A 35 yr old woman presents with primary infeility. On examination a mass is palpable in the pelvis. USG shows a cystic lesion in the ovary with ground glass appearence without internal vascular flow. Her CA-125 level is 90 U/ml. What is the most likely diagnosis?

This patient is most likely suffering from ovarian endometrioma which occur secondary to endometriosis. Ultrasonography is the most commonly used diagnostic method for detecting ovarian endometrioma and laparoscopy is the gold standard for definitive diagnosis. Endometriosis refers to aberrant growth of endometrium outside the uterus paicularly in the dependent pas of the pelvis and ovaries. Patients mainly presents with dysmenorrhea, chronic pelvic pain, dyspareunia, bowel bladder symptoms or infeility. Signs which raise the suspision of endometriosis are: Tender uterosacral ligaments or cul-de-sac nodularity Fixed, retroflexed uterus with laterally dilated cervix Tender pelvic mass especially an enlarged ovary Colored lesion in umbilicus, surgical scars, vulva, vagina or cervix