Differential Diagnosis for Abdominal Pain and Adnexal Mass
The patient presents with intermittent abdominal cramping and a palpable right adnexal mass. The following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Ovarian Cyst: The presence of a thin-walled, 4-cm right adnexal mass with multiple irregular, thickened internal septations on ultrasound is suggestive of an ovarian cyst, possibly a benign neoplasm such as a serous or mucinous cystadenoma. The patient's symptoms and ultrasound findings are consistent with this diagnosis.
- Other Likely Diagnoses
- Endometrioma: Given the patient's history of stopping oral contraceptives and attempting to conceive, an endometrioma is a possible diagnosis. The presence of a palpable adnexal mass and the patient's symptoms could be consistent with an endometrioma, especially if she has a history of endometriosis.
- Dermoid Cyst: A dermoid cyst (mature teratoma) is another possible diagnosis, as it can present as a complex adnexal mass with septations on ultrasound.
- Do Not Miss Diagnoses
- Ovarian Torsion: Although the patient's symptoms are intermittent and not severe, ovarian torsion is a life-threatening condition that requires prompt diagnosis and treatment. The presence of an adnexal mass increases the risk of torsion.
- Ectopic Pregnancy: Despite a negative urine pregnancy test, ectopic pregnancy should always be considered in a woman of childbearing age with abdominal pain and an adnexal mass.
- Ovarian Cancer: Although less likely in a young woman, ovarian cancer is a possibility, especially given the patient's family history of breast cancer (which may indicate a BRCA mutation).
- Rare Diagnoses
- Germ Cell Tumor: Germ cell tumors, such as dysgerminomas or yolk sac tumors, are rare ovarian neoplasms that can present with an adnexal mass and abdominal pain.
- Sex Cord-Stromal Tumor: Sex cord-stromal tumors, such as granulosa cell tumors, are rare ovarian neoplasms that can present with an adnexal mass and hormonal symptoms.