A 27-year-old woman with chronic dysmenorrhoea has a 6 cm left ovarian cyst on ultrasound. Serum CA-125 is 88 U/mL. She is afebrile with no ascites. Which underlying lesion most plausibly accounts for this CA-125 value?

• A Endometrioma ✓
• B Mature cystic teratoma
• C Simple follicular cyst
• D Paraovarian serous cyst

Explanation

CA-125 is derived from coelomic epithelium derivatives including mesothelium and mullerian epithelium, so it rises in menstruation, pregnancy, endometriosis, pelvic inflammatory disease, tuberculosis, and any cause of peritoneal irritation. An endometrioma in a symptomatic young woman commonly produces modest elevations below 200 U/mL. Dermoids, simple functional cysts, and paraovarian cysts are not associated with CA-125 elevation, making this value reassuring rather than alarming in her context.

Reference: Williams Gynecology, 4th ed.

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