Question
A 35 yr old woman presents with primary infertility. On examination, a mass is palpable in the pelvis. USG shows a cystic lesion in the ovary with a ground-glass appearance without internal vascular flow. Her CA-125 level is 90 U/ml. What is the most likely diagnosis?
| A. |
Ovarian Ca
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| B. |
Endometrioma
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| C. |
Tuberculosis
|
| D. |
Borderline ovarian tumor
|
Show Answer
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Correct Answer » B
Explanation
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|
The patient has primary infertility, a pelvic mass, and an ovarian cyst showing a homogeneous ground-glass appearance on ultrasonography, which is the classic imaging feature of an endometrioma (ovarian endometriotic cyst or “chocolate cyst”).
Endometriomas result from ectopic endometrial tissue within the ovary and are commonly associated with:
- Infertility
- Chronic pelvic pain
- Dysmenorrhea
- Dyspareunia
The ground-glass appearance represents old, thick, hemolyzed blood within the cyst. The absence of internal vascular flow helps distinguish it from malignant ovarian masses.
Although CA-125 is elevated (90 U/mL), a mild-to-moderate elevation is common in endometriosis and is not specific for ovarian malignancy.
Option-wise Explanation
A. Ovarian carcinoma – Incorrect
- Usually presents as a complex solid-cystic ovarian mass with papillary projections, thick septations, and internal vascularity.
- CA-125 is often markedly elevated, especially in epithelial ovarian cancer.
- A ground-glass cyst without vascularity is not typical.
B. Endometrioma – Correct
- Classic ultrasound finding: Homogeneous low-level internal echoes (“ground-glass” appearance).
- Usually no internal vascularity.
- Frequently associated with infertility.
- CA-125 may be mildly elevated.
C. Genital tuberculosis – Incorrect
- Causes infertility due to tubal involvement.
- Ultrasound typically shows tubo-ovarian masses, hydrosalpinx, or calcifications rather than a characteristic ground-glass ovarian cyst.
D. Borderline ovarian tumor – Incorrect
- Usually appears as a multiloculated cystic mass with papillary projections.
- Internal vascularity is often present.
- Ground-glass appearance is not characteristic.
