Gynaecological masses: imaging and pathology

Indeterminate adnexal masses arise from inconclusive pelvic ultrasound examinations directed to evaluate suspected gynaecological problems but increasingly on ultrasound and computed tomography examinations performed for other reasons. As imaging of the gastrointestinal and genitourinary tracts has moved from contrast studies to cross-sectional imaging, such adnexal masses are increasingly found. The aim of further imaging is to determine the nature of these masses, to allow a judgment whether the mass is relevant to the presenting symptoms and/or requires any treatment, and if so what treatment is appropriate. Magnetic resonance imaging has been shown to be the single most effective intervention. This review presents a series of indeterminate adnexal masses that were referred to a busy gynaecological oncology MDTM. The differential diagnosis and key discriminant technical and diagnostic strategies are discussed.