Aim: Pelvic ultrasound is commonly used as part of the routine gynecologic exams which resulting in diagnosis of adnexal masses, the majority of which are functional or benign. However, due to the possible complications involving benign adnexal cysts (ie, adnexal torsion, pelvic pain) and the utmost importance of early diagnosis and treatment of ovarian cancer, the correct ultrasound diagnosis of adnexal masses is essential in clinical practice. This review will describe the typical ultrasound appearance of the common physiologic, benign, and malignant adnexal masses with the aim of aiding the clinician to reach the correct diagnosis. Methods: In this study digital database base including PubMed , EMBASE and Google scholars were searched. The survey was carried out using Key word such as “ benign “, malignant “ “adnexal masses” , “ovarian cancer “,adnexal pathology “ neoplasms “diagnosis” risk assessment” ultrasonography” variously associated together. Conclusion: ultrasound is more accurate in discriminating malignancies from benign tumors. The best use for this technique seems in giving further preoperative information about masses with uncertain sonographic characteristics, allowing better timing and tailoring of surgery. Key words: Adnexal benign & malignant masses, neoplasm, adnexal neoplasm, ovarian cancer,ultrasonography