A pelvic mass can arise in numerous disorders of the female reproductive system, whereas certain urinary, gastrointestinal and skeletal diseases can also present with a pelvic mass as well. The diagnosis mandates a thorough imaging workup, preceded by a meticulous clinical examination.
Symptoms that are seen in the case of a pelvic mass may significantly vary depending on the etiology. Because of its very high mortality rate, ovarian cancer is among the first conditions that has to be considered as a possible diagnosis. The majority of women report abdominal pain, bloating, weight loss and urinary tract-related symptoms such as increased urinary frequency, dysuria, and incontinence, in addition to a pelvic mass . Other symptoms are fatigue, early satiety, and loss of appetite. If the abdominal or pelvic pain is coupled with vaginal bleeding and hypotension, ectopic pregnancy should be suspected, whereas intermittent, unilateral pain accompanied by nausea and vomiting could point to ovarian torsion, especially if the onset is abrupt . The cyclic appearance of similar symptoms, in addition to dysmenorrhea, are highly suggestive of endometriosis . If signs of an infection are present (fever, leukocytosis, vaginal discharge), pelvic inflammatory disease (PID), tubo-ovarian abscess, hydrosalpinx or pyosalpinx can be included in the differential diagnosis, as they may also present as a pelvic mass . Acute diverticulitis can manifest as altered bowel habits, pain in the left lower quadrant of the abdomen, fever, and mild leukocytosis. However, gastrointestinal symptoms appearing with a pelvic mass necessitate a detailed workup to exclude neoplastic disorders of the colon . Apart from accompanying symptoms, the size, shape, consistency and exact location of the mass can significantly aid in making a presumptive diagnosis.
A detailed patient history and a thorough physical examination (including a gynecologic exam) are key initial steps in the diagnostic workup, and information regarding the onset and duration of symptoms, family history for similar symptoms and conditions that can present in a similar fashion, as well as features of the pelvic mass (size, shape, consistency, location) can provide vital clues for a presumptive diagnosis . The obtained findings should be supported by various imaging studies, such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), each having its beneficial roles when evaluating a pelvic mass  . Although ultrasonography (both abdominal and vaginal) is considered as a first-line procedure, its depth of penetration is a limiting effect, while the lack of soft tissue contrast is the main limitation of CT . For this reason, MRI is used for all masses with an undisclosed etiology despite performing an ultrasound or CT and is considered as the gold standard of diagnosis  . Laboratory workup is also a vital component of pelvic mass assessment, with complete blood count (CBC), serum beta-human chorionic gonadotropin (β-hCG), CA-125 levels (an ovarian tumor marker that has shown good predictive results across several reports) and inflammatory marker tests (erythrocyte sedimentation rate, C-reactive protein, and fibrinogen) being most important tests   . As a last resort, explorative surgery may be considered, but having in mind the fact that it detects a malignant disease in 13-21% of cases, it should be performed promptly in the absence of a definite diagnosis .
We report the second case in the literature, of a patient presenting with abdominal wall abscess, psoas abscess and hydronephrosis as a long-term complication of Actinomyces israelii infection of the ipsilateral ovary with a favourable outcome having [ncbi.nlm.nih.gov]
Abbreviations A. israelii : Actinomyces israelii CT: computed tomography IUD: intra-uterine device, MRI: magnetic resonance imaging. [jmedicalcasereports.com]
The patient underwent conservative treatment and recovered well, although the skin lesion only healed after 12 weeks of oral antibiotic treatment. [ncbi.nlm.nih.gov]
Treatment for a female pelvic mass Treatment for a cancerous pelvic mass may involve surgery, chemotherapy, radiation therapy or a combination of more than one treatment. [moffitt.org]
Uterine hemangiopericytomas are usually low grade malignancies with better prognosis. The primary treatment is usually total hysterectomy and bilateral salpingo-oophorectomy. [ncbi.nlm.nih.gov]
[…] cell) CA19-9 Monitoring disease status Pancreatic CEA Aid in management and prognosis Not specified (commonly for colorectal) [vermillion.com]
Ewing tumor: Incidence, prognosis and treatment options. Paediatr Drugs, 3 (2001), pp. 899-913  J.P. Ginsberg, S.Y. Woo, M.J. Hicks, M.E. Horowitz. [reumatologiaclinica.org]
For this reason, MRI is used for all masses with an undisclosed etiology despite performing an ultrasound or CT and is considered as the gold standard of diagnosis. [symptoma.com]
Intrapelvic granulomatous masses from polyethylene wear debris can easily be misdiagnosed if orthopaedic etiology is not considered. [ncbi.nlm.nih.gov]
Both etiologies we report have in common the fact that they are of urological origin. [peertechz.com]
Etiology Pelvic masses may originate from gynecologic organs (cervix, uterus, uterine adnexa) or from other pelvic organs (intestine, bladder, ureters, skeletal muscle, bone). Type of mass tends to vary by age group. [msdmanuals.com]
[Ureaplasma] urealyticum might be etiological agents of PID 36. ACCEPTED PROPOSED 1. Menstruating teens 1. Low socio-economic status 2. Multiple sex partners 2. Early age of sexual activity 3. Prior H/O PID 3. Urban living 4. [slideshare.net]
We review the literature on the epidemiology and the treatment options for desmoid tumors and suggest a strong index of suspicion when a new pelvic mass arises in an adult with previous pelvic surgery. [ncbi.nlm.nih.gov]
Epidemiology and risk assessment for ovarian cancer. Semin Oncol 1998; 25:255. Bankhead CR, Kehoe ST, Austoker J. Symptoms associated with diagnosis of ovarian cancer: a systematic review. BJOG 2005;112:857-865. [ogmagazine.org.au]
Hayat MJ, et al. (2007) Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 12(1):20–37 CrossRef PubMed Google Scholar 2. [link.springer.com]
Goodman MT, Howe HL: Descriptive epidemiology of ovarian cancer in the United States, 1992-1997. Cancer 97:: 2615, 2003 -2630, (suppl) Crossref, Medline, Google Scholar 11. [jco.ascopubs.org]
Epidemiology Frequency Epidemiologic features of UPJ obstruction are as follows: Ultrasonography reveals fetal upper urinary tract dilatation in approximately one in 100 pregnancies; however, only one in 500 of those infants are later diagnosed with significant [emedicine.medscape.com]
Pregnancy-related adnexal masses, including ectopic pregnancy, theca lutein cysts, corpus luteum cysts, and luteomas, must be considered in all premenopausal women. [21, 22] Pathophysiology The pathophysiology is not well understood for most adnexal masses [emedicine.medscape.com]
This allows for easy removal and prevents fluid from the mass from spilling into the pelvic cavity. Any masses suspected for malignancy are sent for frozen section analysis. [innovativegyn.com]
Getting prompt medical attention could prevent a benign mass from becoming malignant. [wisegeek.org]
Women with a personal lifetime risk of 5% to 10% should be offered genetic testing.2 Women with BRCA mutations can be offered prophylactic measures to prevent ovarian cancer. [contemporaryobgyn.net]
Moving around as soon as possible after your operation can help to prevent this. We will give you surgical compression stockings to wear whilst you are in hospital, and injections to thin the blood. [hey.nhs.uk]
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