Adnexal tumors are tumors that grow on some organs such as the eyes, skin, and uterus. The word ‘adnexa’ refers to ancillary structures, or appendages, on organ. The term is most commonly applied to structures around the uterus, including ligaments, fallopian tubes, and ovaries.
Hence tumors on these structures are called adnexal tumors. Adnexa also describes structures related to the skin (sweat glands, hair, and nails) and the eye (eyelids, tear ducts, orbital tissue). Eye adnexa are also referred to as accessory visual structures.
Adnexal tumors are mostly benign, or non-cancerous, but can sometimes be malignant. As they are seen in a variety of organs, these tumors can be challenging to diagnose and classify.
Although the exact cause of adnexal tumors is not clear yet, common risk factors include age and gender. While these tumors are more prevalent in middle-aged women, skin adnexal tumors equally affect males and females. The most malignant type is uterine adnexal tumor, especially in older women.
Signs and symptoms
Adnexal tumors on the skin and eye appear as yellow projections on the affected surface. They are not very noticeable during the early stages, and hence are overlooked. Most patients seek medical attention only after the tumors are big enough to cause discomfort or obstruct vision.
Uterine adnexal tumors don’t produce many symptoms until they become large enough to interfere with body functions or become malignant. The most common early symptoms of uterine adnexal tumors include abdominal pain, abdominal cramps, and irregular menstruation. Less common symptoms include nausea and fever.
Diagnosis
Individuals with adnexal tumor present with many different symptoms, which can be associated with several other conditions some of which are a medical emergency. Hence these patients need immediate attention.
A detailed medical history should be gathered and studied carefully. In case of patients presenting with symptoms of uterine adnexal tumors, menstrual history needs to be analyzed to rule out other problems that cause similar symptoms.
Since specific early symptoms of adnexal tumors are insufficient, these tumors are often diagnosed at an advanced stage. In many cases, patients with benign and malignant tumors present with similar symptoms. So careful evaluation is warranted in order to rule out conditions and confirm the diagnosis of adnexal tumors.
Within the differential diagnosis for adnexal tumors are:
- Corpus luteum cyst
- Ovarian torsion
- Follicular cyst
- Polycystic ovaries
- Epithelial carcinoma
- Ovarian sarcoma
- Ectopic pregnancy
- Endometrioma
- Endometrial carcinoma
- Ovarian germ cell tumor
- Fallopian tube carcinoma
- Appendiceal abscess
- Appendicitis
- Diverticular abscess
- Bladder diverticulum
- Nerve sheath tumor
- Peritoneal cyst
- Gastrointestinal carcinoma
- Etroperitoneal sarcomas
The medical history gathered must include information related to surgeries undergone in the past and family history of endometrial, ovarian, or breast cancer. A thorough physical examination followed by laboratory evaluation is usually performed.
Lab tests may include:
- Urine pregnancy tests
- Transvaginal ultrasonography
- Complete blood count
- Differential blood count
- Tests for the presence of tumor markers that can help evaluate adnexal masses
Prognosis and treatment
Since most adnexal masses are non-cancerous, prognosis is often very good after appropriate treatment. Surgical removal of the tumor offers a complete cure for the majority of patients. Malignant adnexal tumors have poor prognosis and lower survival rate, which ranges from a few weeks to over a year, depending on the stage at which the tumor is diagnosed. A type of skin adnexal tumor called the microcystic adnexal carcinoma is highly aggressive and can be fatal if not treated as an emergency. Depending on the type of adnexal tumor, medical or surgical treatment options are offered.
References
- Diagnosis and Management of Adnexal Masses, http://www.aafp.org/afp/2009/1015/p815.html
- Mayo Clinic, Adnexal Tumors, http://www.mayoclinic.org/diseases-conditions/adnexal-tumors/home/ovc-20261382
- Malignant adnexal neoplasms, http://www.nature.com/modpathol/journal/v19/n2s/full/3800511a.html
- Know Cancer, Adnexal Neoplasms,http://www.knowcancer.com/oncology/adnexal-and-skin-appendage-neoplasms/
Further Reading