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Pelvic Mass: Role of Imaging in the Diagnosis and Management

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Breast & Gynecological Diseases

Abstract

The differential diagnosis of a pelvic mass found on clinical examination or on an imaging study varies depending on the age and menstrual status of the patient and the clinical presentation. The most commonly encountered pelvic mass in the gynecological patient arises from the uterus, fallopian tubes, or the ovaries. The most common cause of a pelvic mass is of uterine origin, a leiomyoma being the most common underlying cause of the uterine enlargement. The imaging features and the differential diagnostic considerations in diagnosing uterine, adnexal, and non-ovarian masses are described. Less common causes of pelvic masses include those arising from the gastrointestinal tract. Ultrasonography is the modality of choice in the initial assessment of a pelvic mass and often the only modality that is needed to arrive at an accurate diagnosis and consequently for appropriate management of the pelvic mass. A final section of the chapter describes the imaging differential diagnosis of pelvic masses with a focus on the supplemental role of magnetic resonance imaging (MRI) and computed tomography (CT) in characterizing the nature of the pelvic mass. The current role of CT and MRI in the staging of gynecological malignancies is also presented.

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References

  1. Szklaruk J, Tamm EP, Choi H, Varavithya V. MR imaging of common and uncommon large pelvic masses. Radiographics. 2003;23(2):403–24.

    Article  PubMed  Google Scholar 

  2. Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions, and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46(3):284–98.

    Article  PubMed  Google Scholar 

  3. Early HM, McGahan JP, Scoutt LM, et al. Pitfalls of sonographic imaging of uterine leiomyoma. Ultrasound Q. 2016;32(2):164–74.

    Article  PubMed  Google Scholar 

  4. De La Cruz MS, Buchanan EM. Uterine fibroids: diagnosis and treatment. Am Fam Physician. 2017;95(2):100–7.

    Google Scholar 

  5. Testa AC, Di Legge A, Bonatti M, Manfredi R, Scambia G. Imaging techniques for evaluation of uterine myomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:37–53.

    Article  PubMed  Google Scholar 

  6. Bacanakgil BH, Deveci M, Karabuk E, Soyman Z. Uterine smooth muscle tumor of uncertain malignant potential: clinicopathologic-sonographic characteristics, follow-up and recurrence. World J Oncol. 2017;8(3):76–80. https://doi.org/10.14740/wjon1031w.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fasih N, Prasad Shanbhogue AK, Macdonald DB, et al. Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics. 2008;28(7):1931–48.

    Article  PubMed  Google Scholar 

  8. Cohen DT, Oliva E, Hahn PF, Fuller AFJ, Lee SI. Uterine smooth-muscle tumors with unusual growth patterns: imaging with pathologic correlation. AJR Am J Roentgenol. 2007;188(1):246–55.

    Article  PubMed  Google Scholar 

  9. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: a sonographic diagnosis. Radiographics. 2018;38(5):1576–89.

    Article  PubMed  Google Scholar 

  10. Sun S, et al. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging. 2019;100(10):619–34.

    Article  CAS  PubMed  Google Scholar 

  11. Juhasz-Böss I, Gabriel L, Bohle RM, Horn LC, Solomayer EF, Breitbach GP. Uterine leiomyosarcoma. Oncol Res Treat. 2018;41(11):680–6.

    Article  PubMed  Google Scholar 

  12. Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol. 2017;145(1):208–16.

    Article  PubMed  Google Scholar 

  13. Arleo EK, Schwartz PE, Hui P, McCarthy S. Review of leiomyoma variants. AJR Am J Roentgenol. 2015;205(4):912–21.

    Article  PubMed  Google Scholar 

  14. Exacoustos C, Romanini ME, Amadio A, Amoroso C, Szabolcs B, Zupi E, Arduini D. Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma? J Clin Ultrasound. 2007;35(8):449–57.

    Article  PubMed  Google Scholar 

  15. Mahnert N, Morgan D, Campbell D, Johnston C, As-Sanie S. Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. Obstet Gynecol. 2015;125(2):397–405.

    Article  PubMed  Google Scholar 

  16. Kho KA, Lin K, Hechanova M, Richardson DL. Risk of occult uterine sarcoma in women undergoing hysterectomy for benign indications. Obstet Gynecol. 2016;127(468):28.

    Google Scholar 

  17. Wright JD, Tergas AI, Cui R, et al. Use of electric power morcellation and prevalence of underlying cancer in women who undergo myomectomy. JAMA Oncol. 2015;1(69):29.

    Google Scholar 

  18. Xu X, Lin H, Wright JD, et al. Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy. J Clin Oncol. 2019;37(35):3412–24. (23=27).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wright JD, Tergas AI, Burke WM, et al. Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation. JAMA. 2014;1253(24=28):312.

    Google Scholar 

  20. Raine-Bennett T, Tucker LY, Zaritsky E, et al. Occult uterine sarcoma and leiomyosarcoma: incidence of and survival associated with morcellation. Obstet Gynecol. 2016;29(25=23):127.

    Google Scholar 

  21. Lieng M, Berner E, Busund B. Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J Minim Invasive Gynecol. 2015;22:410.

    Article  PubMed  Google Scholar 

  22. Stewart EA, Morton CC. The genetics of uterine leiomyomata: what clinicians need to know. Obstet Gynecol. 2006;107(4):917–21.

    Article  PubMed  Google Scholar 

  23. Gadducci A, Zannoni GF. Uterine smooth muscle tumors of unknown malignant potential: a challenging question. Gynecol Oncol. 2019;154(3):631–7.

    Article  PubMed  Google Scholar 

  24. Expert Panel on Women’s Imaging, Atri M, Alabousi A, et al. ACR Appropriateness Criteria® clinically suspected adnexal mass, no acute symptoms. J Am Coll Radiol. 2019;16(5S):S77–93.

    Google Scholar 

  25. D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA, et al. ACR BI-RADS® Atlas, breast imaging reporting and data system. Reston: American College of Radiology; 2013.

    Google Scholar 

  26. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I, International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions, and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500–5.

    Article  CAS  PubMed  Google Scholar 

  27. Andreotti RF, Timmerman D, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Glanc P. Ovarian-adnexal reporting lexicon for ultrasound: a white paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol. 2018;15(10):1415–29.

    Article  PubMed  Google Scholar 

  28. Shetty M. Imaging and differential diagnosis of ovarian cancer. Semin Ultrasound CT MR. 2019;40(4):302–18.

    Article  PubMed  Google Scholar 

  29. Granberg S, Wikland M, Jansson I. Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol. 1989;35:139–44.

    Article  CAS  PubMed  Google Scholar 

  30. Valentin L, et al. Risk of malignancy in unilocular cysts: a study of 1148 adnexal masses classified as unilocular cysts at transvaginal ultrasound and review of the literature. Ultrasound Obstet Gynecol. 2013;41(1):80–9.

    Article  CAS  PubMed  Google Scholar 

  31. Parazzini F, Frattaruolo MP, Chiaffarino F, Dridi D, Roncella E, Vercellini P. The limited oncogenic potential of unilocular adnexal cysts: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;225:101–9.

    Article  PubMed  Google Scholar 

  32. Ekerhovd E, Wienerroith H, Staudach A, Granberg S. Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: a comparison between ultrasonographic morphologic imaging and histopathologic diagnosis. Am J Obstet Gynecol. 2001;184(2):48–54.

    Article  CAS  PubMed  Google Scholar 

  33. Valentin L, et al. Unilocular adnexal cysts with papillary projections but no other solid components: is there a diagnostic method that can classify them reliably as benign or malignant before surgery? Ultrasound Obstet Gynecol. 2013;41(5):570–81.

    Article  CAS  PubMed  Google Scholar 

  34. Landolfo C, et al. Differences in ultrasound features of papillations in unilocular-solid adnexal cysts: a retrospective international multicenter study. Ultrasound Obstet Gynecol. 2018;52(2):269–78.

    Article  CAS  PubMed  Google Scholar 

  35. Jung S. Ultrasonography of ovarian masses using a pattern recognition approach. Ultrasonography. 2015;34:173–82.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Van Calster B, Van Hoorde K, Valentin L, International Ovarian Tumour Analysis IOTA Group, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicenter diagnostic study. BMJ. 2014;349:g5920.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Timmerman D, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol. 2005;23(34):8794–801.

    Article  PubMed  Google Scholar 

  38. Park SY, Oh YT, Jung DC. Differentiation between borderline and benign ovarian tumors: combined analysis of MRI with tumor markers for large cystic masses (≥5 cm). Acta Radiol. 2016;57(5):633–9.

    Article  PubMed  Google Scholar 

  39. Exacoustos C, Romanini ME, Rinaldo D, et al. Preoperative sonographic features of borderline ovarian tumors. Ultrasound Obstet Gynecol. 2005;25:50–9.

    Article  CAS  PubMed  Google Scholar 

  40. Pascual MA, Tresserra F, Grases PJ, Labastida R, Dexeus S. Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings. J Clin Ultrasound. 2002;30:76–82.

    Article  PubMed  Google Scholar 

  41. Dilegge A, et al. Clinical and ultrasound characteristics of surgically removed adnexal lesions with largest diameter < 2.5 cm: a pictorial essay. Ultrasound Obstet Gynecol. 2017;50(5):648–56.

    Article  CAS  Google Scholar 

  42. Fruscella E, Testa AC, Ferrandina G, et al. Ultrasound features of different histopathological subtypes of borderline ovarian tumors. Ultrasound Obstet Gynecol. 2005;26(644–650):49.

    Google Scholar 

  43. Valentin L, Ameye L, Testa A, et al. Ultrasound characteristics of different types of adnexal malignancies. Gynecol Oncol. 2006;102:41–8.

    Article  PubMed  Google Scholar 

  44. Tyagi SP, Maheswari V, Tyagi N, et al. Solid tumours of the ovary. J Indian Med Assoc. 1993;91(9):227–30.

    CAS  PubMed  Google Scholar 

  45. Levitin A, Haller KD, Cohen HL, Zinn DL, O’Connor MT. Endodermal sinus tumor of the ovary: imaging evaluation. Am J Roentgenol. 1996;167(3):791–3.

    Article  CAS  Google Scholar 

  46. Sayasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, Timmerman D, Bourne T. The characteristic ultrasound features of specific types of ovarian pathology (review). Int J Oncol. 2015;46(2):445–58.

    Article  PubMed  Google Scholar 

  47. Shaaban AM, et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics. 2014;34(3):777–801.

    Article  PubMed  Google Scholar 

  48. Monterroso V, Jaffe ES, Merino MJ, Medeiros LJ. Malignant lymphomas involving the ovary. A clinicopathologic analysis of 39 cases. Am J Surg Pathol. 1993;17(2):154–70.

    Article  CAS  PubMed  Google Scholar 

  49. Nasioudis D, Sisti G, Holcomb K, Kanninen T, Witkin SS. Malignant brenner tumors of the ovary; a population-based analysis. Gynecol Oncol. 2016;142:44–9.

    Article  PubMed  Google Scholar 

  50. Lang SM, Mills AM, Cantrell LA. Malignant Brenner tumor of the ovary: review and case report. Gynecol Oncol Rep. 2017;3(22):26–31.

    Article  Google Scholar 

  51. Jeong Y, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20:1445–70.

    Article  CAS  PubMed  Google Scholar 

  52. Moro F, et al. Imaging in gynecological disease (12): clinical and ultrasound features of invasive and non-invasive malignant serous ovarian tumors. Ultrasound Obstet Gynecol. 2017;50(6):788–99.

    Article  CAS  PubMed  Google Scholar 

  53. Szubert S, Łojewski A, Moszyński R, Lisowski A, Sajdak S, Szpurek D. Ultrasonographic features and CA125 levels of hormonally active ovarian tumors. Ginekol Pol. 2016;87(4):254–9.

    Article  PubMed  Google Scholar 

  54. Folkman J, Merler E, Abernathz C, Williams G. Isolation of a tumor factor responsible for angiogenesis. J Exp Med. 1971;133:275–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Guerriero S, Ajossa S, Lai MP, Risalvatto A, Paoletti AM, Melis GB. Clinical applications of color Doppler energy imaging in the female reproductive tract and pregnancy. Hum Reprod Update. 1999;5:515–29.

    Article  CAS  PubMed  Google Scholar 

  56. Guerriero S, Alcazar JL, Ajossa S, Lai MP, Errasti T, Mallarini G, et al. Comparison of conventional color Doppler imaging and power-Doppler imaging for the diagnosis of ovarian cancer. Results of a European Study. Gynecol Oncol. 2001;83:299–304.

    Article  CAS  PubMed  Google Scholar 

  57. Kurjak A, Kupesic S, Sparac V, et al. The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler. Gynecol Oncol. 2003;90:258–64.

    Article  PubMed  Google Scholar 

  58. Timmerman D, Schwarzler P, Collins WP, Claerhout F, Coenen M, Amant F, et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol. 1999;13:11–6.

    Article  CAS  PubMed  Google Scholar 

  59. Dirk Timmerman D, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol. 2005;23(34):8794–801.

    Article  PubMed  Google Scholar 

  60. Van Holsbeke C, Van Calster B, Testa AC, et al. Prospective internal validation of mathematical models to predict malignancy in adnexal masses: results from the International Ovarian Tumor Analysis Study. Clin Cancer Res. 2009;15:684–91.

    Article  PubMed  Google Scholar 

  61. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008;31(6):681–90.

    Article  CAS  PubMed  Google Scholar 

  62. EMJ M, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis. Eur J Cancer. 2016;58:17–29.

    Article  Google Scholar 

  63. Valentin L, et al. Adnexal masses difficult to classify as benign or malignant using subjective assessment of gray-scale and Doppler ultrasound findings: logistic regression models do not help. Ultrasound Obstet Gynecol. 2011;38:456–65.

    Article  CAS  PubMed  Google Scholar 

  64. Valentin L, Ameye L, Jurkovic D, Metzger U, Lecuru F, Van Huffel S, Timmerman D. Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis? Ultrasound Obstet Gynecol. 2006;27(4):438–44.

    Article  CAS  PubMed  Google Scholar 

  65. Shetty M. Nonovarian mimics of ovarian malignancy. Semin Ultrasound CT MR. 2019;40(4):319–31.

    Article  PubMed  Google Scholar 

  66. Kalampokas E, Kalampokas T, Tourountous I. Primary fallopian tube carcinoma. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):155–61.

    Article  CAS  PubMed  Google Scholar 

  67. Pectasides D, Pectasides E, Economopoulos T. Fallopian tube carcinoma: a review. Oncologist. 2006;11(8):902–12.

    Article  PubMed  Google Scholar 

  68. Rosen AC, Klein M, Hafner E, et al. Management and prognosis of primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma. Gynecol Obstet Investig. 1999;47:45–51.

    Article  CAS  Google Scholar 

  69. Woolas RP, Smith JHF, Sarharnis P, et al. Fallopian tube carcinoma: an under-recognized primary neoplasm. Int J Gynecol Cancer. 1997;7:284–8.

    Article  Google Scholar 

  70. Ludovisi M, et al. Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer. Ultrasound Obstet Gynecol. 2014;43(3):328–35.

    Article  CAS  PubMed  Google Scholar 

  71. Kurjak A, Kupesic S, Jacobs I. Preoperative diagnosis of the primary fallopian tube carcinoma by three-dimensional static and power Doppler sonography. Ultrasound Obstet Gynecol. 2000;15(3):246–51.

    Article  CAS  PubMed  Google Scholar 

  72. Ko ML, Jeng CJ, Chen SC, Tzeng CR. Sonographic appearance of fallopian tube carcinoma. Clin Ultrasound. 2005;33(7):372–4.

    Article  Google Scholar 

  73. Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics. 2011;31(2):527–48.

    Article  PubMed  Google Scholar 

  74. Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E. Nonovarian cystic lesions of the pelvis. Radiographics. 2010;30:921–38.

    Article  PubMed  Google Scholar 

  75. Bedi DG, Fagan CJ, Nocera RM. Chronic ectopic pregnancy. J Ultrasound Med. 1984;3(8):347–52.

    Article  CAS  PubMed  Google Scholar 

  76. O'Neill D, Pounds R, Vella J, Singh K, Yap J. The diagnostic conundrum of chronic ectopic pregnancy: a case report. Case Rep Womens Health. 2018;9(20):e00086. https://doi.org/10.1016/j.crwh.2018.e00086. eCollection 2018 Oct.

    Article  Google Scholar 

  77. Fujita K, Iyoshi S, Watanabe K, Takeda A. Chronic tubal pregnancy manifesting as a heterogeneous adnexal mass with prominent neovascularization in a woman with a negative serum β-human chorionic gonadotropin level. J Obstet Gynaecol Res. 2019;45(3):729–33.

    Article  CAS  PubMed  Google Scholar 

  78. Yamamoto Y, Yamada R, Oguri H, Maeda N, Fukaya T. Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. Eur J Obstet Gynecol Reprod Biol. 2009;144:163–7.

    Article  PubMed  Google Scholar 

  79. Horrow MM, Rodgers SK, Naqvi S. Ultrasound of pelvic inflammatory disease. Ultrasound Clin. 2007;2(2):297–309.

    Article  Google Scholar 

  80. Chow SN, Chen M. Tuboovarian abscess mimicking malignancy: report of two cases. J Formos Med Assoc. 2000;99(10):779–82.

    CAS  PubMed  Google Scholar 

  81. Ozat M, Altinkaya SO, Gungor T, Cağlar M, Zergeroglu S, Karaca M, Besli M, Mollamahmutoglu L. Extraovarian conditions mimicking ovarian cancer: a single center experience of 15 years. Arch Gynecol Obstet. 2011;284(3):713–9.

    Article  PubMed  Google Scholar 

  82. Filiz Ç, Dilek U, Cinel L, Yazıcı G, Dilek S. A case of large extraovarian endometriotic cyst in pelvis mimicking ovarian cancer. Gynecol Obstet Reprod Med [Online]. 2006;12(2):150–2. Web. 10 Mar. 2019.

    Google Scholar 

  83. Berger A, Graham NW, Berry-Roberts C, Schlaff W. An atypical presentation of extraovarian endometrioma. Obstet Gynecol Cases Rev. 2018;5:125. https://doi.org/10.23937/2377-9004/1410125.

    Article  Google Scholar 

  84. Masch WR, Kamaya A, Wasnik AP, Maturen KE. Ovarian cancer mimics: how to avoid being fooled by extraovarian pelvic masses. Abdom Radiol (NY). 2016;41(4):783–93.

    Article  Google Scholar 

  85. Thawait SK, Batra K, Johnson SI, Torigian DA, Chhabra A, Zaheer A. Magnetic resonance imaging evaluation of non-ovarian adnexal lesions. Clin Imaging. 2016;40(1):33–45.

    Article  PubMed  Google Scholar 

  86. Kishimoto K, Ito K, Awaya H, Matsunaga N, Outwater EK, Siegelman ES. Paraovarian cyst: MR imaging features. Abdom Imaging. 2002;27(6):685–9.

    Article  CAS  PubMed  Google Scholar 

  87. Kim JS, Woo SK, Suh SJ, Morettin LB. Sonographic diagnosis of paraovarian cysts: value of detecting a separate ipsilateral ovary. AJR Am J Roentgenol. 1995;164(6):1441–4.

    Article  CAS  PubMed  Google Scholar 

  88. Dørum A, Blom GP, Ekerhovd E, Granberg S. Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study. Am J Obstet Gynecol. 2005;192:48–54.

    Article  PubMed  Google Scholar 

  89. Barloon TJ, Brown BP, Abu-Yousef MM, Warnock NG. Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography. J Clin Ultrasound. 1996;24(3):117–22.

    Article  CAS  PubMed  Google Scholar 

  90. Gupta A, Gupta P, Manaktala U, Khurana N. Clinical, radiological, and histopathological analysis of paraovarian cysts. J Midlife Health. 2016;7(2):78–82.

    PubMed  PubMed Central  Google Scholar 

  91. Ghossain MA. Extraovarian cystadenomas: ultrasound and MR findings in 7 cases. J Comput Assist Tomogr. 2005;29(1):74–9.

    Article  PubMed  Google Scholar 

  92. Ahmed N, Vimplis S, Deo N. A mucocele of the appendix seen as an adnexal mass on ultrasound scan. J Obstet Gynaecol. 2017;37(1):116–7.

    Article  PubMed  Google Scholar 

  93. Papoutsis D, Protopappas A, Belitsos P, Sotiropoulou M, Antonakou A, Loutradis D, Antsaklis A. Mucocele of the vermiform appendix misdiagnosed as an adnexal mass on transvaginal sonography. J Clin Ultrasound. 2012;40(8):522–5.

    Article  PubMed  Google Scholar 

  94. Balci O, Ozdemir S, Mahmoud AS. Appendiceal mucocele mimicking a cystic right adnexal mass. Taiwan J Obstet Gynecol. 2009;48(4):412–4.

    Article  PubMed  Google Scholar 

  95. Caspi B, Cassif E, Auslender R, Herman A, Hagay Z, Appelman Z. The onion skin sign a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 2004;23:117–21.

    Article  PubMed  Google Scholar 

  96. Piura B, Rabinovich A, Sinelnikov I, Delgado B. Tailgut cyst initially misdiagnosed as ovarian tumor. Arch Gynecol Obstet. 2005;272:301–3.

    Article  PubMed  Google Scholar 

  97. Salih AM, Kakamad FH, AHD J, Habibullah IM, Rauf G, Najar KA. Parasitic leiomyoma: a case report with literature review. Int J Surg Case Rep. 2017;41:33–5.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Tokiwa M, Huang K. Broad ligament fibroid. J Minim Invasive Gynecol. 2015;22(6S):S155. https://doi.org/10.1016/j.jmig.2015.08.583. Epub 2015 Oct 15.

    Article  PubMed  Google Scholar 

  99. Heller DS. Review article. Lesions of the broad ligament: a review. Invasive Gynecol. 2015;22:1163–8.

    Article  Google Scholar 

  100. Roberts P, Nofech-Mozes S, Coburn N, Hamilton P, Gien LT. Retroperitoneal extraovarian fibrothecoma mimicking a malignant epithelial ovarian carcinoma. Case Rep Obstet Gynecol. 2012;281745:2012.

    Google Scholar 

  101. Keitoku M, et al. Extraovarian sex cord-stromal tumor: case report and review of the literature. Int J Gynecol Pathol. 1997;16(2):180–5.

    Article  CAS  PubMed  Google Scholar 

  102. Omori M, et al. Extraovarian fibroma with minor sex cord elements: a case report and literature review. Int J Surg Pathol. 2017;25(5):472–6.

    Article  PubMed  Google Scholar 

  103. Levine CD, Patel UJ, Ghanekar D, Wachsberg RH, Simmons MZ, Stein M. Benign extraovarian mimics of ovarian cancer. Distinction with imaging studies. Clin Imaging. 1997;21(5):350–8.

    Article  CAS  PubMed  Google Scholar 

  104. Sandrasegaran K, Rajesh A, Rydberg J, Rushing DA, Akisik FM, Henley JD. Gastrointestinal stromal tumors: clinical, radiologic, and pathologic features. AJR Am J Roentgenol. 2005;184(3):803–11.

    Article  PubMed  Google Scholar 

  105. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. 2000;7:705–12.

    Article  CAS  PubMed  Google Scholar 

  106. Karaca N, Akpak YK, Tatar Z, Batmaz G, Erken A. Gastrointestinal stromal tumor: may mimic adnexal mass. Glob J Health Sci. 2015;18(2):20–6.

    Google Scholar 

  107. Teoh WC, Teo SY, Ong CL. Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography. Ultrasound Obstet Gynecol. 2011;37(1):107–9.

    Article  CAS  PubMed  Google Scholar 

  108. Pinto V, Ingravallo G, Cicinelli E, Pintucci A, Sambati GS, Marinaccio M, D'Addario V. Gastrointestinal stromal tumors mimicking gynecological masses on ultrasound: a report of two cases. Ultrasound Obstet Gynecol. 2007;30(3):359–61.

    Article  CAS  PubMed  Google Scholar 

  109. Morimura Y, Yamashita N, Koyama N, Ohzeki T, Takayama T, Fujimori K, Sato A. A Gastrointestinal stromal tumor mimicking gynecological disease. Fukushima J Med Sci. 2006;52(1):21–8.

    Article  PubMed  Google Scholar 

  110. Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: report from National Cancer Registry Programme, India. JCO Glob Oncol. 2020;6:1063–75.

    Article  PubMed  Google Scholar 

  111. Saleh M, Virarkar M, Javadi S, Elsherif SB, de Castro Faria S, Bhosale P. Cervical cancer: 2018 Revised International Federation of Gynecology and Obstetrics Staging System and the Role of Imaging. Am J Roentgenol. 2020;214(5):1182–95.

    Article  Google Scholar 

  112. Kaminski PF, Norris HJ. Minimal deviation carcinoma (adenoma malignum) of the cervix. Int J Gynecol Pathol. 1983;2(2):141–52.

    Article  CAS  PubMed  Google Scholar 

  113. Fu YS, Reagan JW, Hsiu J, Storaasli JP, Wentz WB. Adenocarcinoma and mixed carcinoma of the uterine cervix: I. A clinicopathologic study. Cancer. 1982;49(12):2560–70.

    Article  CAS  PubMed  Google Scholar 

  114. Lurie S, Piper I, Woliovitch I, Glezerman M. Age-related prevalence of sonographicaly confirmed uterine myomas. J Obstet Gynaecol. 2005;25(1):42–4.

    Article  CAS  PubMed  Google Scholar 

  115. D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010;116(1):131–9.

    Article  CAS  PubMed  Google Scholar 

  116. Lim D, Wang W-L, Lee C, Dodge T, Gilks B, Oliva E. Old versus new FIGO staging systems in predicting overall survival in patients with uterine leiomyosarcoma: a study of 86 cases. Gynecol Oncol. 2013;128(2):322–6.

    Article  CAS  PubMed  Google Scholar 

  117. Dellacha A, Di AM, Foglia G, Fulcheri E. Lipoleiomyoma of the uterus. Pathologica. 1997;89(6):737–41.

    CAS  PubMed  Google Scholar 

  118. Boronow R, Morrow C, Creasman W, Disaia P, Silverberg S, Miller A, et al. Surgical staging in endometrial cancer: clinical—pathologic findings of a prospective study. Obstet Gynecol. 1984;63(6):825–32.

    CAS  PubMed  Google Scholar 

  119. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. Lancet. 2000;355(9213):1404–11.

    Article  CAS  PubMed  Google Scholar 

  120. Dubinsky T, Parvey H, Maklad N. The role of transvaginal sonography and endometrial biopsy in the evaluation of peri-and postmenopausal bleeding. AJR Am J Roentgenol. 1997;169(1):145–9.

    Article  CAS  PubMed  Google Scholar 

  121. Barwick T, Rockall A, Barton D, Sohaib S. Imaging of endometrial adenocarcinoma. Clin Radiol. 2006;61(7):545–55.

    Article  CAS  PubMed  Google Scholar 

  122. Fagotti A, Ferrandina G, Longo R, Mancuso S, Scambia G. Minilaparotomy in early stage endometrial cancer: an alternative to standard and laparoscopic treatment. Gynecol Oncol. 2002;86(2):177–83.

    Article  PubMed  Google Scholar 

  123. Wong CK, Wong YH, Lo LS, Tai CM, Ng TK. Laparoscopy compared with laparotomy for the surgical staging of endometrial carcinoma. J Obstet Gynaecol Res. 2005;31(4):286–90.

    Article  PubMed  Google Scholar 

  124. Sironi S, Colombo E, Villa G, Taccagni G, Belloni C, Garancini P, et al. Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology. 1992;185(1):207–12.

    Article  CAS  PubMed  Google Scholar 

  125. Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, et al. Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology. 2000;215(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  126. Yamashita Y, Mizutani H, Torashima M, Takahashi M, Miyazaki K, Okamura H, et al. Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR Am J Roentgenol. 1993;161(3):595–9.

    Article  CAS  PubMed  Google Scholar 

  127. Saleh M, Virarkar M, Bhosale P, El Sherif S, Javadi S, Faria SC. Endometrial cancer, the current international federation of gynecology and obstetrics staging system, and the role of imaging. J Comput Assist Tomogr. 2020;44(5):714–29.

    Article  PubMed  Google Scholar 

  128. Ko S-F, Wan Y, Ng S-H, Lee T-Y, Lin J-W, Chen W-J, et al. Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation. AJR Am J Roentgenol. 1999;172(5):1227–33.

    Article  CAS  PubMed  Google Scholar 

  129. Croitoru D, Aaron L, Laberge J-M, Neilson I, Guttman F. Management of complex ovarian cysts presenting in the first year of life. J Pediatr Surg. 1991;26(12):1366–8.

    Article  CAS  PubMed  Google Scholar 

  130. Kim SH, Kim SH. Granulosa cell tumor of the ovary: common findings and unusual appearances on CT and MR. J Comput Assist Tomogr. 2002;26(5):756–61.

    Article  PubMed  Google Scholar 

  131. Silverberg SG. Brenner tumor of the ovary .A clinicopathologic study of 60 tumors in 54 women. Cancer. 1971;28(3):588–96.

    Article  CAS  PubMed  Google Scholar 

  132. Oh SN, Rha SE, Jung SE, Lee YJ, Choi BG, Byun JY, et al. Transitional cell tumor of the ovary: computed tomographic and magnetic resonance imaging features with pathological correlation. J Comput Assist Tomogr. 2009;33(1):106–12.

    Article  PubMed  Google Scholar 

  133. Paladini D, Testa A, Van Holsbeke C, Mancari R, Timmerman D, Valentin L. Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary. Ultrasound in Obstet Gynecol. 2009;34(2):188–95.

    Article  CAS  Google Scholar 

  134. Voytek TM, Ro JY, Edeiken J, Ayala AG. Fibrous dysplasiaand cemento-ossifying fibroma. A histologic spectrum. Am J Surg Pathol. 1995;19(7):775–81.

    Article  CAS  PubMed  Google Scholar 

  135. Guerriero S, Ajossa S, Lai MP, Alcazar JL, Paoletti AM, Marisa O, et al. The diagnosis of functional ovarian cysts using transvaginal ultrasound combined with clinical parameters, CA125 determinations, and color Doppler. Eur J Obstet Gynecol Reprod Biol. 2003;110(1):83–8.

    Article  PubMed  Google Scholar 

  136. Guerriero S, Mallarini G, Ajossa S, Risalvato A, Satta R, Mais V, et al. Transvaginal ultrasound and computed tomography combined with clinical parameters and CA-125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women. Ultrasound in Obstet Gynecol. 1997;9(5):339–43.

    Article  CAS  Google Scholar 

  137. Sawyer RW, Vick CW, Walsh JW, McClure PH. Computed tomography of benign ovarian masses. J Comput Assist Tomogr. 1985;9(4):784–9.

    Article  CAS  PubMed  Google Scholar 

  138. Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2010;256(3):943–54.

    Article  PubMed  Google Scholar 

  139. van Nagell JRJ, Higgins RV, Donaldson ES, Gallion HH, Powell DE, Pavlik EJ, et al. Transvaginal sonography as a screening method for ovarian cancer a report of the first 1000 cases screened. Cancer. 1990;65(3):573–7.

    Article  PubMed  Google Scholar 

  140. Moyle JW, Rochester D, Sider L, Shrock K, Krause P. Sonography of ovarian tumors: predictability of tumor type. Am J Roentgenol. 1983;141(5):985–91.

    Article  CAS  Google Scholar 

  141. Foti PV, Attinà G, Spadola S, Caltabiano R, Farina R, Palmucci S, et al. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016;7(1):21–41.

    Article  PubMed  Google Scholar 

  142. Soslow RA, Tornos C. Diagnostic pathology of ovarian tumors: Springer Science & Business Media; NY, 2011.

    Google Scholar 

  143. Quinn S, Erickson S, Black W. Cystic ovarian teratomas: the sonographic appearance of the dermoid plug. Radiology. 1985;155(2):477–8.

    Article  CAS  PubMed  Google Scholar 

  144. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol. 1998;171(4):1061–5.

    Article  CAS  PubMed  Google Scholar 

  145. Guinet C, Ghossain MA, Buy J-N, Malbec L, Hugol D, Truc JB, et al. Mature cystic teratomas of the ovary: CT and MR findings. Eur J Radiol. 1995;20(2):137–43.

    Article  CAS  PubMed  Google Scholar 

  146. Friedman AC, Pyatt RS, Hartman D, Downey EJ, Olson W. CT of benign cystic teratomas. Am J Roentgenol. 1982;138(4):659–65.

    Article  CAS  Google Scholar 

  147. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002;22(6):1305–25.

    Article  PubMed  Google Scholar 

  148. Brammer H 3rd, Buck J, Hayes W, Sheth S, Tavassoli F. From the archives of the AFIP. Malignant germ cell tumors of the ovary: radiologic-pathologic correlation. Radiographics. 1990;10(4):715–24.

    Article  PubMed  Google Scholar 

  149. Bazot M, Cortez A, Sananes S, Boundghène F, Uzan S, Bigot J-M. Imaging of dermoid cysts with foci of immature tissue. J Comput Assist Tomogr. 1999;23(5):703–6.

    Article  CAS  PubMed  Google Scholar 

  150. Ueno T, Tanaka YO, Nagata M, Tsunoda H, Anno I, Ishikawa S, et al. Spectrum of germ cell tumors: from head to toe. Radiographics. 2004;24(2):387–404.

    Article  PubMed  Google Scholar 

  151. Sugimura K, Takemori M, Sugiura M, Okizuka H, Kono M, Ishida T. The value of magnetic resonance relaxation time in staging ovarian endometrial cysts. Br J Radiol. 1992;65(774):502–6.

    Article  CAS  PubMed  Google Scholar 

  152. Takahashi K, Okada S, Okada M, Kitao M, Kaji Y, Sugimura K. Magnetic resonance relaxation time in evaluating the cyst fluid characteristics of endometrioma. Hum Reprod. 1996;11(4):857–60.

    Article  CAS  PubMed  Google Scholar 

  153. Outwater EK, Mitchell DG. Normal ovaries and functional cysts: MR appearance. Radiology. 1996;198(2):397–402.

    Article  CAS  PubMed  Google Scholar 

  154. Wagner BJ, Buck JL, Seidman JD, McCabe KM. From the archives of the AFIP. Ovarian epithelial neoplasms: radiologic-pathologic correlation. Radiographics. 1994;14(6):1351–74.

    Article  CAS  PubMed  Google Scholar 

  155. Tsili A, Tsampoulas C, Charisiadi A, Kalef-Ezra J, Dousias V, Paraskevaidis E, et al. Adnexal masses: accuracy of detection and differentiation with multidetector computed tomography. Gynecol Oncol. 2008;110(1):22–31.

    Article  CAS  PubMed  Google Scholar 

  156. Pretorius ES, Outwater EK, Hunt JL, Siegelman ES. Magnetic resonance imaging of the ovary. Top Magn Reson Imaging. 2001;12(2):131–46.

    Article  CAS  PubMed  Google Scholar 

  157. Chen VW, Ruiz B, Killeen JL, Cote TR, Wu XC, Correa CN, et al. Pathology and classification of ovarian tumors. Cancer Interdiscip Int J Am Cancer Soc. 2003;97(S10):2631–42.

    Google Scholar 

  158. Kinkel K, Lu Y, Mehdizade A, Pelte M-F, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization—meta-analysis and Bayesian analysis. Radiology. 2005;236(1):85–94.

    Article  PubMed  Google Scholar 

  159. Matsuoka Y, Ohtomo K, Araki T, Kojima K, Yoshikawa W, Fuwa S. MR imaging of clear cell carcinoma of the ovary. Eur Radiol. 2001;11(6):946–51.

    Article  CAS  PubMed  Google Scholar 

  160. Khaled ME. Cross-sectional Imaging of the abdomen and pelvis. New York: Springer-Verlag; 2016.

    Google Scholar 

  161. Holtz F, Hart WR. Krukenberg tumors of the ovary: a clinicopathologic analysis of 27 Cases. Obstet Gynecol Surv. 1983;38(4):234–5.

    Article  Google Scholar 

  162. Togashi K. Ovarian cancer: the clinical role of US, CT, and MRI. Eur Radiol. 2003;13(6):L87–L104.

    Article  PubMed  Google Scholar 

  163. Chang W-C, Meux MD, Yeh BM, Qayyum A, Joe BN, Chen L-M, et al. CT and MRI of adnexal masses in patients with primary nonovarian malignancy. Am J Roentgenol. 2006;186(4):1039–45.

    Article  Google Scholar 

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Shetty, M.K., Vikram, R., Saleh, M. (2021). Pelvic Mass: Role of Imaging in the Diagnosis and Management. In: Shetty, M.K. (eds) Breast & Gynecological Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-69476-0_11

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