Adnexal tumors refer to a large group of conditions of gynecologic and non-gynecologic origin. These masses can be benign or malignant. Various types of adnexal tumors based on the site of their occurrence are discussed below.
Uterine adnexal masses
Adnexal tumors of the uterus mostly affect the fallopian tubes and the ovaries. Adnexal masses seen in premenopausal women include ectopic pregnancies, ovarian cysts, polycystic ovaries, endometriomas, and tubo-ovarian abscess. The most common ones are follicular and corpus luteum cysts. Over 30% of adnexal masses in post-menopausal women are malignant.
In the case of pregnant women, corpus luteum cyst is the most common etiology of adnexal tumors. In non-pregnant women, functional cysts and leiomyomata cause adnexal tumors. Simple cysts seen in premenopausal women are usually benign. Complex masses can often be endometriomas or hemorrhagic cysts; but rarely can also be malignant.
In some cases, ectopic pregnancy, tubo-ovarian abscess, and ovarian torsion can present in the form of a complex mass. Ovarian tumors, thecomas, fibromas, or an ovarian torsion can all present as solid masses. Cystic teratoma is the most common benign ovarian neoplasm.
Skin adnexal tumor
Adnexal tumors of the skin are a diverse group of neoplasms that can be benign or malignant. These masses are morphologically different from the adnexal epithelium of normal skin. They can be hybrid or composite tumors and so difficult to classify precisely.
Most skin adnexal masses are benign, and surgical removal of the growth offers complete cure. However, some of these masses may be markers for other underlying syndromes such as sebaceous tumors in the case of Muir–Torre syndrome and trichilemmomas in the case of Cowden disease. Therefore, the accurate diagnosis of these masses is very crucial.
Malignant skin adnexal tumors are often rare and locally aggressive, though they can involve nodes and can metastasize. The clinical outcome of such tumors is often very poor. Thus, diagnosis of a malignant skin tumor is therapeutically and prognostically critical. Diagnosis of these tumors is also very challenging because pathologists rarely encounter skin adnexal masses and the histogenesis is very broad.
Skin adnexal tumors are often classified based on morphological components that are predominant. Diagnosis of these hybrid skin tumors is through histological evaluation.
Eye adnexal tumors
Adnexal tumors of the eye are rare compared to other adnexal tumors. However, their diagnostic importance is huge given the functional significance of the eye and periocular structures. Adnexal tumors can affect the eyelid, orbit, and conjunctiva.
Major malignant eye adnexal tumors are listed below:
- Premalignant and malignant eyelid tumors
- Actinic keratosis
- Basal cell carcinoma
- Squamous intraepithelial neoplasia
- Squamous cell carcinoma
- Sebaceous cell carcinoma
- Cutaneous melanoma
- Merkel cell carcinoma
- Keratoacanthoma
- Metastatic eyelid tumors
- Premalignant and malignant conjunctival tumors
- Kaposi's sarcoma
- Conjunctival primary acquired melanosis and melanoma
- Conjunctival squamous cell carcinoma
- Lymphoid tumors
- Malignant orbital tumors in adults
- Metastatic orbital tumors
- Lymphoid tumors
- Secondary tumors
- Epithelial lacrimal gland tumors
- Malignant orbital tumors in children
- Metastatic orbital tumors
- Rhabdomyosarcoma
- Burkitt's lymphoma
- Granulocytic sarcoma (chloroma)
Mohs microsurgery has been helpful in reducing the recurrence rate of malignant eyelid tumors in some cases. Cryotherapy and topical mitomycin C use post-surgery has offered better surgical outcomes in cases of conjunctival malignant adnexal tumors such as malignant melanoma and squamous cell carcinoma. For ocular adnexal lymphomas, immunotherapy using CD20 antibodies is an emerging treatment option.
References
- Diagnosis and Management of Adnexal Masses, http://www.aafp.org/afp/2009/1015/p815.html
- Skin adnexal neoplasms—part 1: An approach to tumours of the pilosebaceous unit, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860623/
- Diagnosis and Management of Malignant Tumors of the Eyelid, Conjunctiva, and Orbit.
Further Reading