Table 3 Clinical and radiological findings of tumor mimickers in the female genital tract

Pelvic inflammatory disease and pelvic abscess

Pelvic fat stranding, thickening of uterosacral ligaments, fluid accumulation within the endometrial cavity, hydrosalpinx, tubal thickening, enlarged uterus and ovaries. Abscess appears as complex cystic mass with thick enhancing walls. Solid mural nodules, associated enlarged lymph nodes, peritoneal thickening and ascites may also be seen

Reproductive age. Vaginal discharge, elevated serum inflammatory markers, clinical findings of acute infection

Pelvic actinomycosis

Solid and cystic pelvic masses with diffuse spreading of the inflammatory findings across the pelvic tissue planes. Gas bubbles may be suggestive of infection

IUD is seen in most cases. Microbiological and histopathological examinations are needed for definitive diagnosis

Xanthogranulomatous oophoritis

Complex cystic lesions with thick enhancing walls and solid mural nodularity

Very rare. Surgery is needed for both diagnosis and definitive treatment

Adnexal inflammatory pseudotumors

Complex cystic adnexal masses

Rare. Histopathological examination is needed for definitive diagnosis

Endometriosis

US: Homogeneous hypoechoic cystic mass with diffuse low-level internal echoes. Internal vascularity is not expected on color Doppler US. Septation, fluid–fluid levels, thickened walls and mural nodularity related to retracting clot can be seen. May also appear as solid mass with mural/central calcifications

MRI: Homogeneous, T1-hyper and T2-hypointense lesions with no enhancing solid component

Reproductive age. Pelvic pain and infertility. Catamenial complaints. Associated with increased risk of clear-cell and endometrioid type ovarian cancers

Intrauterine ovarian torsion

Complex heterogeneous cystic mass with fluid-debris levels, internal septations, calcifications and solid areas. Internal vascularity may be seen on color Doppler US

Pelvic mass in the neonatal period. Histopathological examination is needed for definitive diagnosis

Ectopic pregnancy

Complex adnexal mass with internal vascularity. Accompanying endometrial thickening due to the decidual reaction. In atypical locations, the differential diagnosis based on radiological findings may be challenging

Reproductive age. Missed menstrual period and elevated beta-hCG levels are seen mostly. Pelvic pain and vaginal bleeding. The most common locations are fallopian tubes and ovaries. History of in vitro fertilization, previous tubal surgery, pelvic inflammatory disease, IUD or congenital uterine anomalies may be suggestive

Decidualized ovarian endometrioma

US: Complex adnexal masses. Solid components generally have marked vascularity on color Doppler US

MRI: Decidualized solid areas within endometriomas. Solid components have similar signal characteristics with decidual reaction in the uterine endometrium. Restricted diffusion is not expected

Pregnancy-associated disease. Previous medical history of endometriosis can be a clue. In case of suspicion, follow-up is recommended. Serial imaging shows no significant increase in size. Stable CA-125 levels may also be helpful

Hyperreactio luteinalis

Enlarged ovary with multiple ovarian cysts. Bilateral involvement is seen frequently

Pregnancy-associated disease. Mostly seen in the presence of multiple pregnancies or GTNs

Pregnancy luteoma

Solid or complex cystic ovarian lesions. Multiple lesions and bilateral involvement may be seen

Pregnancy-associated disease. Mostly detected incidentally. May present with maternal/fetal virilization. Follow-up is recommended. Generally expected to disappear in the postpartum period

Retained products of conception

US: Heterogeneous material within the endometrial cavity, thickened endometrial echo complex or intrauterine mass. Calcifications may be seen. Internal vascularity is variable

MRI: Heterogeneously enhancing mass with necrotic and hemorrhagic areas

Pregnancy-associated disease. Postpartum hemorrhage and high beta-hCG levels in the early period. During follow-up beta-hCG levels are expected to return to the normal limits within 2–3 weeks