Young Woman with Pelvic Discomfort

A 26-year-old sexually active woman presents to her primary care physician with an insidious onset of dull pelvic pain. The pain is of moderate intensity and has lasted for approximately the past year. Her last menstrual period was about 2 weeks ago and was normal. She denies experiencing fever or weight loss, vaginal discharge or abnormal bleeding, or urinary symptoms such as dysuria or increased frequency. She reports a normal bowel movement pattern. The patient is on birth control pills, but otherwise, she does not take any medications and has no significant past medical history.

On physical examination, the patient has normal vital signs and is in no apparent distress. The abdominal examination reveals fullness in the left lower quadrant with no tenderness to palpation. A large, palpable mass is noted in the left adnexa during the pelvic examination. There is mild tenderness associated with palpation of the mass. There is no cervical discharge noted, the right adnexa are not palpable, and there is no tenderness to palpation. The urine pregnancy test is negative, and findings on an urinalysis are normal.

A transvaginal pelvic ultrasound is obtained (Image 1). The results demonstrate a 4.9 X 8.1 cm complex echogenic mass posterior to the bladder. The patient undergoes subsequent imaging with a CT scan of the abdomen and pelvis (Image 2).

What is the diagnosis?

What is the diagnosis?
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This is the most common benign ovarian tumor.