A 52-year-old postmenopausal woman presents with two months of progressive abdominal distension and decreased appetite. Exam reveals ascites; CT shows multiple pelvic masses with omental thickening. What is the most likely diagnosis?

A 52-year-old postmenopausal woman presents with two months of progressive abdominal distension and decreased appetite. Exam reveals ascites; CT shows multiple pelvic masses with omental thickening. What is the most likely diagnosis?

• A. Ovarian adenocarcinoma
• B. Ectopic pregnancy
• C. Ovarian cystadenoma
• D. Uterine fibroid

Answer: (A)

This scenario tests recognition of advanced ovarian cancer with peritoneal spread. In a postmenopausal woman, new abdominal distension with ascites and imaging showing multiple pelvic masses plus omental thickening is classic for epithelial ovarian carcinoma with peritoneal carcinomatosis. The omentum is a common site for metastatic implants from ovarian cancer, and ascites often results from tumor irritation of the peritoneum and increased vascular permeability. Consider the alternatives briefly: ectopic pregnancy would require pregnancy and a compatible clinical context, not postmenopausal status. a benign ovarian cystadenoma can enlarge the pelvis but typically does not cause ascites or widespread omental metastases. uterine fibroid usually presents with a palpable uterine mass and symptoms like abnormal bleeding rather than ascites or peritoneal implants. Thus, the presentation aligns best with ovarian adenocarcinoma.

This scenario tests recognition of advanced ovarian cancer with peritoneal spread. In a postmenopausal woman, new abdominal distension with ascites and imaging showing multiple pelvic masses plus omental thickening is classic for epithelial ovarian carcinoma with peritoneal carcinomatosis. The omentum is a common site for metastatic implants from ovarian cancer, and ascites often results from tumor irritation of the peritoneum and increased vascular permeability.

Consider the alternatives briefly: ectopic pregnancy would require pregnancy and a compatible clinical context, not postmenopausal status. a benign ovarian cystadenoma can enlarge the pelvis but typically does not cause ascites or widespread omental metastases. uterine fibroid usually presents with a palpable uterine mass and symptoms like abnormal bleeding rather than ascites or peritoneal implants.

Thus, the presentation aligns best with ovarian adenocarcinoma.