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.

Overview

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/abdominal pain or pressure vaginal bleeding/discharge GI dysturbance Fever Tenderness CT scan/US MRI
Gynecologic
Ovarian Follicular cysts +/– +/–
  • In US we may see a >3 cm simple cyst with no internal echo and with posterior acoustic enhancement
  • simple cyst with no internal echo or septa
  • NA
Theca lutein cysts +/– +/–
Serous cystadenoma/carcinoma
  • >55 y/o
+/– +/–
  • In US we may see simple or multiloculated cyst
  • In serous cystadenocarcinoma we may see papillary projection inside the cyst
  • In serous cystadenocarcinoma we may see ascites
  • In Serous cystadenoma we may see a simple cyst with beak sign, hypointense on T1 and hyperintense on T2
  • In serous cystadenocarcinoma we may see some Solid malignant components inside the cyst with intermediate signal on T1 and T2
Mucinous cystadenoma/carcinoma
  • >55 y/o
+/– +/–
  • Stained glass appearance due to variable signal intensity on T1 and T2
  • The more mucin we have, there is more intensity on T1
  • and less intensity on T2
Endometrioma + + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
Teratoma
  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
Dysgerminoma
  • in the second to third decade of life
+ +/– +/–
  • We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging
  • Sheets fried egg appearance cells
Yolk sac tumor + +
  • High levels of AFP
  • In US we may see a combination of echogenic and hypoechoic components
  • Yellow appearance
  • Schiller-Duval bodies (glomeruli like structures)
Fibroma[1]
  • >50 y/o
  • Pulling sensation in the groin
+/–
  • In CT scan we may see a unilateral mass with poor contrast enhancement
  • Low signal intensity on T1 and T2
Thecoma[2][3][4]
  • >50 y/o
+/–
Granulosa cell tumor
[5][6][7][8]
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
[9][10]
  • 15 to 35 y/o
+/–
  • In US we may see unilateral Well-defined hypoechoic lesion
  • Low T2 signal intensity
  • areas of high signal intensity
Brenner tumor
[11][12]
  • >55 y/o
+/–
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
[13][14]
  • >55 y/o
+/– +/–

Based on underlying malignancy

Tubal tubo-ovarian abscess
[15][16][17][18]
+ + + +
  • hypointense in T1 and heterogeneous in T2
Ectopic pregnancy
[19]
+ + +/– +
  • NA
  • NA
Hydrosalpinx
[20][21][22]
  • NA
+ +/–
  • NA
Salpingitis
[23]
+ + + +
  • In US we may see , edematous and thickened endosalpingeal folds
  • NA
  • NA
Fallopian tube carcinoma
[24]
  • >60 y/o
+ + + +/–
  • Low signal on T1
  • In case of hemorrhage inside the tumor we may see high signal intensity on T1
  • Low or of intermediate signal on T2
  • Based on the tumor type we may have different biopsy finding
Uterine Leiomyoma
[25][26]
+ + +/–
  • Low to intermediate signal intensity on T1 and T2
  • In case of necrosis inside the mass, there might be some high signal lesions on T2
Choriocarcinoma
[27][28][29][30]
+ + +/– +
  • We may see an infiltrative uterine mass and thickening of uterine wall
Leiomyosarcoma
[31][32][33][34][35]
  • >55 y/o
+ + +/–
  • Increased uterine size
  • Irregular central zones of low signal intensity (tumor necrosis)
Pregnancy
[36]
+/− +/− +/−
  • NA
Non-gynecologic
GIT Appendiceal abscess
[37]
  • NA
+ + +/– +
  • NA
Appendiceal neoplasm
[38][39][40][41][42]
+ + +/–
  • Soft tissue mass in the appendix
  • We may see invasion to other structures
  • Gray/yellowi color
  • Cystic structures with angiolymphatic invasion
Diverticular abscess
[43]
  • >50 y/o
+ + +/– +
  • Ill-defined lesion with air and fluid inside
  • Adjacent bowel loop wall thickening
  • Smudged mesenteric fat
  • We may see a lesion with air and fluid inside
  • NA
Colorectal cancer
[44][45][46][47]
  • >50 y/o
+ + +/–
  • We may see tumor mass and the extension of tumor to other structures
Renal

Bladder

Pelvic kidney
[48][49]
  • NA
−/+

In case of sever hydronephrosis or renal stone we may have pelvic pain

  • We may see normal kidney structure
  • NA
  • It may cause tract infection (UTI), obstruction, and renal calculi.
  • It may be associated with RCC
Bladder cancer
[50][51][52]
  • ≥65 y/o
+
  • isointense compared to muscle in T1
  • slightly hyperintense compared to muscle in T2
Others Retroperitoneal sarcoma
[53][54][55][56]
  • 40-50 y/o
+ +

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

  • Bladder tumour–associated antigen (BTA)
  • Nuclear matrix proteins (NMP)
  • Mucin and carcinoembryonic antigen (CEA)

References

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