Differential Diagnosis for Bilateral Solid Appearing Ovarian Lesions

Single Most Likely Diagnosis

• Benign Ovarian Neoplasms (e.g., Fibromas, Thecomas): Given the solid appearance and the presence of mild internal flow, benign neoplasms are a strong consideration, especially since the risk of malignancy (ROMA) scores are relatively low, indicating a lower likelihood of cancer.

Other Likely Diagnoses

• Ovarian Metastases: Although less common, metastases to the ovaries from other primary cancers (e.g., gastrointestinal, breast) could present as solid lesions. The varying degrees of internal flow and different ROMA scores might suggest different primary sources or stages of disease.
• Borderline Ovarian Tumors: These are tumors of low malignant potential, which could exhibit solid components and variable vascularity. They are less common than benign or malignant tumors but should be considered in the differential.
• Germ Cell Tumors: While often presenting in younger women, germ cell tumors can appear solid on imaging and have a variable risk of malignancy. The presence of internal flow might suggest a more vascular tumor, such as a dysgerminoma.

Do Not Miss Diagnoses

• Ovarian Cancer: Despite the relatively low ROMA scores, ovarian cancer must be considered, especially in postmenopausal women or those with risk factors. Missing a diagnosis of ovarian cancer could have significant implications for treatment and prognosis.
• Sex Cord-Stromal Tumors with Malignant Potential (e.g., Granulosa Cell Tumors): These tumors can present with solid components and have a potential for malignancy. They are less common but critical to identify due to their potential impact on fertility and overall health.

Rare Diagnoses

• Ovarian Lymphoma: Primary ovarian lymphoma is extremely rare but can present as solid masses. It's essential to consider this in the differential, especially if other imaging findings or clinical symptoms suggest lymphoma.
• Melanoma Metastases to the Ovaries: In patients with a history of melanoma, metastases to the ovaries could appear as solid lesions. This diagnosis is rare but would significantly impact treatment and prognosis.
• Steroid Cell Tumors: These are rare sex cord-stromal tumors that can produce hormones, leading to clinical symptoms. They might appear solid on imaging and have variable vascularity.