The uterine adnexa consist of the ovaries, the Fallopian tubes, and the uterine ligaments. Although adnexal pathology often involves one of these structures, contiguous structures of non-gynecologic origin also may be involved. Adnexal masses are common among women of all ages and two thirds of ovarian tumors are encountered during reproductive years, of those the risk of malignancy in an ovarian mass in patients above 40 years is remarkably high. Even though histopathological examination of the adnexal lesion is the gold standard for the final diagnosis or exclusion of malignancy, clinical examination, 2D U/S, Doppler studies in addition to tumor markers are reasonably accurate, helpful and non-invasive tools for assessment of adnexal lesions particularly distinguishing benign from malignant ovarian tumors.