EP31.21: Pelvic inflammatory disease in a young patient with coinciding ovarian mature teratoma and endometrioma: case report

A 27-year-old nulliparous woman, with irrelevant medical history, presented to our department with a 9-month history of intermenstrual uterine bleeding, progressive dysmenorrhea and dyspareunia, not responding to estroprogestive therapy. Over past two weeks, there was exacerbation characterised by severe lower abdominal pain, fetid vaginal discharge, leucocytosis, elevated CRP 24 U/mL without fever. Physical examination found: fixed retroverted uterus, narrowing of posterior vaginal fornix, acute pain with mobilisation of the cervix and an immobile right adnexal mass of 90 mm. A transvaginal ultrasonography revealed a tenderness right adnexal multilocular formation (3 loci), measuring 101 x 81 x 80 mm, with regular internal walls, mixed content and no vascularisation with colour Doppler. Serum CA 125 = 369 U/mL. The formation was classified as benign by ultrasound simple rules. The IOTA ADNEX model showed a 99.4% probability of being a benign tumour and 0,6% risk of malignancy (including 0,2% borderline tumour risk). The ultrasound also demonstrated deep infiltrating endometriosis in the anterior rectal wall with extension into the rectovaginal septum. Since there was no response to endovenous antibiotherapy, she was submitted to an explorative laparotomy with a right ovarian quistectomy and periovarian abscess drainage. The histological diagnosis was mature cystic teratoma and endometrioma. The patient had a positive post-operative recovery. Pelvic inflammatory disease, endometriosis and ovarian teratomas are frequents in young patients; however there rarely coexist. Our case alerts clinics, sonographers and pathologists about such coexistence which necessary results in complex and atypical clinical and imagiological patients' presentation.