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.
- 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.