Infiltrative Endometriosis Clinically Mimicking Ovarian Malignancy: Diagnostic Utility of Intraoperative Frozen Section

Aparna Gupta, Reena Tomar, Robin Yadav, Deepika Rani, Asmita Rathore
Cureus · 2025 · vol. 17(12) , pp. e99229 · doi:10.7759/cureus.99229 · PMID:41541919 · PMC12799589 · W7115179955
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case highlights how intraoperative frozen section analysis can aid in differentiating infiltrative endometriosis from ovarian malignancy when clinical and radiological findings are suggestive of cancer.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper reports a case of a 40-year-old woman with pelvic pain and dysmenorrhea whose right ovarian mass appeared malignant on imaging and laboratory testing, including a markedly elevated serum CA-125 level (>1265 U/mL) and a multiloculated solid-cystic lesion with thick enhancing septae and calcifications on ultrasound and CECT. Intraoperative frozen section using toluidine blue unexpectedly demonstrated endometrial glands and stroma consistent with infiltrative endometriosis, with no malignancy, which was later confirmed on full histopathology and immunohistochemistry (CD10, PAX8, and estrogen receptor positivity), along with focal simple hyperplasia without atypia and reactive lymph nodes. The major limitation is that this is a single case report, so diagnostic performance of frozen section cannot be generalized beyond this context. This paper is centrally about endometriosis — specifically, a case of infiltrative ovarian endometriosis that clinically mimicked ovarian malignancy and used intraoperative frozen section for diagnostic differentiation.

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Abstract

Endometriosis is a benign gynecological condition that commonly affects women of reproductive age. It is characterized by the presence of ectopic endometrial tissue, predominantly within the pelvic cavity. Ovarian endometriosis usually presents as an endometrioma with typical clinical and radiological features. However, atypical presentations such as varied symptoms, elevated tumor markers, and inconclusive imaging often complicate the differentiation between benign and malignant ovarian masses. This poses significant diagnostic challenges, which can be addressed with the use of intraoperative frozen sections. We hereby report a case of infiltrative endometriosis that presented with clinical features, radiological findings, and elevated serum tumor markers suggestive of ovarian malignancy.

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endometriosisendometrioma

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