Ovarian Cancer (Answer: B)
The diagnosis is ovarian cancer (Option B), as the combination of an adnexal mass with systemic symptoms including weight loss, shortness of breath, and dysplasia represents the classic presentation of advanced-stage ovarian malignancy with metastatic disease. 1
Clinical Reasoning
The clinical presentation points definitively toward ovarian cancer through several key features:
Adnexal mass location: The mass originates from the ovary/fallopian tube region (adnexa), which directly indicates ovarian pathology rather than uterine, endometrial, or cervical origin 2
Shortness of breath: This symptom in the context of an adnexal mass strongly suggests pleural effusion, which occurs in stage IV ovarian cancer through peritoneal-pleural communication and lymphatic obstruction 3, 1
Weight loss: This constitutional symptom reflects advanced malignancy with systemic disease burden, characteristic of metastatic ovarian cancer 3
Dysplasia: While the term is somewhat unusual in this context, it likely refers to cellular atypia or malignant transformation, consistent with ovarian carcinoma 3
Why Other Options Are Incorrect
Uterine sarcoma (Option A) does not typically present with adnexal masses as the primary finding, as these tumors arise from the uterine corpus itself 1, 2
Endometrial cancer (Option C) rarely causes pleural effusion or significant ascites, and would not manifest as an adnexal mass 2
Cervical cancer (Option D) does not typically present with adnexal masses or pleural effusion as initial manifestations 2
Diagnostic Features Supporting Ovarian Cancer
The American College of Radiology identifies specific imaging and clinical features that characterize malignant adnexal masses 3:
- Ascites and pleural effusions are key imaging features in malignant adnexal masses 1, 2
- Systemic symptoms (weight loss, shortness of breath) combined with an adnexal mass are highly suggestive of ovarian cancer rather than other gynecologic malignancies 1
- Stage IV disease commonly presents with shortness of breath due to pleural effusion 3
Clinical Context
Most ovarian cancers (64-81%) diagnosed are advanced stage, with high-grade serous carcinoma accounting for nearly 80% of ovarian cancer deaths 3. The presence of systemic symptoms indicates likely advanced-stage disease (Stage III-IV), which unfortunately represents the majority of ovarian cancer presentations due to the lack of effective early screening 3.