Differential Diagnosis

• Single most likely diagnosis
  • Ovarian cancer: The presence of an ovarian cyst and liver metastasis on ultrasound is highly suggestive of ovarian cancer, which is known to metastasize to the liver and other distant sites.
• Other Likely diagnoses
  • Metastatic cancer from another primary site: Although the ovarian cyst is suggestive of ovarian cancer, it's possible that the primary cancer site is elsewhere (e.g., gastrointestinal, breast) and has metastasized to the ovary and liver.
  • Tuberculosis (TB) with ovarian involvement: TB can cause ovarian cysts and liver involvement, although the absence of pelvic lymphadenopathy makes this less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lymphoma: Although less common, lymphoma can present with ovarian involvement and liver metastasis, and missing this diagnosis could lead to delayed treatment and poor outcomes.
  • Metastatic germ cell tumor: Germ cell tumors can metastasize to the liver and ovary, and missing this diagnosis could lead to delayed treatment and poor outcomes.
• Rare diagnoses
  • Ovarian lymphangioma with liver metastasis: This is a rare benign tumor that can metastasize to the liver, although it's unlikely given the presence of liver metastasis.
  • Krukenberg tumor: This is a rare metastatic tumor to the ovary, usually from a gastrointestinal primary site, which can present with ovarian cysts and liver involvement.