Adnexal mass and ovarian cancer in menopause

The differential diagnosis of the adnexal mass indeed varies with the age. Age is the most important factor in determining the potential for malignancy. In postmenopausal women, an adnexal mass should be considered highly abnormal and must be promptly evaluated. The risk of malignancy in this age group is increased from 13% in premenopausal to 45% in postmenopausal women, however 55% of postmenopausal women with palpable ovaries do have a benign tumor. The most common ovarian tumors in this age group include epithelial ovarian tumors followed by stromal tumors and sex-cord tumors. The standard operative approach to adnexal masses in postmenopausal women has been explorative laparotomy to ensure adequate exposure for the treatment of ovarian cancer. However, laparoscopic evaluation of suspicious adnexal masses is considered a reasonable approach with ability to perform frozen section histologic analysis and confirm to laparotomy if needed.