A 22-year-old woman presents with progressive pelvic pain. Transvaginal ultrasound shows a 6 cm complex right ovarian cyst with areas of echogenic material and acoustic shadowing, consistent with a dermoid cyst. Serum CA-125 is mildly elevated at 48 U/mL. Which of the following is the MOST appropriate management?

• A Immediate oophorectomy due to malignancy risk
• B Laparoscopic cystectomy preserving ovarian tissue ✓
• C Medical management with combined oral contraceptive pills for 3 months
• D Fine needle aspiration and cytology

Explanation

A dermoid cyst (mature cystic teratoma) is the most common benign ovarian tumor in young women. At 6 cm with symptoms, surgical removal is indicated to prevent torsion (risk increases above 5 cm) and rupture. Laparoscopic cystectomy with preservation of normal ovarian tissue is preferred in reproductive-age women. Mildly elevated CA-125 is non-specific and can occur with benign conditions; malignancy is unlikely given the age and imaging characteristics.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.