<prompt> A 35-year-old woman presents with infertility and palpable pelvic mass. Her CA-125 level is 90 mIUmL diagnosis is:Ovarian CaEndometriomaTuberculosisBorderline ovarian tumor  <response>: Ans. is b, i.e. EndometriomaRef Novak Gynecology 14thed, p1466, 1146, 1147; Williams Gynae 1sted, p232,210 Textbook of Gynae, sheila Balakrishnan p185In this question we have insufficient information to make any definite diagnosis. At the best we can try to make the most probable diagnosis.CA-125 This is a non-specific tumor marker CA-125 is a glycoprotein which is normally not produced by ovarian epithelium but may be produced by both malignant and benign epithelial ovarian tumors. Cut off level of CA-125 is 35UmL. Levels of CA-125 can be raised in CA-125Neoplastic conditionsNon-neoplasticBenign conditionsGynecological Ovarian cancer non mucinous Endometrial cancer Tubal cancerNon-gynecological Lung cancer Breast cancer Ca Pancreas Colon cancer Endometriosis Peritoneal inflammation, including PID Tuberculosis Hemorrhagic ovarian cysts Liver disease Leiomyoma Pregnancy Menstruation Thus, CA-125 levels, can be raised in all the four options, given in the question Palpable mass may also be present in all the four conditions. Infertility is a feature of endometriosis and tuberculosis. But for ovarian cancers, infertility due to use of ovulation inducing drugs is a risk factor, not a presenting symptom. Coming to Age: Patient is 35 years old. Age of 35 years favors endometrioma endometriosis the most. Peak incidence of invasive epithelial ovarian cancer most common ovarian cancer is at 56-60 years of age and for border line tumor average age is 46 years approximately - Novak 14thed, p1466 Patient with tuberculosis are in their twenties commonly, the maximum age incidence at diagnosis being 28 years. Also in tuberculosis, CA-125 has least significance as it is neither used for diagnosis nor for follow up Thus, based on age and infertility - the most probable diagnosis is endometriomaendometriosis. Our answer is further supported by following lines from - Textbook ofgynae, Sheila Balakrishnan 1sted, p185 Serum CA 125 This is useful in post menopausal women when a high level may indicate malignancy. In the reproductive age group, the predictive value is not good as the marker may be raised in endometriosis.In young females if the value of CA-125 is 200IUmL, it is considered to indicate malignancy. 