Endometrioma With Hemorrhagic Ascites Mimicking Ovarian Malignancy: A Case Report

Iván L Rosso, Maria Paula Morales Ortigoza, Angela Duque Jimenez, Andrés F Marín, Wilmer Aponte
In: Cureus · 2026 · doi:10.7759/cureus.113351 · W7171218478
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This case report details a young woman without prior pelvic pain who presented with an ovarian mass, ascites, and pleural effusion, initially presumed malignant but ultimately diagnosed pathologically as endometriosis.

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Abstract

Endometriosis is a highly prevalent and morbid condition in women of reproductive age, often leading to well-known complications such as infertility, intestinal adhesions, and severe chronic pelvic pain. There is a particular and less frequent entity, even in patients with no prior history of pelvic pain or endometriosis, that presents as a pelvic mass associated with hemorrhagic ascites. This finding can be confused with a malignant ovarian neoplasm, a diagnostic error with unfavorable outcomes and a significant impact on patients' lives. We present the case of a young woman with no prior history of pelvic pain who presented with a right adnexal mass, ascites, pleural effusion, and elevated tumor markers. She underwent a radical hysterectomy with a presumption of an ovarian neoplasm involving the peritoneum. Imaging findings included a right ovarian bilobed lesion with high T2 signal intensity, a shading sign, a fluid-fluid level, and thick walls. The final pathological diagnosis was endometriosis.
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