VP05.25: Myometrial endometriotic cyst simulating left ovarian mass: an unusual presentation of deep endometriosis

51-year-old female, multiparous, referred for left ovarian “complex” mass on transvaginal ultrasound (TVS). The symptoms' summary: menorrhagia; dysmenorrhoea 7/10; dyspareunia 0/10; dyschezia 2/10; dysuria 0/10. Final advanced TVS conclusions were deep endometriosis (DE); complete obliteration of the Pouch of Douglas; normal morphology of the left ovary; ground-glass myometrial cystic lesion of the torus uterinus (simulating an Endometrioma – possibly a cystic adenomyoma); myometrial features compatible with adenomyosis; Anterior intramural uterine fibroid; Endometrioma of the right ovary; DE nodules of the right uterosacral ligament and torus; No evident rectal or bowel nodules; Normal anterior compartment. After careful counselling of risks and benefits of medical versus surgical options, the patient's final therapeutic decision favoured a levonorgestrel intrauterine device and close clinical follow up. The adoption of standardised diagnostic protocols, particularly the use of MUSA, IOTA, and IDEA consensus, mapping the pelvis regarding DE, lead to identifying a misdiagnosed concerning adnexal mass. Additionally, the clinical management should shift to a patient-centred fashion, where the simplicity of the chosen therapy is more important than the complexity or exuberance of the diagnostic finding. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.