OVARIAN CARCINOMA

DIFFERENTIAL DIAGNOSIS
AND
INVESTIGATIONS

PRACHI
ROLL NO.-59
 DIFFERENTIAL DIAGNOSIS
• Pregnancy
• Full bladder
• Fibroid
• Functional cyst
• Ascites
• Fallopian tube carcinoma
• Ovarian Endometrioma (chocolate cyst)
• Pregnancy with fibroid
• Encysted peritonitis
PREGNANT UTERUS
• Careful bimanual examination is made and signs of pregnancy are
looked for exclusion.
• Appropriate investigations such as ultrasonic examination and a
pregnancy test will help to rule out pregnancy.
• Mistakes are made because this possibility is not considered, especially
in an unmarried girl who denies history of amenorrhoea.

FULL BLADDER
• Full bladder is tense and tender, fixed in position, anterior to the
uterus and projecting anteriorly more than an ovarian cyst.
• A catheter should be placed to establish the diagnosis.
FIBROID
• Confusion arises especially in cases of subserous fibroid more so, if
degeneration occurs.
• Ultrasonography or laparoscopy is helpful.

FUNCTIONAL CYST
• These cysts are usually small.
• Ultrasonography or re-examination after 4-6 weeks solve the diagnosis in most
cases.
• The follicular or corpus luteum cyst usually regresses, while neoplastic cyst
usually increases in size .
• Laparoscopy is of help.
ASCITES
• In ascites, the percussion note is dull over the flanks, while the
abdomen is tympanic in the midline.
• While in large ovarian cyst, the note over the tumour is dull, whereas
both flanks are resonant.
• Physical signs of shifting dullness
present in ascites.
FALLOPIAN TUBE CARCINOMA
• Fallopian tube carcinoma on bimanual examination reveals a unilateral
mass which may be tender.
• It reduces in size on compression, along with a watery discharge through
the cervix.
• In Ovarian carcinoma on per abdomen examination a mass is felt in the
hypogastrium; too often it may be bilateral.
• In ultrasound a fluid filled sausage shaped mass separate from the uterus
and ovary is seen in fallopian tube carcinoma.
• Ascites may be present.
OVARIAN ENDOMETRIOMA (Chocolate cyst)
• If asymptomatic, may be confused with benign ovarian tumor and in
symptomatic one, with malignant ovarian tumor.
• Presence of nodules in pouch of Douglas further confuses the diagnosis.
• Ultrasonography showing homogenous
internal echoes may be helpful.
• Laparoscopy differentiates one from other.
• Too often, the diagnosis is made only
during laparotomy.
PREGNANCY WITH FIBROID
• In such condition, the pregnant uterus feels more soft and cystic but the
fibroid feels little firm.
• As such, the former is confused as ovarian cyst and the latter one as
uterus .
• USG is useful to differentiate .

ENCYSTED PERITONITIS
• There may be features of tubercular infection
• The encysted mass is usually irregular ,not movable with ill defined
margins and usually situated high ups .
• Pelvic examination usually gives us a negative findings
 INVESTIGATIONS
To Confirm Malignancy
• Cytologic examination for detection of malignant cells from the fluid collected by
abdominal paracentesis or “cul-de-sac” aspiration.
• Tumor marker: elevated CA-125 level >65 U/ml with a pelvic mass may be
suggestive.

To Identify the Extent of Lesion

• Straight X-ray chest to exclude pleural effusion and chest metastasis.
• Barium enema to detect any colon or rectal cancer.
• Ultrasound imaging: to detect involvement of omentum or contralateral ovary.
• Computed tomography (CT) for retroperitoneal lymph node
assessment and detection of metastasis (liver, omentum). It helps in
staging of ovarian carcinoma.
• Magnetic resonance imaging (MRI) to determine the nature of ovarian
neoplasm and also for the retroperitoneal lymph nodes and detection
of metastasis.
• Positron emission tomography (PET) can differentiate normal tissue
from cancerous tissues.
• Intravenous pyelography.
• Examination under anesthesia.
• Diagnostic uterine curettage.
To Detect the Primary Site
• Barium meal X- ray
• Gastroscopy / colonoscopy
• Mammography.
Thank You.