Objectives: We aimed to compare Bosniak III and IV cystic renal masses (CRM) using Bosniak classification version 2005 (BC-v2005) versus BC-v2019 and analyze radiological findings and patterns of benignity and malignancy. Methods: We retrospectively reviewed all Bosniak III-IV CRMs using BC-v2005 at our center with four-phase CT confirmed pathology, between January 2014 and June 2019. Two radiologists independently re-evaluated each lesion using both BCs, including findings of benignity and malignancy. Bosniak III-IV CRMs were classified in four radiological patterns: inflammatory (CRM-IP), cystic nephroma (CRM-CNP), papillary (CRM-PP), and clear cell (CRM-CCP). Characteristics of patterns were compared. Results: Out of 97 patients, 57 Bosniak III-IV CRMs met the inclusion criteria. Twenty-four (42.10%) lesions were reclassified as solid tumours using BC-v2019. Any lesion was downgraded to IIF or lower. Nine (15.78%) lesions were upgraded to Bosniak III-IV CRMs by BC-v2019, despite benign lesions. The presence of acute-angle nodules was the only statistically significant sign of malignancy ( p < 0.01). All benign lesions, not considered solid, were included in the two patterns of benignity, characterized by thickened septa and/or wall and without acute-angle nodules. All malignant CRMs presented two patterns of malignancy, proposed as acute-angle nodules. All clear cell carcinomas presented with hyperenhancing acute-angle nodules in the arterial phase. Pattern classification was better for BC-v2005 and BC-v2029, differentiating benign and malignant CRM. Conclusion: The proposed four radiological patterns improved performance than BC-v2019 in classifying benign lesions (CRM-IP and CRM-CNP) and malignant ones (CRM-PP and CRM-CCP), with wall and septa thickening and acute-angle nodules as relevant biomarkers.

Primary fallopian tube carcinoma (PFTC) is seldom diagnosed preoperatively and is often mistaken for epithelial ovarian carcinoma (EOC). This report details a case of primary high-grade serous carcinoma (HGSC) of the fallopian tube, highlighting radiological and clinical indicators to aid in accurate diagnosis and avoid misdiagnosis. A 46-year-old premenopausal woman presented with symptoms and a transvaginal ultrasound (TVUS) indicating a malignant ovarian tumor. Further imaging with CT and MRI revealed a solid-cystic mass suggestive of a fallopian tube tumor rather than an ovarian origin. Oncological surgery confirmed the presence of a high-grade serous carcinoma in the fallopian tube. This case underscores the diagnostic challenges of PFTC and the superior sensitivity and specificity of MRI over CT and US in distinguishing adnexal lesions. Key MRI features such as the sausage-shaped mass and associated hematosalpinx were crucial in differentiating PFTC from EOC. The report emphasizes the importance of considering PFTC in differential diagnoses of adnexal masses to ensure accurate preoperative identification.

Objectives: To improve the differentiation of borderline ovarian-adnexal tumours (BOTs) from malignant ovarian-adnexal masses, most of which fall into the indeterminate O-RADS MRI 4 category, by developing a multimodal predictive model that integrates clinical, analytic, and MRI parameters. Methods: This retrospective, single-centre study included 248 women who underwent standardised MRI for ovarian-adnexal mass characterisation between 2019 and 2024. Of these, 201 had true ovarian-adnexal masses (114 benign, 22 borderline, and 65 malignant), confirmed by histopathology or stability after ≥12-month follow-up. Forty-one clinical, laboratory, and imaging variables were initially assessed, and after a bivariate evaluation, 18 final predictors with clinical relevance were selected for model construction with thresholds learned from the data. A classification and regression tree (CART) model (“Full Model”) was applied as a second-stage tool after O-RADS MRI scoring, using 10-fold cross-validation to prevent overfitting. A pruned “Simplified Model” was also derived to enhance interpretability. Results: O-RADS MRI performed well at the extremes (scores 2–3 and 5) but showed limited discrimination between BOTs and malignancies within category 4 (PPV for borderline = 0.50). The decision-tree models significantly improved diagnostic performance, increasing overall accuracy from 0.856 with O-RADS MRI alone to 0.905 (Simplified Model) and 0.955 (Full Model). The PPV for BOTs within the intermediate O-RADS MRI 4 category increased from 0.49 with O-RADS MRI alone to 0.77 and 0.90 with the simplified and full models, respectively, while maintaining high accuracy for benign and malignant lesions. Conclusions: In this retrospective single-centre cohort, the addition of an interpretable rule-based predictive model as a second-line tool within O-RADS MRI category 4 was associated with improved discrimination between borderline and invasive malignant ovarian-adnexal tumours. These findings suggest that multimodal integration of clinical, laboratory, and MRI features may help refine risk stratification in indeterminate cases; however, external validation in prospective multicentre cohorts is required before clinical implementation.

Aggressive pelvic angiomyxoma (APA) is a rare, locally infiltrative mesenchymal tumor that primarily affects women of reproductive age. Surgical resection remains the treatment of choice. The high local recurrence rate and insidious growth pattern of APA make preoperative diagnosis crucial for optimal surgical planning. Careful radiological evaluation is vital to determine the full extent of the tumor and to minimize the risk of recurrence. This article presents 3 cases of APA highlighting the radiological characteristics and pathological findings. In all cases, magnetic resonance imaging (MRI) was essential for diagnosis, with typical findings including a hyperintense mass on T2-weighted (T2WI) images with low-signal bands creating a distinctive laminated pattern. This case series emphasizes the importance of recognizing the specific MRI features of APA to guide clinical management and improve patient outcomes.