Adneksiyal Kitlelere Yaklaşım
Özet
Adneksiyal kitleler, her yaş grubundaki kadında görülebilen, over, fallop tüpü veya çevre dokulardan kaynaklanan katı ya da kistik yapılardır. En sık premenopozal (%8-35) ve postmenopozal (%3-17) dönemde over kitleleri şeklinde saptanırlar. Hastalar sıklıkla pelvik ağrı, şişkinlik ve idrar şikayetleri ile başvurabileceği gibi tamamen asemptomatik de olabilirler. Tanı sürecinde hastanın tıbbi özgeçmişi, pelvik muayenesi, tam kan sayımı, gebelik testi ve transvajinal ultrasonografi (TVUSG) temel unsurlardır. Ayırıcı tanıda CA 125, HE4 gibi tümör belirteçleri ve ROMA, RMI gibi multimodal testler etkin şekilde kullanılmaktadır. Ektopik gebelik, torsiyon, tuboovaryen apse ve rüptüre kistler acil müdahale gerektirir. Malignite riskini standartlaştırmak için geliştirilen O-RADS sınıflandırma sistemi, kitleleri 0 ile 5 arasında skorlayarak yönetim stratejilerini (takip, uzman danışmanlığı veya jinekolojik onkoloji cerrahisi) belirler. O-RADS 5 skoru taşıyan yüksek riskli kitlelerde cerrahi tedavi ön plandadır; ancak malign hücrelerin peritona dökülme riski nedeniyle over kitlelerinden iğne biyopsisi yapılması önerilmez. Yönetim kararlarında hastanın yaşı ve menopoz durumu en kritik iki faktördür.
Adnexal masses are solid or cystic structures originating from the ovaries, fallopian tubes, or surrounding tissues that can occur in women of all ages. They are most commonly detected as ovarian masses in premenopausal (8-35%) and postmenopausal (3-17%) periods. Patients often present with pelvic pain, bloating, and urinary symptoms, or they may be completely asymptomatic. Medical history, pelvic examination, complete blood count, pregnancy test, and transvaginal ultrasonography (TVUSG) are fundamental in the diagnosis. Tumor markers like CA 125, HE4, and multimodal tests such as ROMA and RMI are effectively used in differential diagnosis. Ectopic pregnancy, torsion, tubo-ovarian abscess, and ruptured cysts require emergency intervention. The O-RADS classification system, developed to standardize malignancy risk, scores masses from 0 to 5 to determine management strategies (follow-up, specialist consultation, or gynecologic oncology surgery). Surgical treatment is paramount for high-risk masses with an O-RADS 5 score; however, needle biopsy from ovarian masses is not recommended due to the risk of spilling malignant cells into the peritoneum. Patient age and menopausal status are the two most critical factors in management decisions.
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