Epithelial ovarian tumors differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Ovarian_cancer]]
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Epithelial_ovarian_tumors]]


{{CMG}}; {{AE}} {{HMHJ}}
{{CMG}}; {{AE}} {{Fs}} {{AE}} {{HMHJ}}
==Overview==
==Overview==
On the basis of age of onset, [[vaginal discharge]], and constitutional symptoms, ovarian cancer must be differentiated from [[tubo-ovarian abscess]], [[ectopic pregnancy]], [[hydrosalpinx]], [[salpingitis]], [[fallopian tube]] [[carcinoma]], [[uterine leiomyoma]], [[choriocarcinoma]], [[leiomyosarcoma]], [[pregnancy]], [[Appendix|appendiceal]] [[abscess]], [[Appendiceal cancer|appendiceal neoplasm]], [[diverticular abscess]], [[colorectal cancer]], [[pelvic kidney]], advanced [[bladder cancer]], and [[retroperitoneal]] [[sarcoma]].
On the basis of age of onset, [[vaginal discharge]], and constitutional symptoms, ovarian cancer must be differentiated from [[tubo-ovarian abscess]], [[ectopic pregnancy]], [[hydrosalpinx]], [[salpingitis]], [[fallopian tube]] [[carcinoma]], [[uterine leiomyoma]], [[choriocarcinoma]], [[leiomyosarcoma]], [[pregnancy]], [[Appendix|appendiceal]] [[abscess]], [[Appendiceal cancer|appendiceal neoplasm]], [[diverticular abscess]], [[colorectal cancer]], [[pelvic kidney]], advanced [[bladder cancer]], and [[retroperitoneal]] [[sarcoma]].
==Differentiating ovarian cancer from other Diseases==
==Differentiating Ovarian Cancer from Other Diseases==
===Differentiating ovarian cancer from other diseases on the basis of age of onset, vaginal discharge and constitutional symptoms===
===Differentiating ovarian cancer from other diseases on the basis of age of onset, vaginal discharge and constitutional symptoms===


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* We may see [[Atypia|atypical cells]], high [[mitotic]] rate, geographic areas of [[coagulative necrosis]] separated from viable [[neoplasm]]
* We may see [[Atypia|atypical cells]], high [[mitotic]] rate, geographic areas of [[coagulative necrosis]] separated from viable [[neoplasm]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* In case of rapid [[uterine]] growth in post [[Menopause|menopausal]] [[women]] we may suspect [[uterine sarcoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pregnancy]]<br><ref name="CacctatoreTttttnen1990">{{cite journal|last1=Cacctatore|first1=Bruno|last2=Tttttnen|first2=Atla|last3=Stenman|first3=Ulf-Hakan|last4=Ylostalo|first4=Pekka|title=Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings|journal=BJOG: An International Journal of Obstetrics and Gynaecology|volume=97|issue=10|year=1990|pages=899–903|issn=1470-0328|doi=10.1111/j.1471-0528.1990.tb02444.x}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG|BhCG]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see ​[[gestational sac]], [[yolk sac]], double bleb sign and [[fetal]] pore
* In [[CT scan]] we may see [[cystic]] structure filled with fluid, curvilinear enhancing structure ([[placenta]]) and [[fetal]] pore
| style="background: #F5F5F5; padding: 5px;" |
* [[Cystic]] structure filled with fluid
* Curvilinear enhancing structure ([[placenta]])
* [[Fetal]] pore
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[laboratory]]<br>findings
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[CT scan]] and [[MRI]] in [[pregnancy]] but We may unintentionally image the [[pregnancy]] with [[CT scan]] and [[MRI]].
|-
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Non-gynecologic
|-
| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal tract|GIT]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendix|Appendiceal]] [[abscess]]<br><ref name="pmid16037513">{{cite journal |vauthors=Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C |title=CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings |journal=AJR Am J Roentgenol |volume=185 |issue=2 |pages=406–17 |date=August 2005 |pmid=16037513 |doi=10.2214/ajr.185.2.01850406 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Fluid collection in the [[appendicular]] region
* [[appendicolith]] may be visualized.
| style="background: #F5F5F5; padding: 5px;" |
* Fluid collection in the [[appendicular]] region
* [[appendicolith]] may be visualized.
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]/<br>[[History and Physical examination|history]]
| style="background: #F5F5F5; padding: 5px;" |
* The most common [[complication]] of [[acute appendicitis]]
* It may cause pleural effusion
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendix cancer|Appendiceal  neoplasm]]<br><ref name="WHO">Chapter 5: Tumours of the Appendix - IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019</ref><ref name="GoedeCaplin2003">{{cite journal|last1=Goede|first1=A. C.|last2=Caplin|first2=M. E.|last3=Winslet|first3=M. C.|title=Carcinoid tumour of the appendix|journal=British Journal of Surgery|volume=90|issue=11|year=2003|pages=1317–1322|issn=0007-1323|doi=10.1002/bjs.4375}}</ref><ref name="Pablo CarmignaniHampton2004">{{cite journal|last1=Pablo Carmignani|first1=C.|last2=Hampton|first2=Regina|last3=E. Sugarbaker|first3=Christina|last4=Chang|first4=David|last5=H. Sugarbaker|first5=Paul|title=Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix|journal=Journal of Surgical Oncology|volume=87|issue=4|year=2004|pages=162–166|issn=0022-4790|doi=10.1002/jso.20107}}</ref><ref name="pmid20587792">{{cite journal |vauthors=Limsui D, Vierkant RA, Tillmans LS, Wang AH, Weisenberger DJ, Laird PW, Lynch CF, Anderson KE, French AJ, Haile RW, Harnack LJ, Potter JD, Slager SL, Smyrk TC, Thibodeau SN, Cerhan JR, Limburg PJ |title=Cigarette smoking and colorectal cancer risk by molecularly defined subtypes |journal=J. Natl. Cancer Inst. |volume=102 |issue=14 |pages=1012–22 |date=July 2010 |pmid=20587792 |pmc=2915616 |doi=10.1093/jnci/djq201 |url=}}</ref><ref name="pmid2886072">{{cite journal |vauthors=Duh QY, Hybarger CP, Geist R, Gamsu G, Goodman PC, Gooding GA, Clark OH |title=Carcinoids associated with multiple endocrine neoplasia syndromes |journal=Am. J. Surg. |volume=154 |issue=1 |pages=142–8 |date=July 1987 |pmid=2886072 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 60-70 y/o for [[adenocarcinoma]],
* 30-50 y/o for [[Carcinoid cancer|carcinoid]] tumors
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* In [[adenocarcinoma]] type we may have high levels of [[CEA]] and [[CA 19-9]]
* In [[Carcinoid cancer|carcinoid]] type we may see high levels of [[chromogranin A]], [[5-HIAA]] and Ki67
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see:
** [[Soft tissue]] thickening and Cystic lesion with Internal septation
** Wall irregularity
** [[Calcification]]
** Peri-[[Appendix|appendiceal]] fat stranding
| style="background: #F5F5F5; padding: 5px;" |
* Soft tissue mass in the [[appendix]]
* We may see invasion to other structures
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* Gray/yellowi color
* Cystic structures with angiolymphatic invasion
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
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* It is associated with:
** [[MEN1 syndrome]]
** [[Ulcerative colitis]]
** [[Neurofibromatosis type 1]]
** [[HNPCC]]
** [[Smoking]]
* It may cause pleural effusion
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Colorectal cancer]]<br><ref name="ZhuKaneshiro2010">{{cite journal|last1=Zhu|first1=Amy|last2=Kaneshiro|first2=Marc|last3=Kaunitz|first3=Jonathan D.|title=Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective|journal=Digestive Diseases and Sciences|volume=55|issue=3|year=2010|pages=548–559|issn=0163-2116|doi=10.1007/s10620-009-1108-6}}</ref><ref name="pmid10528904">{{cite journal| author=Macdonald JS| title=Carcinoembryonic antigen screening: pros and cons. | journal=Semin Oncol | year= 1999 | volume= 26 | issue= 5 | pages= 556-60 | pmid=10528904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10528904  }}</ref><ref name="pmid21037809">{{cite journal |vauthors=Haggar FA, Boushey RP |title=Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors |journal=Clin Colon Rectal Surg |volume=22 |issue=4 |pages=191–7 |date=November 2009 |pmid=21037809 |pmc=2796096 |doi=10.1055/s-0029-1242458 |url=}}</ref><ref name="pmid2014406">{{cite journal| author=Taylor AJ, Youker JE| title=Imaging in colorectal carcinoma. | journal=Semin Oncol | year= 1991 | volume= 18 | issue= 2 | pages= 99-110 | pmid=2014406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2014406  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* [[Anemia]]
* Positive [[Fecal occult blood test]]
* High levels of [[CEA]] and [[CA 19-9]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see luminal narrowing, [[intestinal]] wall thickening,[[intussusception]], [[bowel obstruction]], [[Metastases|hepatic metastases]], intestinal perforation,[[enlarged lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[tumor]] mass and the extension of [[tumor]] to other structures
* We may see [[metastasis]] to the [[liver]], [[lung]] and [[brain]]
| style="background: #F5F5F5; padding: 5px;" |
* Based on the sub-type we may have different [[histopathological]] feature (for more information [[Colorectal cancer|click here]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[smoking]], positive [[family history]], processed meat, low [[Dietary fiber|fiber]] diet, [[Hereditary nonpolyposis colorectal cancer|lynch Syndrome]] and [[familial adenomatous polyposis]]
* They have apple core lesion on [[barium enema]] [[X-ray|xray]]
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal]]
[[Bladder]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic kidney]]<br><ref name="WeizerSpringhart2005">{{cite journal|last1=Weizer|first1=Alon Z.|last2=Springhart|first2=W. Patrick|last3=Ekeruo|first3=Wesley O.|last4=Matlaga|first4=Brian R.|last5=Tan|first5=Yeh H.|last6=Assimos|first6=Dean G.|last7=Preminger|first7=Glenn M.|title=Ureteroscopic management of renal calculi in anomalous kidneys|journal=Urology|volume=65|issue=2|year=2005|pages=265–269|issn=00904295|doi=10.1016/j.urology.2004.09.055}}</ref><ref name="RossKay1998">{{cite journal|last1=Ross|first1=Jonathan H.|last2=Kay|first2=Robert|title=URETEROPELVIC JUNCTION OBSTRUCTION IN ANOMALOUS KIDNEYS|journal=Urologic Clinics of North America|volume=25|issue=2|year=1998|pages=219–225|issn=00940143|doi=10.1016/S0094-0143(05)70010-0}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−/+
In case of sever [[hydronephrosis]] or [[renal stone]] we may have [[pelvic]] [[pain]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
* In [[sonography]] we may see normal appearing [[kidney]] in [[Pelvis|pelvic]] position
* We may see [[renal calculi]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see normal [[kidney]] structure
* [[Renal calculi]]
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[hypertension]]
* It may cause tract infection ([[Urinary tract infection|UTI]]), obstruction, and [[renal calculi]].
* It may be associated with [[RCC]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder cancer]]<br><ref name="pmid8797968">{{cite journal |vauthors=Barentsz JO, Jager GJ, Witjes JA, Ruijs JH |title=Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT |journal=Eur Radiol |volume=6 |issue=2 |pages=129–33 |date=1996 |pmid=8797968 |doi= |url=}}</ref><ref name="pmid18660854">{{cite journal |vauthors=Shariat SF, Karam JA, Lotan Y, Karakiewizc PI |title=Critical evaluation of urinary markers for bladder cancer detection and monitoring |journal=Rev Urol |volume=10 |issue=2 |pages=120–35 |date=2008 |pmid=18660854 |pmc=2483317 |doi= |url=}}</ref><ref name="pmid10918764">{{cite journal |vauthors=Metts MC, Metts JC, Milito SJ, Thomas CR |title=Bladder cancer: a review of diagnosis and management |journal=J Natl Med Assoc |volume=92 |issue=6 |pages=285–94 |date=June 2000 |pmid=10918764 |pmc=2640522 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* ≥65 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* Low [[red blood cell]] count
* Elevated [[alkaline phosphatase]]
* Positive [[Tumor marker|tumor markers]] such as BTA, NMP, and [[CEA]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see masses protruding into the [[bladder]] lumen or asymmetric thickening of the [[bladder]]
* [[Calcification|calcifications]]
* Nodal [[metastases]]
| style="background: #F5F5F5; padding: 5px;" |
* isointense compared to [[muscle]] in T1
* slightly hyperintense compared to [[muscle]] in T2
| style="background: #F5F5F5; padding: 5px;" |
* Based on the sub-type we may have different [[Histopathology|histopathological]] feature (for more information [[Bladder cancer|click here]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may presents with [[hematuria]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Others
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Retroperitoneum|Retroperitoneal]] [[sarcoma]]<br><ref name="pmid2064467">{{cite journal |vauthors=Storm FK, Mahvi DM |title=Diagnosis and management of retroperitoneal soft-tissue sarcoma |journal=Ann. Surg. |volume=214 |issue=1 |pages=2–10 |date=July 1991 |pmid=2064467 |pmc=1358407 |doi= |url=}}</ref><ref name="pmid16154826">{{cite journal |vauthors=Francis IR, Cohan RH, Varma DG, Sondak VK |title=Retroperitoneal sarcomas |journal=Cancer Imaging |volume=5 |issue= |pages=89–94 |date=August 2005 |pmid=16154826 |doi=10.1102/1470-7330.2005.0019 |url=}}</ref><ref name="SilversteinWakim1964">{{cite journal|last1=Silverstein|first1=Murray N.|last2=Wakim|first2=Khalil G.|last3=Bahn|first3=Robert C.|title=Hypoglycemia associated with neoplasia|journal=The American Journal of Medicine|volume=36|issue=3|year=1964|pages=415–423|issn=00029343|doi=10.1016/0002-9343(64)90168-8}}</ref><ref name="pmid20644672">{{cite journal |vauthors=Storm FK, Mahvi DM |title=Diagnosis and management of retroperitoneal soft-tissue sarcoma |journal=Ann. Surg. |volume=214 |issue=1 |pages=2–10 |date=July 1991 |pmid=2064467 |pmc=1358407 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 40-50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
* Mild [[leukocytosis]].
* It may cause [[hypoglycemia]] because of production of [[Insulin-like growth factor|insulinlike]] substances
| style="background: #F5F5F5; padding: 5px;" |
* We may see irregular solid, semisolid, [[Liquefactive necrosis|liquefactive]] areas and patchy [[necrosis]] on [[CT scan]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[Retroperitoneum|retroperitoneal]] involvement and degree of [[tumor]] extension
* We may see [[liver]] and [[lung]] [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" |
* There are two types:  [[liposarcoma]] and [[leiomyosarcoma]]
* In [[Liposarcoma|liposarcomas]] we may see background of [[Adipocyte|adipocytes]] with scattered lipoblasts, and [[Inflammatory cells|inflammatory cell]] infiltrate
* In [[leiomyosarcoma]] we may see smooth [[muscle cells]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* May cause [[lower extremity]] [[edema]], Serous [[ascites]]
* we should perform [[chest]] [[CT scan]] to rule out [[pulmonary]] [[metastases]]
|}
'''ABBREVIATIONS'''
BTA=Bladder tumor associated antigen, NMP= Nuclear matrix proteins, [[CEA]]= [[Carcinoembryonic antigen]], [[Ultrasound|US]]= [[Ultrasound]], [[Human chorionic gonadotropin|HCG]]= [[Human chorionic gonadotropin]], [[Lactate dehydrogenase|LDH]]= [[Lactate dehydrogenase]], [[AFP]]= [[AFP|Alpha fitoprotein]], [[CA125]]= [[CA125|Cancer antigen 125]], [[H&E]]= [[Hematoxylin and eosin stain|Hematoxylin and eosin]], [[MRI]]= [[Magnetic resonance imaging]], [[GI]]= [[Gastrointestinal tract]], [[PID]]= [[Pelvic inflammatory disease]], [[CA19-9]]= [[CA-19-9|Carbohydrate antigen 19-9]], [[5-hydroxyindoleacetic acid|5HIAA]]= [[5-Hydroxyindoleacetic acid|5-hydroxyindoleacetic acid]], [[MEN syndromes|MEN syndrome]]= [[Multiple endocrine neoplasia|Multiple endocrine neoplasia syndrome]], [[HNPCC]]= [[Hereditary nonpolyposis colorectal cancer]], [[UTI]]= [[Urinary tract infection]], [[RCC]]= [[Renal cell carcinoma]]
|}
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 19:20, 14 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]

Overview

On the basis of age of onset, vaginal discharge, and constitutional symptoms, ovarian cancer must be differentiated from tubo-ovarian abscess, ectopic pregnancy, hydrosalpinx, salpingitis, fallopian tube carcinoma, uterine leiomyoma, choriocarcinoma, leiomyosarcoma, pregnancy, appendiceal abscess, appendiceal neoplasm, diverticular abscess, colorectal cancer, pelvic kidney, advanced bladder cancer, and retroperitoneal sarcoma.

Differentiating Ovarian Cancer from Other Diseases

Differentiating ovarian cancer from other diseases on the basis of age of onset, vaginal discharge and constitutional symptoms

On the basis of age of onset, vaginal discharge, and constitutional symptoms, ovarian cancer must be differentiated from tubo-ovarian abscess, ectopic pregnancy, hydrosalpinx, salpingitis, fallopian tube carcinoma, uterine leiomyoma, choriocarcinoma, leiomyosarcoma, pregnancy, appendiceal abscess, appendiceal neoplasm, diverticular abscess, colorectal cancer, pelvic kidney, advanced bladder cancer, and retroperitoneal sarcoma.

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
[1]
+/– +/–
  • 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
[2][3][4]
+/– +/–
Serous cystadenoma/carcinoma
[5][6][7][8]
  • >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
[9][10][11]
  • >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
[12][13][14]
+ + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
Teratoma
[15][16][17][18]


  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
Dysgerminoma
[19][20]
  • 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
[21][22][23]
+ +
  • 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
[24][25][26]
  • >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
[27][28][29]
  • >50 y/o
+/–
Granulosa cell tumor
[30][31][32][33]
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
[34][35]
  • 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
[36][37]
  • >55 y/o
+/–
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
[38][39]
  • >55 y/o
+/– +/–

Based on underlying malignancy

Tubal tubo-ovarian abscess
[40][41][42][43]
+ + + +
  • hypointense in T1 and heterogeneous in T2
Ectopic pregnancy
[44]
+ + +/– +
  • NA
  • NA
Hydrosalpinx
[45][46][47]
  • NA
+ +/–
  • NA
Salpingitis
[48]
+ + + +
  • In US we may see , edematous and thickened endosalpingeal folds
  • NA
  • NA
Fallopian tube carcinoma
[49]
  • >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
[50][51]
+ + +/–
  • 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
[52][53][54][55]
+ + +/– +
  • We may see an infiltrative uterine mass and thickening of uterine wall
Leiomyosarcoma
[56][57][58][59][60]
  • >55 y/o
+ + +/–
  • Increased uterine size
  • Irregular central zones of low signal intensity (tumor necrosis)
Pregnancy
[61]
+/− +/− +/−
  • NA
Non-gynecologic
GIT Appendiceal abscess
[62]
  • NA
+ + +/– +
  • NA
Appendiceal neoplasm
[63][64][65][66][67]
+ + +/–
  • Soft tissue mass in the appendix
  • We may see invasion to other structures
  • Gray/yellowi color
  • Cystic structures with angiolymphatic invasion
Colorectal cancer
[68][69][70][71]
  • >50 y/o
+ + +/–
  • We may see tumor mass and the extension of tumor to other structures
Renal

Bladder

Pelvic kidney
[72][73]
  • 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
[74][75][76]
  • ≥65 y/o
+
  • isointense compared to muscle in T1
  • slightly hyperintense compared to muscle in T2
Others Retroperitoneal sarcoma
[77][78][79][80]
  • 40-50 y/o
+ +

ABBREVIATIONS

BTA=Bladder tumor associated antigen, NMP= Nuclear matrix proteins, CEA= Carcinoembryonic antigen, US= Ultrasound, HCG= Human chorionic gonadotropin, LDH= Lactate dehydrogenase, AFP= Alpha fitoprotein, CA125= Cancer antigen 125, H&E= Hematoxylin and eosin, MRI= Magnetic resonance imaging, GI= Gastrointestinal tract, PID= Pelvic inflammatory disease, CA19-9= Carbohydrate antigen 19-9, 5HIAA= 5-hydroxyindoleacetic acid, MEN syndrome= Multiple endocrine neoplasia syndrome, HNPCC= Hereditary nonpolyposis colorectal cancer, UTI= Urinary tract infection, RCC= Renal cell carcinoma |}

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