Differentials
Endometrial hyperplasia
SIGNS / SYMPTOMS
Commonly presents with abnormal uterine bleeding.[31]
If a woman is premenopausal, she may have a history of irregular heavy periods or amenorrhea.
If a woman is postmenopausal, history and physical examination are indistinguishable from endometrial cancer.
Endometrial polyp
SIGNS / SYMPTOMS
Usually asymptomatic, but when polyps are the cause of abnormal vaginal bleeding, the history is no different from cancer.
Occasionally, pelvic examination reveals an exocervical polyp.
INVESTIGATIONS
Transvaginal ultrasound may show thickened endometrial lining that is not uniform.
Saline infusion sonohysterogram demonstrates polyps well.
MRI will also demonstrate polyps, but is not usually necessary.
Endometriosis
SIGNS / SYMPTOMS
More common in younger, premenopausal women.
Pelvic pain, dyspareunia, and painful defecation are key features of this condition.
Physical examination will detect tenderness and may detect typical nodularity.
INVESTIGATIONS
Pelvic (transvaginal) ultrasound may show endometrioma.
If a tissue biopsy is obtained, it shows characteristic benign endometrioid glands associated with changes of hemorrhage including hemosiderin-laden macrophages.
Cervical cancer
SIGNS / SYMPTOMS
Patients are typically younger, may be multiparous, and usually have not had a cervical Pap smear for a long time.
Vaginal bleeding is usually provoked (e.g., by sexual intercourse).
Sometimes, there is associated offensive discharge.
Physical examination shows an abnormal-looking cervix, and there may be an exophytic cauliflower growth.
INVESTIGATIONS
Colposcopy may show a mass lesion on the cervix.
Cervical biopsy and histopathology will show invasive squamous cell carcinoma, often associated with an in-situ component.
Pyometra
SIGNS / SYMPTOMS
Commonly associated with cervical stenosis, and there may be a history of recent cervical surgery.
Patients may be febrile and have other symptoms of sepsis.
Physical examination may reveal an enlarged, tender uterus.
Can be associated with an occult endometrial carcinoma, especially in older women.
INVESTIGATIONS
Pelvic (transvaginal) ultrasound will show intrauterine collection of fluid.
Cervical dilation will lead to pus drainage from the cervix.
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