Question

A 35-year-old nullipara female presented with dull aching pain with exacerbation during the menstrual cycle. USG reveals a heterogeneous mass in the right adnexa. MRI reveals a 4 x 5 cm T1 hyperintense mass with no suppression on fat-saturated images. T2-weighted images show low signal with dark shading. Diagnosis?

• A. Dermoid cyst
• B. Endometrioma
• C. Ovarian cancer
• D. Para-Ovarian Cyst

Hint:

Endometriomas are typically seen as T1 hyperintense and T2 hypointense masses on MRI, often with a history of menstrual pain and infertility.

Answer 1

The Correct Option is B

The given clinical scenario presents a 35-year-old nullipara female with dull aching pain exacerbating during the menstrual cycle, accompanied by imaging findings from USG and MRI. Let's analyze the provided details to reach the diagnosis:

• USG Findings: A heterogeneous mass in the right adnexa.
• MRI Findings:

1. T1-weighted images show a hyperintense mass, meaning the mass appears brighter on this type of imaging.
2. No suppression on fat-saturated images, indicating the hyperintensity is not due to fat content.
3. T2-weighted images show low signal with dark shading, characteristic of blood products such as hemosiderin found in endometriosis.

Analyzing these details: The dull aching pelvic pain, which worsens during menstruation, is indicative of a condition affected by hormonal changes, such as endometriosis. The imaging characteristics of a T1 hyperintense and T2 low signal mass with dark shading correlate well:

• An endometrioma (chocolate cyst) is known for containing old blood that appears hyperintense on T1-weighted MRI due to methemoglobin and hypointense on T2-weighted images because of the high protein content and chronic blood products. Absence of signal suppression on fat-saturated images rules out a fat-containing lesion like a dermoid cyst.

In summary, the combination of clinical and imaging features is most consistent with an endometrioma. Therefore, the diagnosis is Endometrioma.