title: Malignancy risk of sonographically benign appearing purely solid adnexal masses in asymptomatic postmenopausal women.
abstract: To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women.
  
  
  
  Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis.
  
  
  
  Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5).
  
  
  
  The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.
authors.affiliation: 1Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain 2Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain 3Department of Obstetrics and Gynecology, Policlinico Universitario Duilio Casula, University of Cagliari, Monserrato, Cagliari, Italy.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcazar
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Pascual
authors.forename: Reyes
authors.initials: R
authors.lastname: Marquez
authors.forename: Silvia
authors.initials: S
authors.lastname: Ajossa
authors.forename: Leire
authors.initials: L
authors.lastname: Juez
authors.forename: Betlem
authors.initials: B
authors.lastname: Graupera
authors.forename: Alba
authors.initials: A
authors.lastname: Piras
authors.forename: Lourdes
authors.initials: L
authors.lastname: Hereter
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
mesh_terms: D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D017698:Postmenopause; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen