Pelvic mass

Gynecological Causes

Ovarian cyst: Common cause of a pelvic mass; may be asymptomatic or associated with pain and menstrual irregularities.
Fibroids (leiomyomas): Benign uterine tumors; associated with menorrhagia, pelvic pain, and pressure symptoms.
Endometriosis: Ectopic endometrial tissue; presents with chronic pelvic pain, dysmenorrhea, and may involve a pelvic mass.
Ovarian cancer: Can present as an asymptomatic mass or with abdominal distension, weight loss, and nonspecific gastrointestinal symptoms.
Ectopic pregnancy: Presents with pelvic pain, amenorrhea, and a pelvic mass; associated with vaginal bleeding.

Urological Causes

Bladder distension: Often due to urinary retention; presents as a midline pelvic mass with associated difficulty in urination.
Bladder cancer: May present as a pelvic mass with hematuria, frequency, and urgency.
Pelvic kidney: Ectopic kidney located in the pelvis, which can be mistaken for a pelvic mass.

Gastrointestinal Causes

Colorectal cancer: Can present as a pelvic mass with associated symptoms of bowel obstruction, weight loss, and altered bowel habits.
Diverticular abscess: Presents with a painful pelvic mass, fever, and signs of sepsis; often in the context of known diverticular disease.
Appendiceal abscess: Localized pelvic mass, often following acute appendicitis; associated with pain, fever, and gastrointestinal symptoms.
Pelvic inflammatory disease (PID): Chronic or acute infection of the female reproductive organs; presents with lower abdominal pain, fever, and sometimes a palpable mass due to tubo-ovarian abscess.
Crohn’s disease: Inflammatory bowel disease that can present with a palpable mass due to inflamed bowel loops or an abscess.

Other Causes

Lymphoma: Can present as a pelvic mass with associated systemic symptoms such as weight loss, night sweats, and fatigue.
Retroperitoneal sarcoma: A rare cause of pelvic mass; presents with non-specific symptoms such as abdominal pain, weight loss, and mass effect symptoms.
Hematoma: A history of trauma or surgery may precede the development of a pelvic mass due to bleeding.
Benign cystic teratoma (dermoid cyst): A type of germ cell tumor; usually asymptomatic but can present as a pelvic mass or with complications like torsion.
Peritoneal inclusion cyst: Often presents as a pelvic mass in women with a history of abdominal surgery or endometriosis.

Onset and Duration

Acute onset: Suggests conditions like ectopic pregnancy, ovarian torsion, or abscess formation.
Chronic onset: More consistent with benign conditions like fibroids, ovarian cysts, or malignancies such as ovarian cancer.
Intermittent symptoms: May indicate a condition like an ovarian cyst, which can fluctuate in size.

Associated Symptoms

Pain: Sharp, sudden pain may suggest ovarian torsion or rupture of a cyst, while dull, persistent pain may be more indicative of a mass effect or chronic conditions like fibroids or malignancy.
Menstrual irregularities: Common in gynecological causes like fibroids, ovarian cysts, or endometriosis.
Gastrointestinal symptoms: Bloating, changes in bowel habits, and weight loss may suggest gastrointestinal causes such as colorectal cancer.
Urinary symptoms: Frequency, urgency, or retention can occur with masses compressing the bladder, such as in fibroids or large ovarian cysts.
Fever: Suggests an infectious etiology like pelvic inflammatory disease or abscess formation.
Weight loss and systemic symptoms: Concerning for malignancy such as ovarian or colorectal cancer, or lymphoma.
Vaginal discharge or bleeding: May indicate gynecological causes like endometrial cancer or infection.

Background

Obstetric and gynecological history: Includes past pregnancies, miscarriages, and surgeries; relevant in assessing risk for conditions like ectopic pregnancy or pelvic adhesions.
Sexual history: Important for assessing risk of pelvic inflammatory disease, sexually transmitted infections, or ectopic pregnancy.
Family history: Consider familial patterns, especially for ovarian, colorectal cancer, or hereditary cancer syndromes like Lynch syndrome.
Past medical history: Includes history of endometriosis, inflammatory bowel disease, or previous malignancies.
Medication use: Includes use of hormonal contraception or hormone replacement therapy, which can influence the risk of certain gynecological conditions.
Surgical history: Previous abdominal or pelvic surgeries can lead to adhesions and increase the risk of complications such as bowel obstruction or pelvic abscess.

Imaging

Transvaginal ultrasound: First-line imaging for assessing gynecological causes such as ovarian cysts, fibroids, and ectopic pregnancy.
Pelvic ultrasound: Useful for identifying masses in both gynecological and urological systems; can assess the size, location, and characteristics of the mass.
CT scan: Provides detailed imaging for assessing complex masses, evaluating for malignancy, or detecting metastatic disease.
MRI pelvis: Particularly useful for characterizing soft tissue masses and assessing the extent of pelvic malignancies.
Colonoscopy: Indicated if there is suspicion of colorectal cancer or other gastrointestinal causes based on history or initial imaging.
Cystoscopy: Performed if there is suspicion of bladder involvement, such as bladder cancer or severe endometriosis affecting the bladder.

Laboratory Tests

Full blood count (FBC): Useful in detecting anemia or infection, particularly in cases of malignancy, abscess, or ectopic pregnancy.
Beta-hCG: Essential in any female of childbearing age to rule out or confirm pregnancy, including ectopic pregnancy.
Tumor markers (e.g., CA-125, CEA): May be elevated in certain malignancies, such as ovarian or colorectal cancer; useful for diagnosis and monitoring.
Inflammatory markers (CRP, ESR): Elevated in cases of infection or inflammation, such as pelvic inflammatory disease or diverticular abscess.
Urinalysis and urine culture: Important in cases with urinary symptoms to rule out infection or hematuria suggestive of bladder pathology.
Liver function tests and renal function tests: To assess for systemic involvement in cases of malignancy or chronic disease.
Endometrial biopsy: Indicated if there is abnormal uterine bleeding or suspicion of endometrial cancer.
STI screening: Important in cases where pelvic inflammatory disease is suspected.

Cancer