Differential Diagnosis
- Single most likely diagnosis
- Ovarian cancer: The presence of bilateral ovarian enlargement, free fluid in the rectouterine pouch, and mucin-filled cells with flat, peripheral nuclei on biopsy specimens are highly suggestive of ovarian cancer, particularly a mucinous subtype.
- Other Likely diagnoses
- Metastatic cancer (e.g., gastrointestinal cancer): The presence of mucin-filled cells could also suggest metastasis from a gastrointestinal primary tumor, such as gastric or colon cancer.
- Meigs' syndrome: Although less likely, Meigs' syndrome (a benign ovarian tumor associated with ascites and pleural effusion) could be considered, but the biopsy findings would not typically show mucin-filled cells.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tuberculosis: Although less common, tuberculosis can cause ovarian enlargement, ascites, and peritoneal involvement, and it is essential to consider this diagnosis, especially if the patient has risk factors or exposure history.
- Lymphoma: Ovarian involvement by lymphoma can cause similar symptoms and findings, and it is crucial to rule out this diagnosis due to its potential for aggressive behavior.
- Rare diagnoses
- Pseudomyxoma peritonei: A rare condition characterized by recurrent mucinous ascites, often associated with a primary appendiceal or ovarian tumor.
- Sclerosing peritonitis: A rare condition that can cause abdominal pain, ascites, and ovarian enlargement, often associated with chronic peritoneal inflammation.