33 year old lady complains of cyclical pain, usually just before the onset of menstruation, as well as pelvic discomfort She and her husband have been trying unsuccessfully to conceive for the past 2 years.
Both ovaries are enlarged and pale due to fibrosis. In the left ovary, there is a unilocular cyst with a dark brown to blackish haemorrhagic inner surface. No solid or papillary areas are identified. Several smaller cysts are also noted in the left ovary.
On the posterior uterine serosa, small foci of haemorrhage are noted, possibly representing areas of endometriosis.