Differential Diagnosis for Bilateral Ovarian Mass Lesions
- Single most likely diagnosis
- Ovarian Cancer: The presence of large complex solid cystic bilateral lower abdomino-pelvic mass lesions arising from bilateral adnexae, encasing the uterus, and showing close approximation to the sigmoid with indistinct fat planes, along with a large amount of ascites, omental thickening/cake, and moderate right pleural effusion, strongly suggests ovarian cancer with omentoperitoneal metastasis.
- Other Likely diagnoses
- Borderline Ovarian Tumors: These tumors can present similarly to ovarian cancer but have a better prognosis. They can also cause large masses and ascites but may not have as extensive metastasis.
- Germ Cell Tumors: Although less common, germ cell tumors can present with large masses and metastasis, especially in younger women.
- Sex Cord-Stromal Tumors: These rare tumors can also present with large masses and have the potential for metastasis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: Although less common, lymphoma can involve the ovaries and present with large masses and systemic symptoms. Missing this diagnosis could lead to a delay in appropriate treatment.
- Metastatic Disease to the Ovaries: Ovaries can be a site for metastasis from other primary cancers (e.g., gastrointestinal, breast). The clinical presentation can mimic primary ovarian cancer, and missing the primary site could alter the treatment approach significantly.
- Rare diagnoses
- Ovarian Leiomyomatosis: A rare condition where smooth muscle tumors (leiomyomas) metastasize to the ovaries, potentially mimicking malignant ovarian tumors.
- Desmoplastic Small Round Cell Tumor (DSRCT): A rare and aggressive tumor that can involve the abdominal cavity, including the ovaries, and presents with masses and ascites.
- Krukenberg Tumors: Metastatic tumors to the ovaries, typically from a gastric primary, which can present as bilateral ovarian masses.