Differential Diagnosis for Breast Tenderness and Ovarian Mass
- The patient's presentation of breast tenderness, weight gain, and an ovarian mass suggests a hormonal or malignant process.
Single Most Likely Diagnosis
- Ovarian Cancer: The presence of a large, complex ovarian mass with solid components and multiple septations, along with the patient's symptoms of breast tenderness and weight gain, suggests ovarian cancer as the most likely diagnosis. The tumor marker most likely to be elevated in this patient is CA-125.
Other Likely Diagnoses
- Polycystic Ovary Syndrome (PCOS): Although less likely given the patient's age and menopausal status, PCOS could cause hormonal imbalances leading to breast tenderness and ovarian cysts. However, the large size and complexity of the ovarian mass make this diagnosis less probable.
- Hormone-Secreting Ovarian Tumor: A tumor secreting estrogen, such as a granulosa cell tumor, could cause breast tenderness and endometrial thickening.
Do Not Miss Diagnoses
- Endometrial Cancer: The patient's increased endometrial stripe (9 mm) and the presence of an ovarian mass suggest the possibility of endometrial cancer, which could be related to the ovarian tumor or a separate primary cancer.
- Metastatic Cancer: Although less likely, the presence of a large ovarian mass and breast tenderness could suggest metastatic cancer, such as metastatic breast cancer to the ovary, which would be a critical diagnosis to rule out.
Rare Diagnoses
- Sex Cord-Stromal Tumors: These rare ovarian tumors, including granulosa cell tumors and Sertoli-Leydig cell tumors, can produce hormones leading to breast tenderness and other symptoms.
- Gynandroblastoma: A rare, sex cord-stromal tumor that can produce both estrogen and androgen, leading to a variety of symptoms, including breast tenderness.