Skip to main content Accessibility help
Hostname: page-component-55597f9d44-xbgml Total loading time: 1.515 Render date: 2022-08-10T08:20:35.997Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Section XI - Pelvic Masses and Cysts

Published online by Cambridge University Press:  20 February 2019

David Chelmow
Virginia Commonwealth University
Nicole W. Karjane
Virginia Commonwealth University
Hope A. Ricciotti
Harvard Medical School
Amy E. Young
University of Texas, Austin
Get access
Office Gynecology
A Case-Based Approach
, pp. 226 - 251
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Practice Bulletin No. 174: Evaluation and management of adnexal masses. ObstetGynecol 2016 November;128(5): e210e26. PubMed PMID: 27776072. Epub 2016/ 10/25.eng.
Outwater, EK, Siegelman, ES, Hunt, JL. Ovarian teratomas: tumor types and imaging characteristics. RadioGraphics 2001;21(2):475490. PubMed PMID: 11259710.CrossRefGoogle ScholarPubMed
Guerriero, S, Mallarini, G, Ajossa, S et al. Transvaginal ultrasound and computed tomography combined with clinical parameters and CA-125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 1997 May;9(5):339343. PubMed PMID: 9201878. Epub 1997/ 05/01.eng.CrossRefGoogle ScholarPubMed
Koshiba, H. Severe chemical peritonitis caused by spontaneous rupture of an ovarian mature cystic teratoma: a case report. J Reprod Med 2007 October;52(10):965967. PubMed PMID: 17977177. Epub 2007/ 11/06.eng.Google ScholarPubMed
Pepin, K, del Carmen, M, Brown, A, Dizon, DS. CA 125 and epithelial ovarian cancer: role in screening, diagnosis, and surveillance. Am J Hematol Oncol 2014;10(6):2229.Google Scholar
Grzybowski, W, Beta, J, Fritz, A et al. [Predictive value of CA 125 in detection of ovarian cancer in pre- and postmenopausal patients]. Ginekologia Polska 2010 July;81(7):511515. PubMed PMID: 20825052. Epub 2010/09/10. Wartosc predykcyjna stezenia CA 125 w diagnostyce raka jajmnika u kobiet przed i po menopauzie. pol.Google Scholar
Takagi, H, Ichigo, S, Murase, T, Ikeda, T, Imai, A. Early diagnosis of malignant-transformed ovarian mature cystic teratoma: fat-suppressed MRI findings. J Gynecol Oncol 2012 April;23(2):125128. PubMed PMID: 22523630. Pubmed Central PMCID: PMC3325347. Epub 2012/ 04/24.eng.CrossRefGoogle ScholarPubMed
Briones-Landa, CH, Ayala-Yanez, R, Leroy-Lopez, L et al. [Comparison of laparoscopic vs. laparotomy treatment in ovarian teratomas]. Ginecol Obstet Mex 2010 October;78(10):527532. PubMed PMID: 21966769. Epub 2011/10/05. Comparacion del tratamiento laparoscopico vs laparotomia en teratomas ovaricos. spa.Google Scholar
Hoo, WL, Yazbek, J, Holland, T et al. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol 2010;36(2):235240.CrossRefGoogle ScholarPubMed
Alcazar, JL, Castillo, G, Jurado, M, Garcia, GL. Is expectant management of sonographically benign adnexal cysts an option in selected asymptomatic premenopausal women? HumReprod (Oxford, England) 2005 November;20(11):32313234. PubMed PMID: 16024535. Epub 2005/ 07/19.eng.CrossRefGoogle ScholarPubMed
Suh-Burgmann, E, Kinney, W. Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses. Am J Obstet Gynecol 2015 12//;213(6):816.e1816.e4.CrossRefGoogle ScholarPubMed
van Nagell, JR Jr., Miller, RW. Evaluation and management of ultrasonographically detected ovarian tumors in asymptomatic women. Obstet Gynecol 2016;127:848858.CrossRefGoogle ScholarPubMed
Kinkel, K, Lu, Y, Mehdizade, A, Pelte, M-F, Hricak, H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization – meta-analysis and Bayesian analysis. Radiology 2005;236:8594.CrossRefGoogle ScholarPubMed
The National Cancer Institute. BRCA1 and BRCA2: Cancer risk and genetic testing fact sheet. 2015. (Accessed April 4, 2017.)
American College of Obstetricians and Gynecologists. Evaluation and management of adnexal masses. Practice Bulletin No. 174. Obstet Gynecol 2016;128:11931195.CrossRef
Kaijser, J, Sayasneh, A, Van Hoorde, K et al. Presurgical diagnosis of adnexal tumors using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2014;20:449462.CrossRefGoogle ScholarPubMed
Modesitt, SC, Pavlik, EJ, Ueland, FR et al. Risk of malignancy in unilocular ovarian cystic tumors less than 10 cm in diameter. Obstet Gynecol 2003;102:594599.Google Scholar
Suh-Burgmann, E, Hung, YY, Kinney, W. Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol 2014;211:623.e1623.e7.CrossRefGoogle ScholarPubMed
Suh-Burgmann, E, Kinney, W. Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses. Am J Obstet Gynecol 2015;213:816.e1816.e4.CrossRefGoogle ScholarPubMed
Timor-Tritsch, IE. Adnexal masses. In: Timor-Tritch, IE, Goldstein, SR, eds. Ultrasound in Gynecology. Philadelphia. Churchill Livingstone. 2007;100.CrossRefGoogle ScholarPubMed
Barroihet, L, Vitonis, A, Shipp, T, Muto, M, Benacerraf, B. Sonographic predictors of ovarian malignancy. J Clin Ultrasound 2013 June;41(5):269274.CrossRefGoogle Scholar
Farghaly, SA. Current diagnosis and management of ovarian cysts. Clin Exp Obstet Gynecol 2014;41(6):609612.Google ScholarPubMed
American College of Obstetricians and Gynecologists. Evaluation and management of adnexal masses. Practice bulletin no. 174. Obstet Gynecol 2016;128(5):11931195.CrossRef
Alcazar, JL, Castillo, G, Jurado, M et al. Is expectant management of sonographically benign adnexal cysts and option in selected asymptomatic premenopausal women? Hum Reprod 2005;20(11):3231.CrossRefGoogle ScholarPubMed
Glanc, P, Benacerraf, B, Bourne, T et al. First international consensus report on adnexal masses: management recommendations. J Ultrasound Med 2017 May;36(5):849863. doi: 10.1002/jum.14197. Epub 2017 Mar 7.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists. Management of endometriosis. Practice bulletin no. 114. Obstet Gynecol 2010;116(1):223236.CrossRef
American College of Obstetricians and Gynecologists. Evaluation and management of adnexal masses. Practice bulletin no. 174. Obstet Gynecol 2016;128(5): e210e26.CrossRef
Maul, LV, Morrision, JE, Schollmeyer, T, Alkatout, I, Mettler, L. Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS 2014;18(3).CrossRefGoogle ScholarPubMed
Guo, SW. Recurrence of endometriosis and its control. Hum Reprod Update 2009;15(4):441461.CrossRefGoogle ScholarPubMed
Dan, H, Limin, F. Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas: a meta-analysis of randomized controlled trials. Gynecol Obstet Invest 2013;76(2):7582.CrossRefGoogle ScholarPubMed
Benschop, L, Farquhar, C, van der Poel, N, Heineman, MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 2010(11):CD008571.Google Scholar
Garcia-Velasco, JA, Somigliana, E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009;24(3):496501.CrossRefGoogle ScholarPubMed
Koga, K, Takamura, M, Fujii, T, Osuga, Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril 2015;104(4):793801.CrossRefGoogle ScholarPubMed
Spinelli, C, Piscioneri, J, Strambi, S. Adnexal torsion in adolescents: update and review of the literature. Curr Opin Obstet Gynecol 2016;27:320325.CrossRefGoogle Scholar
Ashwal, E, Hiersch, L, Krissi, H et al. Characteristics and management of ovarian torsion in premenarchal compared to postmenarchal patients. Obstet Gynecol 2015;126:514520.CrossRefGoogle ScholarPubMed
Sasaki, KJ, Miller, CE. Adnexal torsion: review of the literature. J Min Invasive Gynecol 2014;21:196202.CrossRefGoogle ScholarPubMed
Melcer, Y, Sarig-Meth, T, Maymon, R et al. Similar but different: A comparison of adnexal torsion in pediatric, adolescent, and pregnant and reproductive-age women. J Women’s Health 2016;25(4):391396.CrossRefGoogle ScholarPubMed
Boswell, K, Silverberg, KM. Recurrence of ovarian torsion in a multiple pregnancy: conservative management via transabdominal ultrasound-guided ovarian cyst aspiration. Fertil Steril 2010;94:1910e11910e3.CrossRefGoogle Scholar
Lourenco, AP, Swenson, D, Tubbs, RJ, Lazarus, E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol 2014;21:179187.CrossRefGoogle ScholarPubMed
Sibal, M. Follicular ring sign: a simple sonographic sign for early diagnosis of ovarian torsion. J Ultrasound Med 2012;31:18031809.CrossRefGoogle ScholarPubMed
Ginath, S, Shalev, A, Keidar, R et al. Differences between adnexal torsion in pregnant and nonpregnant women. J Min Invasive Gynecol 2012;19:708714.CrossRefGoogle ScholarPubMed
Pansky, M, Smorgick, N, Herman, A, Schneider, D, Halperin, R. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol 2007;109:355359.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention 2015 STD Treatment Guidelines: Pelvic Inflammatory Disease. Accessible at
Centers for Disease Control and Prevention STD Surveillance 2015. Accessible at
Collins, CG, Frank, GN, Cerha, HT. Ruptured tuboovarian abscess. Am J Obstet Gynecol 1956;72:820829.CrossRefGoogle Scholar
Lareau, SM, Beigi, RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am 2008;22:693708.CrossRefGoogle Scholar
Savaris, RF, Fuhrich, DG, Duarte, RV, Franik, S, Ross, J. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database Syst Rev 2017, Issue 4. Art. No.: CD010285. DOI: 10.1002/14651858.CD010285.pub2CrossRefGoogle ScholarPubMed
Gjelland, K, Ekerhovd, E, Granberg, S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: A study of 302 cases. Am J Obstet Gynecol 2005; 193: 1323–30.CrossRefGoogle ScholarPubMed
Grimes, DA. Intrauterine device and upper-genital-tract infection. Lancet 2000;356:10131019.CrossRefGoogle ScholarPubMed
Sweet, RL. Treatment of Acute Pelvic Inflammatory Disease. Infect Dis Obstet Gynecol Vol. 2011, Article ID 561909, 13 pages, 2011. doi:10.1155/2011/561909CrossRefGoogle ScholarPubMed
Protopas, AG et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 2004;114:203209.CrossRefGoogle Scholar
Ness, RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial. Am J Obstet Gynecol 2002;186:929937CrossRefGoogle ScholarPubMed
Ross, J. Pelvic Inflammatory, Disease. Am Fam Physician. 2014 November 15;90(10):725726.Google Scholar
Grandson, M. Pelvic inflammatory disease. Am Fam Physician. 2012, April 15;85(8):791796.Google Scholar
Magtibay, PM, Magrina, J. Ovarian remnant syndrome. Clin Obstet Gynecol 2006 September;49(3):526534.CrossRefGoogle ScholarPubMed
Kho, R, Abrao, M. Ovarian remnant syndrome: etiology, diagnosis, treatment and impact of endometriosis. Curr Opin Obstet Gynecol 2012 August;24(4):210214CrossRefGoogle ScholarPubMed
Magtibay, PM, Nyholm, JL, Hernandez, JL, Podratz, KC. Ovarian remnant syndrome. Am J Obstet Gynecol 2005 December;193(6):20622066.CrossRefGoogle ScholarPubMed
Vilos, GA, Marks-Adams, JL, Vilos, AG et al. Medical treatment of ureteral obstruction associated with ovarian remnants and/or endometriosis: report of three cases and review of the literature. J Minim Invasive Gynecol 2015 March–April;22(3):462468.CrossRefGoogle ScholarPubMed
Zapardiel, I, Zanagnolo, V, Kho, RM, Magrina, JF, Magtibay, PM. Ovarian remnant syndrome: comparison of laparotomy, laparoscopy and robotic surgery. Acta Obstet Gynecol Gynecol Scand 2012 August;91 (8):965969.CrossRefGoogle ScholarPubMed
Barnhart, K, van Mello, NM, Bourne, T et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil and Steril 2011;95:857866.CrossRefGoogle ScholarPubMed
van Mello, NM, Mol, F, Ankum, WM et al. Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril 2012;98:10661073.CrossRefGoogle ScholarPubMed
Condous, G, Kirk, E, Van Huffel, S et al. Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with pregnancy of unknown location. Ultrasound Obstet Gynecol 2005;26:770775.CrossRefGoogle ScholarPubMed
Connolly, AM, Ryan, DH, Stuebe, AM, Wolfe, HM. Reevaluation of discriminatory and threshold levels for serum b-hCG in early pregnancy. Obstet Gynecol 2013;121:6570.CrossRefGoogle Scholar
Bree, RL, Edwards, M, Bohm-Velez, M et al. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with hCG level. Am J Roentgenol 1989;153:7579.CrossRefGoogle ScholarPubMed
Goldstein, I, Zimmer, EA, Tamir, A et al. Evaluation of normal gestational sac growth: appearance of embryonic heartbeat and embryo body movements using transvaginal technique. Obstet Gynecol 1991;77:885888.Google ScholarPubMed
Kadar, N, Caldwell, BV, Romero, R. A method of screening for ectopicpregnancy and its indications. Obstet Gynecol 1981;58:162166.Google ScholarPubMed
Barnhart, K. Early pregnancy failure: beware the pitfalls of modern management. Fert Steril 2012;98:10611065.CrossRefGoogle ScholarPubMed
Barnhart, K, Guo, W, Cary, M et al. Differences in serum human chorionic gonadotropin rise in early pregnancy by race and value at presentation. Obstet Gynecol 2016;128:504511.CrossRefGoogle Scholar
Shaunik, A, Kulp, J, Appleby, DH et al. Utility of dilation and curettage in the diagnosis of pregnancy of unknown location. Am J Obstet Gynecol 2011;204:130.e1130.e6.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats