Ovarian cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Differentiating [Disease name] from other Diseases

Diseases		Clinical manifestations							Para-clinical findings				Gold standard	Additional findings
		Age of onset	Symptoms			Physical examination
									Lab Findings	Imaging		Immunohistopathology
			pelvic pain or pressure	vaginal discharge	GI dysturbance	Pleural effusion	Fever	Tenderness		CT scan/US	MRI
Gynecologic
Ovarian	Follicular cysts						–							It is associated with hyperestrogenism and endometrial hyperplasia
	Theca lutein cysts						–				Bilateral Multiple			It is associated with hydatidiform moles and choriocarcinoma
	Serous cystadenoma/carcinoma	>55 y/o					–				Bilateral			Most common ovarian neoplasm
	Mucinous cystadenoma/carcinoma	>55 y/o					–							It may cause pseudomyxoma peritonei
	Endometrioma		+				–			Complex mass on US Increased Doppler flow because of increased vascularture It may present with catamenial pneumothorax, hemothorax, and lung nodules in CT scan.	hyperintensity on T1-weighted images and a hypointensity on T2-weighted images Powder burn hemorrhages	Chocolate cyst		Infertility
	Teratoma	10-30 y/o					–		High level of HCG and LDH					It may cause ovarian torsion May content thyroid tissue and cause hyperthyroidism
	Dysgerminoma						–		High level of HCG and LDH			Sheets fried egg appearance cells	Biopsy	Same as male seminomas
	Choriocarcinoma	During or after pregnancy					–		High level of B-hCG			Trophoblastic tissue origin columns and sheets of trophoblastic tissue invading uterine muscle and blood vessels		It is associated with bilateral Theca lutein cysts Cannonball metastases to the lungs May cause hemoptysis
	Yolk sac tumor	Young children Male infants					–		High levels of AFP			Yellow appearance Hemorrhagic Schiller-Duval bodies (glomeruli like structures)	Biopsy	The other name is ovarian endodermal sinus tumor
	Fibroma		Pulling sensation in the groin				–					Spindle-shaped fibroblast		It may cause Meigs syndrome (ovarian fibroma, ascites, and hydrothorax)
	Thecoma			Postmenopausal bleeding			–		High level of estrogen
	Granulosa cell tumor	50-60 y/o		Postmenopausal bleeding			–		High level of estrogen and progestron			Call-Exner bodies	Biopsy	In postmenopausal women may cause breast tenderness
	Sertoli-leydig cell tumor						–							Virilization
	Brenner tumor											Yellow/pale appearance Transitional cell tumor (resembles bladder) Coffee bean nuclei on H&E
	Krukenberg tumor				+						Bilateral	GI adenocarcinoma metastases Mucin-secreting signet cell
Tubal	tubo-ovarian abscess						+							fever and vaginal discharge
	Ectopic pregnancy
	Hydrosalpinx													infertility
	Tuberculosis salpingitis						+/–
	Epithelial carcinoma
	serous tubal intraepithelial neoplasm
Uterine	Myoma
	Sarcoma
	Pregnancy
Non-gynecologic
GIT	Appendiceal abscess				+	+
	Appendiceal neoplasm				+							Soft tissue thickening Wall irregularity Calcification Internal septations Periappendiceal fat stranding Cystic lesion		It is associated with: MEN1 Syndome Ulcerative colitis Neurofibromatosis type 1 HNPCC Smoking
	Diverticular abscess				+	+
	GI neoplasm				+ (abdominal pain Intestinal obstruction and bleeding in small bowel cancer)?
Renal	Pelvic kidney													It may cause tract infection (UTI), obstruction, and renal calculi.
Others	Retroperitoneal sarcoma				+ Gastrointestinal symptoms, such as early satiety, obstruction									May cause lower extremity edema, Serous ascites

check sites of cancer that may metastasize to the ovaries (eg, stomach, colorectal, breast)

check rectum, liver, spleen, lungs, inguinal or supraclavicular lymph nodes for ovary metastase