Uterine adnexal mass
Introduction
Introduction The uterus is located in the ovary and fallopian tube behind the uterus. It is often called the uterus attachment in clinic. The mass in the attachment area may be an ectopic pregnancy. Ovarian salpingitis can also appear in the attachment area. In addition, the following pathological changes can also appear uterine attachment lumps: ectopic pregnancy, ovarian tumors (can occur at any age, but more common in women of childbearing age), pelvic endometriosis, endometriosis invade the ovaries, form the ovaries Endometriotic cysts. Pelvic inflammatory disease has a pelvic mass formed or manifested as thickening of bilateral para-uterine tissue, resulting in a uterine attachment mass.
Cause
Cause
The cause can be normal pregnancy, ectopic pregnancy, tumor, inflammatory mass.
Salpingitis is more common in infertile women. The cause is caused by pathogen infection. The pathogens are mainly caused by staphylococcus, streptococcus, Escherichia coli, Neisseria gonorrhoeae, Proteus, Pneumococcal and Chlamydia. The most common time for infection is postpartum, post-abortion or post-menstrual. Injury of the birth canal and placental stripping surface caused by childbirth or abortion, or wounds of endometrial exfoliation during menstruation are all ways in which the pathogen infects the internal genitalia. Sometimes infections are associated with less stringent aseptic procedures, such as the placement of intrauterine devices, curettage, tubal fluid, and lipiodol. Sexual life is too frequent, sexual intercourse during menstruation, can also cause infection and fallopian tube inflammation. A small number of patients are caused by the direct spread of inflammation of adjacent organs, such as appendicitis or other parts of the body, which are transmitted through the bloodstream to the fallopian tubes.
Ovarian cysts are common gynecological diseases. They are benign and malignant. They can be sick at all ages, but they are most common in 20-50 years old. The cause of the disease is still not very clear, and may be related to genetic, environmental and lifestyle, endocrine factors and other reasons.
Examine
an examination
Related inspection
Gynecological ultrasound examination gynecological examination
1, gynecological examination. Most pelvic masses and ovarian abnormalities can be found by gynaecological examination, but smaller lumps or obese ones are difficult to detect by pelvic examination.
2, B-ultrasound. It is one of the economical, rapid and effective means of screening for pelvic masses, and the nature of ovarian enlargement and mass can be found. Transvaginal B-ultrasound can more accurately show abnormalities of the ovary. A CT scan is feasible in cases where ovarian cancer is highly suspected and there is no evidence or economic conditions permitting.
3. Detection of serum tumor antigen 125 (CA125). Detection of CA125 and other tumor markers is helpful in diagnosis when the nature of the ovarian mass is unknown. However, CA125 can also be elevated in pelvic inflammation or in the presence of endometriosis. In addition, not all ovarian cancer CA125 has abnormal performance.
4, family history, check BRCA (breast cancer gene) 1 and BRCA2 can further screen high-risk individuals in the family, but the positive rate of this test in ovarian cancer patients is only 5% to 10%.
In addition, pregnancy tests, probe tests, hysterosalpingography, X-ray or laparoscopy, CT scans, nuclear magnetic resonance and other auxiliary examinations can help diagnose.
Diagnosis
Differential diagnosis
The mass associated with the attachment:
Ectopic pregnancy, the most common typical symptoms of tubal pregnancy, vaginal bleeding and abdominal pain, such as pregnancy, fallopian tube rupture, excessive intra-abdominal hemorrhage, can be combined with shock, check for abdominal pain, rebound tenderness and mobile dullness, cervical pain Obviously, the posterior iliac crest is on the side of the uterus and the boundary is unclear, but after the tender mass is obvious, the puncture-extracted blood does not condense or there is a small clot in the extracted blood to confirm the diagnosis.
Ovarian tumors can occur at any age, but are more common in women of childbearing age. Clinically, ovarian tumors are divided into benign and malignant types. Benign ovarian tumors grow slowly, except for severe abdominal pain caused by twisted tumor pedicles, or excessive tumors. In addition to the symptoms of compression, the patient has no discomfort. The gynecological examination on the side or both sides of the uterus touches the surface with a smooth boundary, and the active mass is mostly cystic and vicious. Ovarian tumors are also asymptomatic in the early stage, but the rapid growth of metastasis is rapid. When there is abdominal distension, abdominal enlargement, anorexia nausea, vomiting or difficulty in defecation, it is often late, except for gynecological examination, on the side or both sides of the uterus or even the uterus. The rectal fossa and other places touch the fixed solid mass and nodules. The external abdomen examination can also touch the abdominal mass and have mobile dullness. In the above cases, ovarian malignant tumors are considered.
Pelvic endometriosis, endometriosis invades the ovaries, forms ovarian endometriotic cysts, and the cyst wall is thicker, containing dark brown and thin paste-like old blood cysts, close to the uterus and broad ligament Connected inactivity, more tenderness, ectopic endometrium can also invade other parts of the pelvic cavity, such as the uterine humerus ligament depression, or the vaginal rectum, etc., forming painful nodules or solids of different sizes For the mass, the typical symptoms of this disease are secondary, dysmenorrhea and infertility. The diagnosis is more difficult, but some patients with ovarian endometriosis have no dysmenorrhea. At this time, attention should be paid to the identification of tubal ovarian cysts.
Pelvic inflammatory disease: common gynecological diseases, clinically divided into acute and chronic pelvic inflammatory disease, the main manifestations of acute pelvic inflammatory disease are bilateral lower abdominal pain, increased high fever vaginal discharge, abdominal examination, lower abdomen tenderness, rebound tenderness and muscle tension, Pelvic examination of cervical congestion and edema, lifting pain is obvious, the uterus has tenderness, such as inflammation and the fallopian tube, can touch the thickening and swelling, and there are obvious tenderness of the bilateral fallopian tubes; when the lesion continues to develop, can be in the uterus on both sides of the fallopian tube swelling and even involving the ovaries Form a fallopian tube ovarian inflammation block or fallopian tube ovarian abscess, such as pus discharge into the abdominal cavity can accumulate in the posterior depression, forming an abscess, at this time can touch the mass of the mass backwards, prominent and fluctuating, such as inflammation mainly affects the connective tissue of the uterus, The lateral or bilateral parametrial tissue can be thickened and severe tenderness; if the lesion continues to develop, the tissue purulent forms a retroperitoneal abscess.
Chronic pelvic inflammatory disease is often caused by the prolonged treatment of acute pelvic inflammatory disease. Many pelvic masses are formed or manifested as thickening of bilateral para-uterine tissue. Common pelvic masses have hydrosalpinx, fallopian tube ovarian cysts and fallopian tube ovarian inflammation. The masses are located on both sides of the uterus, closely connected to the uterus, and most of them are inactive. Chronic pelvic inflammatory disease patients have a history of infertility, such as accompanied by amenorrhea or excessive menstruation, should consider pelvic inflammatory disease for tuberculosis, diagnostic curettage sent biopsy, can help diagnose.
