Differential Diagnosis for Postmenopausal Woman with Small Septated Cysts

Single Most Likely Diagnosis

• Simple Ovarian Cysts: These are common in postmenopausal women and can be multiple, septated, and vary in size. They are usually benign and can be monitored with serial ultrasounds.

Other Likely Diagnoses

• Ovarian Fibromas: These are benign tumors that can present as septated cysts. They are more common in postmenopausal women and can cause symptoms due to their size or torsion.
• Hemorrhagic Ovarian Cysts: Although less common in postmenopausal women, these can occur and may appear septated due to clot formation.
• Endometriomas: If the patient has a history of endometriosis, these cysts could be considered, especially if they are septated and contain low-level echoes suggesting old blood.

Do Not Miss Diagnoses

• Ovarian Cancer: Although less likely, ovarian cancer must be considered, especially in postmenopausal women. The presence of septations and solid components increases the suspicion for malignancy. CA-125 levels and further imaging or biopsy may be necessary.
• Borderline Ovarian Tumors: These are tumors of low malignant potential that can present similarly to benign cysts but have a higher risk of recurrence and potential for malignant transformation.

Rare Diagnoses

• Dermoid Cysts (Mature Cystic Teratomas): While more common in younger women, these can occur in postmenopausal women and may appear as complex, septated masses due to their varied contents (e.g., hair, teeth, fat).
• Ovarian Metastases: In a patient with a known history of cancer, metastases to the ovaries could present as multiple, septated cysts. This would be a rare but important consideration in the differential diagnosis.