imaging techniques
like trans-abdominal or vaginal ultra-sonography,
Doppler color scans, and MRI scans, the internal
structure of the mass can be characterized in detail and
it is possible to determine the exact nature of the
adnexal mass. In all age groups, the physician needs to
also consider the possibility of uterine masses or
structural deformities. Pregnancy-related adnexal
masses, including ectopic pregnancy, corpus luteum
cysts, and other types of cysts must be considered in
all premenopausal women.
Most adnexal
dermoids are asymptomatic, small, and simple cysts
which more often than not resolve spontaneously.
Overzealous surgeons rush these women into surgery and
often create more pathology than they cure. It must be
kept in mind that any surgery performed on adnexal
structures can affect fertility adversely. However, on
the other hand, these same asymptomatic masses could be
early ovarian cancers that require immediate attention.
The use of cancer antigen 125 (CA-125) can be used
in combination with radiologic testing to determine
the risk of adnexal masses.
Considering nonsurgical management and follow-up in patients with low-risk adnexal dermoids is important. Along with routine follow-ups, these women are best served by holistic medicine approach. This approach helps plan out modalities tailored to individual patients rather than just aimed at alleviating the symptoms.
