A 42 year-old single woman, reported regular monthly menstruation with no abdominal pain during periods. But in this month's period, the patient experienced dull pain in the lower abdomen. The pain subsided after menstruation ended.
Past medical history: The patient has had annual general blood tests at Medic since 2024, with no abnormalities recorded.
On August 10, 2026, she had an annual blood test, and an additional CA- 125 test which showed elevated levels, leading to an abdominal and pelvic MRI and ultrasound.
Pelvic MRI:
Left ovarian cystic lesion, 65x50mm in diameter, with clear, smooth borders, no septa, no solid tissue, homogeneous high signal on T1W1, heterogeneous high signal on T2W2, and heterogeneous diffusion restriction.
• Dilation at the left fallopian tube.
• The uterus has several fibroids within the muscle, measuring 14mm, 20mm, and 50mm in diameter, not compressing the endometrium or surrounding areas.
Mucinous cyst in the left ovary, size 65x50mm (O-RADS 2). Dilated at the left fallopian tube. Multiple uterine fibroids within the muscle.
Pelvic ultrasound:
Multiple uterine fibroids (L4, L5/Figo)
Pelvic ultrasound suspected bilateral endometrioma, left greater than right tumor and tubal drainage due to fluid accumulationwhixh was not ruling out as endometrial hyperplasia in the fallopian tube.
Conclusions
Ultrasound findings of ovarian tumors (benign/malignant). O-RADS classification. Blood tests: CA- 125 and ROMA Test (CA-125 and HE 4)
Note: CA- 125/blood levels are elevated; patient's age should be taken into account.
• ≥ 50 years old, menopause + ovarian tumor + increased CA- 125 test: suspected ovarian cancer
• < 50 years old, still menstruating + ovarian tumor + increased CA -125: look for other benign causes
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