Differential Diagnosis
- Single most likely diagnosis
- Ovarian fibroma: This is the most likely diagnosis given the presence of a hypoechoic mass involving the left ovary and the histologic evaluation showing clusters of spindle-shaped cells, which are characteristic of fibromas. Ovarian fibromas are known to produce ascites, which would explain the large collection of peritoneal fluid and the symptoms of shortness of breath due to the increased abdominal pressure.
- Other Likely diagnoses
- Ovarian thecoma: Thecomas are also composed of spindle-shaped cells and can produce estrogen, but they are less likely to cause ascites compared to fibromas. However, they can still be considered in the differential diagnosis.
- Serous cystadenoma: While serous cystadenomas are common ovarian tumors, they are typically filled with fluid and may not match the hypoechoic mass described. However, they can cause ascites and should be considered.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ovarian cancer: Although the histologic evaluation shows spindle-shaped cells, which are more characteristic of benign tumors, ovarian cancer should always be considered in the differential diagnosis, especially in postmenopausal women. A missed diagnosis of ovarian cancer could be deadly.
- Rare diagnoses
- Dermoid cyst: Dermoid cysts are benign tumors that can contain a variety of tissues, but they are not typically composed of spindle-shaped cells and are less likely to cause ascites.
- Endometrioma: Endometriomas are cysts filled with old blood and are associated with endometriosis. They are not typically composed of spindle-shaped cells and are less likely to cause ascites.