Cervical cancer differential diagnosis: Difference between revisions
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:* Clear cell adenocarcinoma | :* Clear cell adenocarcinoma | ||
{| | {| | ||
! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis | |||
! | |||
! | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ob-Gyn neoplasm and diseases | ||
! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | |||
! colspan=" | ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings | ||
! colspan="1" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | |||
|- | |- | ||
! colspan=" | ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam | ||
! colspan=" | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | ||
! colspan=" | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology | ||
|- | |- | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal | ||
vaginal bleeding | vaginal bleeding | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Genitourinary/ Gastrointestinal symptoms | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic | ||
pain | pain | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal | ||
mass | mass | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HPV | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HPV | ||
Pap smear | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | |||
STI panel | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other labs | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other | ||
imagings | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical cancer<ref name="pmid23336450">{{cite journal |vauthors=Hippisley-Cox J, Coupland C |title=Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm |journal=Br J Gen Pract |volume=63 |issue=606 |pages=e11–21 |date=January 2013 |pmid=23336450 |pmc=3529288 |doi=10.3399/bjgp13X660733 |url=}}</ref><ref name="DunyoEffah2018">{{cite journal|last1=Dunyo|first1=Priscilla|last2=Effah|first2=Kofi|last3=Udofia|first3=Emilia Asuquo|title=Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study|journal=BMC Public Health|volume=18|issue=1|year=2018|issn=1471-2458|doi=10.1186/s12889-018-6065-6}}</ref><ref name="pmid30603660">{{cite journal |vauthors=Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R |title=Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report |journal=Gynecol Oncol Rep |volume=27 |issue= |pages=38–41 |date=February 2019 |pmid=30603660 |pmc=6302027 |doi=10.1016/j.gore.2018.12.006 |url=}}</ref><ref>{{cite journal|doi=10.1097/PAS.0000000000000498.}}</ref><ref name="pmid8828559">{{cite journal |vauthors=Brenner PF |title=Differential diagnosis of abnormal uterine bleeding |journal=Am. J. Obstet. Gynecol. |volume=175 |issue=3 Pt 2 |pages=766–9 |date=September 1996 |pmid=8828559 |doi= |url=}}</ref><ref name="AlcázarArribas2014">{{cite journal|last1=Alcázar|first1=Juan Luis|last2=Arribas|first2=Sara|last3=Mínguez|first3=José Angel|last4=Jurado|first4=Matías|title=The Role of Ultrasound in the Assessment of Uterine Cervical Cancer|journal=The Journal of Obstetrics and Gynecology of India|volume=64|issue=5|year=2014|pages=311–316|issn=0971-9202|doi=10.1007/s13224-014-0622-4}}</ref><ref name="pmid25223869">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref><ref name="pmid252238692">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postmenopausal | * Postmenopausal | ||
| Line 60: | Line 62: | ||
* Postcoital | * Postcoital | ||
* Bleeding after pelvic exam | * Bleeding after pelvic exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Dysuria | ||
* | * Urinary hesitancy | ||
* | * Dyspareunia | ||
* Vaginal discharge | |||
* Itching or burning of the vulva | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
+ | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cervical mass on exam | * Cervical mass on exam | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |± | | style="background: #F5F5F5; padding: 5px;" |± [[Human papilloma virus|HPV]] | ||
* Atypical cells on [[Pap smear]] | |||
* STI: ±Chlamydia | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * ↑ [[CA-125]] | ||
* | * Leukomoid reaction | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Large cervical cancer | * Large cervical cancer | ||
| Line 87: | Line 90: | ||
* Lymph node involvement | * Lymph node involvement | ||
| style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''' : | | style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''' : | ||
* Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. | * Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. '''PET/CT scan''': | ||
** Detect tumor size | |||
* Detect tumor size | ** Lymph node involvement, | ||
* Lymph node involvement, | ** Metastases to [[bladder]] or [[rectum]] | ||
* Metastases to bladder or rectum | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* CIN1: mild dysplasia | * CIN1: mild dysplasia | ||
| Line 101: | Line 103: | ||
* Colposcopy/biopsy | * Colposcopy/biopsy | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical polyp]]<ref name="pmid151660702">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postcoital | * Postcoital | ||
| Line 107: | Line 109: | ||
* Postmenopausal | * Postmenopausal | ||
* Bleeding after exam | * Bleeding after exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Vaginal discharge | |||
* Dyspareunia | |||
| style="background: #F5F5F5; padding: 5px;" | − | | style="background: #F5F5F5; padding: 5px;" | − | ||
| style="background: #F5F5F5; padding: 5px;" | − | | style="background: #F5F5F5; padding: 5px;" | − | ||
| Line 117: | Line 119: | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| | * ↓ [[RBC]] count | ||
* ↓ Hb, ↓ [[Hematocrit|Hct]] | |||
* ↓ Serum Iron | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Hyper/hypoechogenic masses with or without cysts | * Hyper/hypoechogenic masses with or without cysts | ||
* Filling the endocervical or vaginal canal | * Filling the endocervical or vaginal canal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| Line 134: | Line 137: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[leiomyoma]]<ref name="pmid27887011">{{cite journal |vauthors=Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H |title=Large primary leiomyoma causing progressive cervical deformity |journal=J Surg Case Rep |volume=2016 |issue=11 |pages= |date=November 2016 |pmid=27887011 |pmc=5159177 |doi=10.1093/jscr/rjw190 |url=}}</ref><ref name="pmid27190823">{{cite journal |vauthors=Adaikkalam J |title=Lipoleiomyoma of Cervix |journal=J Clin Diagn Res |volume=10 |issue=4 |pages=EJ01–2 |date=April 2016 |pmid=27190823 |doi=10.7860/JCDR/2016/16505.7531 |url=}}</ref><ref name="HouserCarrasco1979">{{cite journal|last1=Houser|first1=L. Murray|last2=Carrasco|first2=C. H.|last3=Sheehan|first3=C. R.|title=Lipomatous tumour of the uterus: radiographic and ultrasonic appearance|journal=The British Journal of Radiology|volume=52|issue=624|year=1979|pages=992–993|issn=0007-1285|doi=10.1259/0007-1285-52-624-992}}</ref><ref name="KeriakosMaher2013">{{cite journal|last1=Keriakos|first1=Remon|last2=Maher|first2=Mark|title=Management of Cervical Fibroid during the Reproductive Period|journal=Case Reports in Obstetrics and Gynecology|volume=2013|year=2013|pages=1–3|issn=2090-6684|doi=10.1155/2013/984030}}</ref><ref name="pmid10775744">{{cite journal |vauthors=Coronado GD, Marshall LM, Schwartz SM |title=Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study |journal=Obstet Gynecol |volume=95 |issue=5 |pages=764–9 |date=May 2000 |pmid=10775744 |doi= |url=}}</ref><ref name="Kamra2013">{{cite journal|last1=Kamra|first1=Hemlata T|title=Myxoid Leiomyoma of Cervix|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2013|issn=2249782X|doi=10.7860/JCDR/2013/6171.3805}}</ref><ref name="El-agwany2015">{{cite journal|last1=El-agwany|first1=Ahmed Samy|title=Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma|journal=The Egyptian Journal of Radiology and Nuclear Medicine|volume=46|issue=1|year=2015|pages=211–213|issn=0378603X|doi=10.1016/j.ejrnm.2014.10.001}}</ref><ref name="pmid14960521">{{cite journal |vauthors=Chaparala RP, Fawole AS, Ambrose NS, Chapman AH |title=Large bowel obstruction due to a benign uterine leiomyoma |journal=Gut |volume=53 |issue=3 |pages=386, 430 |date=March 2004 |pmid=14960521 |pmc=1773948 |doi= |url=}}</ref><ref name="pmid14564105">{{cite journal |vauthors=Yokoyama Y, Shinohara A, Hirokawa M, Maeda N |title=Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma |journal=Gynecol. Obstet. Invest. |volume=56 |issue=4 |pages=179–83 |date=2003 |pmid=14564105 |doi=10.1159/000074104 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Heavy/prolonged menstrual bleeding | * Heavy/prolonged menstrual bleeding | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Urinary retention | * Urinary retention | ||
* Constipation | * [[Constipation]] | ||
* Infertility | * Infertility | ||
* Bowel obstruction | * [[Bowel obstruction]] | ||
* Increase in pregnancy/labor complications | * Increase in pregnancy/labor complications | ||
* Vaginal discharge | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Large,irregular pelvic mass | * Large,irregular pelvic mass | ||
| Line 154: | Line 156: | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Erythrocytosis]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Well circumscribed hyperechoic mass | * Well circumscribed hyperechoic mass | ||
| Line 163: | Line 165: | ||
enhancement | enhancement | ||
* Red degeneration | * Red degeneration | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Spindle shaped smooth muscle cells | * Spindle shaped smooth muscle cells | ||
| Line 171: | Line 172: | ||
* Clinical diagnosis/ and | * Clinical diagnosis/ and | ||
* Ultrasound | * [[Ultrasound]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma|Cervical lymphoma]]<ref name="pmid10422676">{{cite journal |vauthors=Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E |title=Malignant lymphoma of the cervix. An unusual presentation and a rare disease |journal=Eur. J. Gynaecol. Oncol. |volume=20 |issue=1 |pages=26–8 |date=1999 |pmid=10422676 |doi= |url=}}</ref><ref name="KanaanParente2012">{{cite journal|last1=Kanaan|first1=Daniel|last2=Parente|first2=Daniella Braz|last3=Constantino|first3=Carolina Pesce Lamas|last4=Souza|first4=Rodrigo Canellas de|title=Linfoma de colo de útero: achados na ressonância magnética|journal=Radiologia Brasileira|volume=45|issue=3|year=2012|pages=167–169|issn=0100-3984|doi=10.1590/S0100-39842012000300009}}</ref><ref name="pmid17065003">{{cite journal |vauthors=Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD |title=Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature |journal=Leuk. Lymphoma |volume=47 |issue=9 |pages=1894–901 |date=September 2006 |pmid=17065003 |doi=10.1080/10428190600687653 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postmenopausal bleeding | * [[Postmenopausal bleeding]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Difficulty urinating | * Difficulty urinating | ||
* Post-coital pain | * Post-coital pain | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| Line 190: | Line 189: | ||
* Irregularity | * Irregularity | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |'''Pap smear:''' | ||
| style="background: #F5F5F5; padding: 5px;" | | * Small round blue cells | ||
| | * High nuclear/cytoplasm ratio, | ||
* Scant cytoplasm | |||
| style="background: #F5F5F5; padding: 5px;" |'''Immunohistochemistry markers:''' | |||
* [[CD19]], [[CD20]], [[CD79a|CD79]]<nowiki/>a, [[PAX5]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Well-defined, solid, concentric, hypoechoic mass | * Well-defined, solid, concentric, hypoechoic mass | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | ||
* Intramyometrial infiltrative nodules | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Small tumor cells with large nuclei | * Small tumor cells with large nuclei | ||
* High mitoses and proliferation | * High mitoses and proliferation | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Biopsy | * Biopsy | ||
* [[Diffuse large B-cell lymphoma|diffuse large B-Cell lymphoma]] ([[DLBCL]]) most frequent type. | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical|Cervical sarcoma]]<ref name="pmid16051326">{{cite journal |vauthors=Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK |title=Cervical sarcomas: an analysis of incidence and outcome |journal=Gynecol. Oncol. |volume=99 |issue=2 |pages=348–51 |date=November 2005 |pmid=16051326 |doi=10.1016/j.ygyno.2005.06.021 |url=}}</ref><ref name="KhoslaGupta2012">{{cite journal|last1=Khosla|first1=Divya|last2=Gupta|first2=Ruchi|last3=Srinivasan|first3=Radhika|last4=Patel|first4=Firuza D.|last5=Rajwanshi|first5=Arvind|title=Sarcomas of Uterine Cervix|journal=International Journal of Gynecological Cancer|volume=22|issue=6|year=2012|pages=1026–1030|issn=1048-891X|doi=10.1097/IGC.0b013e31825a97f6}}</ref><ref name="pmid26587944">{{cite journal |vauthors=Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA |title=Imaging Features of Uncommon Gynecologic Cancers |journal=AJR Am J Roentgenol |volume=205 |issue=6 |pages=1346–59 |date=December 2015 |pmid=26587944 |pmc=5502476 |doi=10.2214/AJR.14.12695 |url=}}</ref><ref>{{cite journal|doi=10.1097/IGC.0b013e31825a97f6.}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Intermentrual | * Intermentrual | ||
* Postmenopausal | * [[Postmenopausal]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Post-coital pain | * Post-coital pain | ||
* Fullness in pelvic | * Fullness in pelvic | ||
* Vaginal discharge | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | ± | | style="background: #F5F5F5; padding: 5px;" | ± | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cervical mass | * [[Cervical Cancer|Cervical]] mass | ||
* Lump protruding from vagina/vulva | * Lump protruding from vagina/vulva | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[Leiomyosarcoma]] markers: | ||
* Positive for for [[S-100]] and [[vimentin]] and are negative for [[desmin]], [[myoglobin]] and [[actin]]. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Endometrial mass with heterogeneous echogenicity | |||
| style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | |||
* Endometrial polypoid mass | |||
* Hypointense hypervascular solid components | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Poorly circumscribed bulky mass protruding from cervical canal | |||
* Different subtypes: | |||
** [[Leiomyosarcoma]] | |||
** Endocervical [[sarcoma]] | |||
** Embryonal rhabdomyosarcoma( [[Sarcoma botryoides]]) | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Biopsy | * [[Biopsy]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical erosion]]([[Ectropion]])<ref name="pmid28460993">{{cite journal |vauthors=Mitchell L, King M, Brillhart H, Goldstein A |title=Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis |journal=Sex Med |volume=5 |issue=3 |pages=e212–e214 |date=September 2017 |pmid=28460993 |pmc=5562466 |doi=10.1016/j.esxm.2017.03.001 |url=}}</ref><ref name="pmid15166070">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref><ref name="SharmaOjha2013">{{cite journal|last1=Sharma|first1=Abhishek|last2=Ojha|first2=Ranapratap|last3=Sengupta|first3=Parama|last4=Chattopadhyay|first4=Sarbani|last5=Mondal|first5=Soumit|title=Cervical intramural pregnancy: Report of a rare case|journal=Nigerian Medical Journal|volume=54|issue=4|year=2013|pages=271|issn=0300-1652|doi=10.4103/0300-1652.119670}}</ref><ref>{{cite journal|doi=10.12865/CHSJ.42.02.11}}</ref><ref name="pmid212702912">{{cite journal |vauthors=Casey PM, Long ME, Marnach ML |title=Abnormal cervical appearance: what to do, when to worry? |journal=Mayo Clin. Proc. |volume=86 |issue=2 |pages=147–50; quiz 151 |date=February 2011 |pmid=21270291 |pmc=3031439 |doi=10.4065/mcp.2010.0512 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Light bleeding after pelvic exam | * Light bleeding after pelvic exam | ||
* Spotting | * Spotting | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Post-coital pain | * Post-coital pain | ||
| Line 241: | Line 248: | ||
* Painful cramps | * Painful cramps | ||
* | * [[Dyspareunia]] | ||
| style="background: #F5F5F5; padding: 5px;" | | * [[Vaginal discharge]] | ||
* Itching of vulvovaginal area | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Red, glandular area around os of cervix | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Squamous metaplasia]] | |||
* Vascular ectasia | |||
* [[Lymphocytic]] infiltration | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Colposcopy]] and [[biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervicitis]]<ref name="pmid27243142">{{cite journal |vauthors=Mattson SK, Polk JP, Nyirjesy P |title=Chronic Cervicitis: Presenting Features and Response to Therapy |journal=J Low Genit Tract Dis |volume=20 |issue=3 |pages=e30–3 |date=July 2016 |pmid=27243142 |doi=10.1097/LGT.0000000000000225 |url=}}</ref><ref name="pmid2660084">{{cite journal |vauthors=Rosenfeld WD, Clark J |title=Vulvovaginitis and cervicitis |journal=Pediatr. Clin. North Am. |volume=36 |issue=3 |pages=489–511 |date=June 1989 |pmid=2660084 |doi= |url=}}</ref><ref name="pmid27681919">{{cite journal |vauthors=Meyer T |title=Diagnostic Procedures to Detect Chlamydia trachomatis Infections |journal=Microorganisms |volume=4 |issue=3 |pages= |date=August 2016 |pmid=27681919 |doi=10.3390/microorganisms4030025 |url=}}</ref><ref name="WoodsBailey2011">{{cite journal|last1=Woods|first1=Jennifer L.|last2=Bailey|first2=Sarabeth L.|last3=Hensel|first3=Devon J.|last4=Scurlock|first4=Amy M.|title=Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?|journal=Journal of Pediatric and Adolescent Gynecology|volume=24|issue=6|year=2011|pages=359–364|issn=10833188|doi=10.1016/j.jpag.2011.06.006}}</ref><ref name="Jayakumar2015">{{cite journal|last1=Jayakumar|first1=Naveen Kumar Bhagavathula|title=Cervicitis: How Often Is It Non-specific!|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2015|issn=2249782X|doi=10.7860/JCDR/2015/11594.5673}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
| Line 263: | Line 278: | ||
* Bleeding after pelvic exam | * Bleeding after pelvic exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pain during urination | * Pain during urination | ||
| Line 272: | Line 283: | ||
* Pain during sex | * Pain during sex | ||
* Painful menstruation | * Painful menstruation | ||
* Purulent [[vaginal discharge]] | |||
* Itching of vulva | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* May have fever only | * May have fever only | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Red,inflammed swollen cervix | * Red,inflammed swollen cervix | ||
* Inflammation/irritation of vulva/vagina | * Inflammation/irritation of vulva/vagina | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |'''STI panel:''' | ||
* [[Chlamydia]] | |||
* Chlamydia | |||
* Gonorrhea | * Gonorrhea | ||
* Herpes simplex | * [[Herpes simplex]] | ||
* Trichomonas vaginalis | * [[Trichomonas vaginalis]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* ↑ [[WBC]] | |||
* + [[NAAT]] for [[chlamydia]], [[gonorrhea]] | |||
* | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | |||
May be detected as retention cysts in cervix. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Non-specific, lymphocytic infiltration may be seen in microscopic histology. | |||
* Koilocytic changes in case of HPV as cause of chronic cervicitis. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s) | |||
|- | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Endometrial carcinoma]]<ref name="pmid10326893">{{cite journal |vauthors=Bakour SH, Dwarakanath LS, Khan KS, Newton JR, Gupta JK |title=The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenopausal bleeding |journal=Acta Obstet Gynecol Scand |volume=78 |issue=5 |pages=447–51 |date=May 1999 |pmid=10326893 |doi= |url=}}</ref><ref name="BeddyO'Neill2012">{{cite journal|last1=Beddy|first1=Peter|last2=O'Neill|first2=Ailbhe C.|last3=Yamamoto|first3=Adam K.|last4=Addley|first4=Helen C.|last5=Reinhold|first5=Caroline|last6=Sala|first6=Evis|title=FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging|journal=RadioGraphics|volume=32|issue=1|year=2012|pages=241–254|issn=0271-5333|doi=10.1148/rg.321115045}}</ref><ref name="pmid26623410">{{cite journal |vauthors=Byun JM, Jeong DH, Kim YN, Cho EB, Cha JE, Sung MS, Lee KB, Kim KT |title=Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge |journal=Obstet Gynecol Sci |volume=58 |issue=6 |pages=468–74 |date=November 2015 |pmid=26623410 |doi=10.5468/ogs.2015.58.6.468 |url=}}</ref><ref name="pmid27356704">{{cite journal |vauthors=Wan-Nor-Asyikeen WA, Siti-Azrin AH, Jalil NA, Othman NH, Zain AA |title=Endometrial Cancer in Hospital Universiti Sains Malaysia |journal=Asian Pac. J. Cancer Prev. |volume=17 |issue=6 |pages=2867–70 |date=2016 |pmid=27356704 |doi= |url=}}</ref><ref name="pmid17630117">{{cite journal |vauthors=Horn LC, Meinel A, Handzel R, Einenkel J |title=Histopathology of endometrial hyperplasia and endometrial carcinoma: an update |journal=Ann Diagn Pathol |volume=11 |issue=4 |pages=297–311 |date=August 2007 |pmid=17630117 |doi=10.1016/j.anndiagpath.2007.05.002 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Postmenopausal bleeding]] | |||
* Intermesntrual | |||
bleeding | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Vaginal discharge | ||
* Pain during urination | |||
* Pain during sex | |||
* Fulness in pelvic | |||
* Difficulty emptying bladder | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |± | | style="background: #F5F5F5; padding: 5px;" |± | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Often normal | |||
* Vaginal lump | |||
* Pelvic mass | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |− | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* ↑ [[CA-125]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Thickened endometrium | |||
* Myometrial invasion | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
'''T1-weighted MRI:''' | |||
* Hypo-to-isointense | |||
'''T2-weighted MRI:''' | |||
* Intermediate signal intensity lower than the normal endometrium | |||
| style="background: #F5F5F5; padding: 5px;" |'''Type I endometrioid endometrial carcinomas (EECs):''' | |||
* Moderately differentiated | |||
* Superficial invasion into the [[myometrium]] | |||
'''Type II non-endometrioid endometrial carcinomas (NEECs):''' | |||
* Deep invasion of the [[myometrium]] | |||
* Poorly differentiated | |||
* Highly metastatic | |||
* Not related to [[endometrial hyperplasia]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Hysterectomy and biopsy | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial hyperplasia]]<ref name="PalmerPerunovic2008">{{cite journal|last1=Palmer|first1=Julia E|last2=Perunovic|first2=Branko|last3=Tidy|first3=John A|title=Endometrial hyperplasia|journal=The Obstetrician & Gynaecologist|volume=10|issue=4|year=2008|pages=211–216|issn=14672561|doi=10.1576/toag.10.4.211.27436}}</ref><ref name="pmid19393600">{{cite journal |vauthors=Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, Voigt LF, Weiss NS |title=Incidence of endometrial hyperplasia |journal=Am. J. Obstet. Gynecol. |volume=200 |issue=6 |pages=678.e1–6 |date=June 2009 |pmid=19393600 |pmc=2692753 |doi=10.1016/j.ajog.2009.02.032 |url=}}</ref><ref name="pmid16285581">{{cite journal |vauthors=Novac L, Grigore T, Cernea N, Niculescu M, Cotarcea S |title=Incidence of endometrial carcinoma in patients with endometrial hyperplasia |journal=Eur. J. Gynaecol. Oncol. |volume=26 |issue=5 |pages=561–3 |date=2005 |pmid=16285581 |doi= |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* [[Postmenopausal bleeding]] | |||
* Intermenstrual bleeding | |||
* [[Amenorrhea]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* [[Dysmenorrhea]] | |||
* [[Amenorrhea]] | |||
* [[Dyspareunia]] | |||
* Heavy menstrual bleeding | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Normal or thickened endometrium | |||
| style="background: #F5F5F5; padding: 5px;" |± | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |N/A | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Thickened [[endometrium]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
'''T1-weighted MRI:''' | |||
* Hypo-to-isointense | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Simple(cystic) [[hyperplasia]] | |||
* Complex hyperplasia | |||
* Simple hyperplasia with [[atypia]] | |||
* Complex hyperplasia with atypia (glands are highly irregular in size and shape) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Biopsy | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometriosis (female)|Endometriosis]]<ref name="pmid20436318">{{cite journal |vauthors=Hsu AL, Khachikyan I, Stratton P |title=Invasive and noninvasive methods for the diagnosis of endometriosis |journal=Clin Obstet Gynecol |volume=53 |issue=2 |pages=413–9 |date=June 2010 |pmid=20436318 |pmc=2880548 |doi=10.1097/GRF.0b013e3181db7ce8 |url=}}</ref><ref name="ChamiéBlasbalg2011">{{cite journal|last1=Chamié|first1=Luciana Pardini|last2=Blasbalg|first2=Roberto|last3=Pereira|first3=Ricardo Mendes Alves|last4=Warmbrand|first4=Gisele|last5=Serafini|first5=Paulo Cesar|title=Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy|journal=RadioGraphics|volume=31|issue=4|year=2011|pages=E77–E100|issn=0271-5333|doi=10.1148/rg.314105193}}</ref><ref name="pmid18850447">{{cite journal |vauthors=Datta S, Kunde K |title=From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy |journal=J Obstet Gynaecol |volume=28 |issue=5 |pages=552–3 |date=July 2008 |pmid=18850447 |doi=10.1080/01443610802247352 |url=}}</ref><ref name="ChamiéBlasbalg20112">{{cite journal|last1=Chamié|first1=Luciana Pardini|last2=Blasbalg|first2=Roberto|last3=Pereira|first3=Ricardo Mendes Alves|last4=Warmbrand|first4=Gisele|last5=Serafini|first5=Paulo Cesar|title=Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy|journal=RadioGraphics|volume=31|issue=4|year=2011|pages=E77–E100|issn=0271-5333|doi=10.1148/rg.314105193}}</ref><ref name="pmid14734195">{{cite journal |vauthors=Bedaiwy MA, Falcone T |title=Laboratory testing for endometriosis |journal=Clin. Chim. Acta |volume=340 |issue=1-2 |pages=41–56 |date=February 2004 |pmid=14734195 |doi= |url=}}</ref><ref name="pmid20503240">{{cite journal |vauthors=Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D |title=Endometriomas: their ultrasound characteristics |journal=Ultrasound Obstet Gynecol |volume=35 |issue=6 |pages=730–40 |date=June 2010 |pmid=20503240 |doi=10.1002/uog.7668 |url=}}</ref><ref>{{cite journal|doi=10.1148/rg.314105193.}}</ref> | |||
| | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Heavy mentrual bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Painful menstruation | * Painful menstruation | ||
* Burning | * Burning/painful urination | ||
* Pain during | * Painful bowel movement | ||
* Pain during or after sex | |||
* [[Infertility]] | |||
* Watery vaginal discharge | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pelvic pain | * Pelvic pain | ||
* Back pain | |||
| style="background: #F5F5F5; padding: 5px;" |− | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Tender [[Uterosacral ligament|uterosacral]] nodularity | ||
* Immobile uterus | |||
| style="background: #F5F5F5; padding: 5px;" | | * [[Cervical|Cervica]]<nowiki/>l motion tenderness | ||
* Retroverted uterus | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * ↑ [[IL-6]] | ||
* ↑ [[TNF-α]] | |||
* | * ↑ [[CA-125]] | ||
(limited value) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Ground glass echogenicity of the cyst fluid (Endonetrioma) | |||
* Cysts are unilocular | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* MRI findings is variable, depending upon the sites of endometriosis such as peritoneal implants, ovarian endometrioma, pelvic endometriosis. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Endometrial type glands and stroma presence is charracteristic histology findings, suggestive for endometriosis. | |||
* | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Visual inspection by [[laparoscopy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic inflammatory diseases]]<ref name="pmid30606817">{{cite journal |vauthors=Hoenderboom BM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, Land JA, van der Sande MAB, Morré SA, van den Broek IVF |title=Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial |journal=Sex Transm Infect |volume= |issue= |pages= |date=January 2019 |pmid=30606817 |doi=10.1136/sextrans-2018-053778 |url=}}</ref><ref name="pmid21822367">{{cite journal |vauthors=Jaiyeoba O, Soper DE |title=A practical approach to the diagnosis of pelvic inflammatory disease |journal=Infect Dis Obstet Gynecol |volume=2011 |issue= |pages=753037 |date=2011 |pmid=21822367 |pmc=3148590 |doi=10.1155/2011/753037 |url=}}</ref><ref name="Czeyda-PommersheimKalb2016">{{cite journal|last1=Czeyda-Pommersheim|first1=Ferenc|last2=Kalb|first2=Bobby|last3=Costello|first3=James|last4=Liau|first4=Joy|last5=Meshksar|first5=Arash|last6=Arif Tiwari|first6=Hina|last7=Martin|first7=Diego|title=MRI in pelvic inflammatory disease: a pictorial review|journal=Abdominal Radiology|volume=42|issue=3|year=2016|pages=935–950|issn=2366-004X|doi=10.1007/s00261-016-1004-4}}</ref><ref name="MitchellPrabhu2013">{{cite journal|last1=Mitchell|first1=Caroline|last2=Prabhu|first2=Malavika|title=Pelvic Inflammatory Disease|journal=Infectious Disease Clinics of North America|volume=27|issue=4|year=2013|pages=793–809|issn=08915520|doi=10.1016/j.idc.2013.08.004}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Bleeding after sex | ||
* | |||
* Intermenstrual bleeding | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Fever]] | ||
* | * Pelvic pain | ||
* | * [[Dyspareunia]] | ||
* | * [[Dysmenorrhea]] | ||
* [[Dysuria]] | |||
* [[Dyschezia]] | |||
* Smelly grey/white/yellow vaginal discharge | |||
* Itching and burning of vulvovaginal area | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Pelvic pain | ||
* Cervical motion tenderness | * Cervical motion tenderness | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Oral temperature >101F | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Vaginal/vulvar tender lesion depending on microbial causes | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |'''STI panel:''' | ||
* [[Chlamydia]] | |||
* [[Gonorrhea]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* ↑ [[CRP]] | |||
* ↑ [[ESR]] | |||
* ↑ [[WBC]] | |||
* Oral temperature >101F | |||
* | |||
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:''' | |||
* Thickened, fluid-filled tubes with or without free [[pelvic]] or tuboovarian complex | |||
| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:''' | |||
* Inflammation in pelvic soft tissue | |||
* Hydrosalpinx | |||
* Tubo-ovarian abscess in chronic PID. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Inflamed, purulent fallopian tubes | |||
* | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Clinical diagnosis is gold standard for diagnosing [[PID]] | |||
* | |||
* [[Laparoscopy]] is confirmatory in acute salpengitis | |||
* | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyosis|Adenemyosis]]<ref name="pmid30486633">{{cite journal |vauthors=Filip G, Balzano A, Cagnacci A |title=Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance |journal=Minerva Ginecol |volume= |issue= |pages= |date=November 2018 |pmid=30486633 |doi=10.23736/S0026-4784.18.04291-0 |url=}}</ref><ref name="pmid1492806">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid14928062">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid9275451">{{cite journal |vauthors=Zhou Y, Wu B, Li H |title=[The value of serum CA125 assays in the diagnosis of uterine adenomyosis] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=31 |issue=10 |pages=590–3 |date=October 1996 |pmid=9275451 |doi= |url=}}</ref><ref name="TamaiTogashi2005">{{cite journal|last1=Tamai|first1=Ken|last2=Togashi|first2=Kaori|last3=Ito|first3=Tsuyoshi|last4=Morisawa|first4=Nobuko|last5=Fujiwara|first5=Toshitaka|last6=Koyama|first6=Takashi|title=MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls|journal=RadioGraphics|volume=25|issue=1|year=2005|pages=21–40|issn=0271-5333|doi=10.1148/rg.251045060}}</ref><ref name="Dartmouth2014">{{cite journal|last1=Dartmouth|first1=Katherine|title=A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis|journal=Ultrasound|volume=22|issue=3|year=2014|pages=148–157|issn=1742-271X|doi=10.1177/1742271X14528837}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Abnormal uterine bleeding | * Abnormal uterine bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Painful menstruation | * Painful menstruation | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Polypoid mass protruding into the endocervical canal. | * Polypoid mass protruding into the endocervical canal. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Enlarged uterus may present as abdominal mass | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* ↑ [[CA-125 test|CA-125]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Subendometrial striations | |||
* Myometrial cysts | |||
* Asymetrical thickness in myometrium walls | |||
* Heterogenous exhotexture of myometrum | |||
| style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | |||
* Thickened junctional zone | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Presence of ectopic endometrial glands into the myometrium. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Histology findings post hysterectomy | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[ectopic pregnancy]]<ref name="pmid28955106">{{cite journal |vauthors=Mouhajer M, Obed S, Okpala AM |title=Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis |journal=Ghana Med J |volume=51 |issue=2 |pages=94–97 |date=June 2017 |pmid=28955106 |pmc=5611908 |doi= |url=}}</ref><ref name="RathodSamal2015">{{cite journal|last1=Rathod|first1=Setu|last2=Samal|first2=SunilKumar|title=Cervical ectopic pregnancy|journal=Journal of Natural Science, Biology and Medicine|volume=6|issue=1|year=2015|pages=257|issn=0976-9668|doi=10.4103/0976-9668.149221}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Amenorrhea]] | ||
* Bleeding after pelvic exam | * Bleeding after [[pelvic exam]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | * [[Pelvic pain]] | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Soft and disporportionally enlarged uterus. | * Soft and disporportionally enlarged uterus. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |± | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* ↑ β-[[HCG]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Empty uterine | * Empty uterine | ||
| Line 434: | Line 553: | ||
'''T1-weighted MRI''': | '''T1-weighted MRI''': | ||
* Partially hyperintense mass | * Partially hyperintense mass | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Necrotic hemorrhagic mass with chorionic villus | * Necrotic hemorrhagic mass with chorionic villus | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Hysterectomy and biopsy | * [[Hysterectomy]] and biopsy | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vaginal cancer]]<ref name="pmid25045355">{{cite journal |vauthors=Tarney CM, Han J |title=Postcoital bleeding: a review on etiology, diagnosis, and management |journal=Obstet Gynecol Int |volume=2014 |issue= |pages=192087 |date=2014 |pmid=25045355 |pmc=4086375 |doi=10.1155/2014/192087 |url=}}</ref><ref name="MiccòSala20152">{{cite journal|last1=Miccò|first1=Maura|last2=Sala|first2=Evis|last3=Lakhman|first3=Yulia|last4=Hricak|first4=Hedvig|last5=Vargas|first5=Hebert Alberto|title=Imaging Features of Uncommon Gynecologic Cancers|journal=American Journal of Roentgenology|volume=205|issue=6|year=2015|pages=1346–1359|issn=0361-803X|doi=10.2214/AJR.14.12695}}</ref><ref name="KimSong2013">{{cite journal|last1=Kim|first1=Hwi-Gon|last2=Song|first2=Yong Jung|last3=Na|first3=Yong Jin|last4=Choi|first4=Ook-Hwan|title=A Case of Vaginal Cancer with Uterine Prolapse|journal=Journal of Menopausal Medicine|volume=19|issue=3|year=2013|pages=139|issn=2288-6478|doi=10.6118/jmm.2013.19.3.139}}</ref><ref name="pmid17139994">{{cite journal |vauthors=Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C |title=Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report |journal=Eur. J. Gynaecol. Oncol. |volume=27 |issue=5 |pages=528–30 |date=2006 |pmid=17139994 |doi= |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postcoital bleeding | * Postcoital bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Tenesmus | |||
* [[Dysuria]] | |||
* Urinary frequency | |||
* [[Constipation]] | |||
* Pelvic pain | |||
* [[Vaginal discharge]] | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" |± | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Ill-defined vaginal ulcer | |||
* Vaginal lump | |||
* Inguinal [[lymphadenopathy]] | |||
* Edema and ulceration of vaginal wall | |||
* Foul-odor blood tinged vaginal discharge | |||
* [[Vaginal prolapse]] | |||
* [[Cystocele]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* In case of metastases to internal organs | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Pap smear]] can be normal | |||
* ± [[HPV]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* ↓ [[RBC]] count | |||
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:''' | |||
* [[Hydronephrosis]] in case of pelvic metastases | |||
* Multiple liver metastases | |||
| style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | |||
* Isointense on T1-weighted images | |||
* Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images | |||
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy findings:''' | |||
* [[Squamous cell carcinoma]] of vagina | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Biopsy | |||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paget's disease]] of vulva to cervix<ref name="van der LindenMeeuwis2016">{{cite journal|last1=van der Linden|first1=M.|last2=Meeuwis|first2=K.A.P.|last3=Bulten|first3=J.|last4=Bosse|first4=T.|last5=van Poelgeest|first5=M.I.E.|last6=de Hullu|first6=J.A.|title=Paget disease of the vulva|journal=Critical Reviews in Oncology/Hematology|volume=101|year=2016|pages=60–74|issn=10408428|doi=10.1016/j.critrevonc.2016.03.008}}</ref><ref name="pmid10605411">{{cite journal |vauthors=Lloyd J, Evans DJ, Flanagan AM |title=Extension of extramammary Paget disease of the vulva to the cervix |journal=J. Clin. Pathol. |volume=52 |issue=7 |pages=538–40 |date=July 1999 |pmid=10605411 |pmc=501500 |doi= |url=}}</ref><ref name="pmid19952933">{{cite journal |vauthors=Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ |title=Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course |journal=Int. J. Gynecol. Pathol. |volume=29 |issue=1 |pages=69–78 |date=January 2010 |pmid=19952933 |doi=10.1097/PGP.0b013e3181b1cc5e |url=}}</ref><ref name="AsmoukiOumouloud2012">{{cite journal|last1=Asmouki|first1=Hamid|last2=Oumouloud|first2=Rachid|last3=Aboulfalah|first3=Abderrahim|last4=Soummani|first4=Abderraouf|last5=Marrat|first5=Abdelouahed|title=Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report|journal=Case Reports in Oncological Medicine|volume=2012|year=2012|pages=1–4|issn=2090-6706|doi=10.1155/2012/854827}}</ref><ref name="Gonçalves AmorimBatista Fraga Mendes2015">{{cite journal|last1=Gonçalves Amorim|first1=Andressa|last2=Batista Fraga Mendes|first2=Brunelle|last3=Neves Ferreira|first3=Rodrigo|last4=Chambô Filho|first4=Antônio|title=Paget Disease of the Vulva: Diagnosis by Immunohistochemistry|journal=Case Reports in Dermatological Medicine|volume=2015|year=2015|pages=1–5|issn=2090-6463|doi=10.1155/2015/162483}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Bleeding from lesion | * Bleeding from lesion | ||
* Oozing | * Oozing | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * ±Vaginal discharge | ||
* Pain in vulva | * Pain in vulva | ||
* Itching or burning sensation in vulva | |||
| style="background: #F5F5F5; padding: 5px;" |− | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Scaly eczematoid lesion in vulva. | * Scaly eczematoid lesion in vulva. | ||
* Erythematous plaques with white scaling. | * Erythematous plaques with white scaling. | ||
* Inguinal lymphadenopathy in case of metastases. | * [[Inguinal]] lymphadenopathy in case of metastases. | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Positive for cytokeratins(CK7) | |||
* Negative for S-100 and Melan-A | |||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" |'''MRI:''' | |||
* Hyperintense on diffusion weighted imaging | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Thick vulvar skin | |||
* "Cake-icing effect", pathognomic for vulvar paget's disease | |||
* Intraepidermal adenocarcinoma which involves epidermis | * Intraepidermal adenocarcinoma which involves epidermis | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Biopsy of lesion | * Biopsy of lesion | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nabothian cyst]]<ref name="pmid21270291">{{cite journal |vauthors=Casey PM, Long ME, Marnach ML |title=Abnormal cervical appearance: what to do, when to worry? |journal=Mayo Clin. Proc. |volume=86 |issue=2 |pages=147–50; quiz 151 |date=February 2011 |pmid=21270291 |pmc=3031439 |doi=10.4065/mcp.2010.0512 |url=}}</ref><ref name="Bin ParkLee2010">{{cite journal|last1=Bin Park|first1=Sung|last2=Lee|first2=Jong Hwa|last3=Lee|first3=Young Ho|last4=Song|first4=Mi Jin|last5=Choi|first5=Hye Jeong|title=Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation|journal=American Journal of Roentgenology|volume=195|issue=2|year=2010|pages=517–523|issn=0361-803X|doi=10.2214/AJR.09.3619}}</ref><ref name="Torky2016">{{cite journal|last1=Torky|first1=Haitham A.|title=Huge Nabothian cyst causing Hematometra (case report)|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=207|year=2016|pages=238–240|issn=03012115|doi=10.1016/j.ejogrb.2016.10.042}}</ref><ref name="OkamotoTanaka2003">{{cite journal|last1=Okamoto|first1=Yoshikazu|last2=Tanaka|first2=Yumiko O.|last3=Nishida|first3=Masato|last4=Tsunoda|first4=Hajime|last5=Yoshikawa|first5=Hiroyuki|last6=Itai|first6=Yuji|title=MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation|journal=RadioGraphics|volume=23|issue=2|year=2003|pages=425–445|issn=0271-5333|doi=10.1148/rg.232025065}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postcoital bleeding | * Postcoital bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pain during sex | |||
* [[Vaginal discharge]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* In very rare cases depending upon the size of cyst it can cause abdominal pain and amenorhea | |||
| style="background: #F5F5F5; padding: 5px;" |− | |||
| style="background: #F5F5F5; padding: 5px;" |− | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Majority of them are asymptomatic due to their small size( few milimeters) | |||
* | |||
* | * [[Cystic]] mass on exam | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Anechoic well defined cystic lesions | |||
| style="background: #F5F5F5; padding: 5px;" | '''T1-weighted''' | |||
* Intermediate or slightly high signal intensity '''T2-weighted''' | |||
* High signal intensity on T2-weighted images | |||
* Benign cystic lesion | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Multiple benign cystic masses, usually few milimieters in diameter. | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Histopathological exam if large cystic masses | |||
|- | |||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intrauterine device|IUD]] use<ref name="pmid347074">{{cite journal |vauthors=Trobough GE |title=Pelvic pain and the IUD |journal=J Reprod Med |volume=20 |issue=3 |pages=167–74 |date=March 1978 |pmid=347074 |doi= |url=}}</ref><ref name="NowitzkiHoimes2015">{{cite journal|last1=Nowitzki|first1=Kristina M.|last2=Hoimes|first2=Matthew L.|last3=Chen|first3=Byron|last4=Zheng|first4=Larry Z.|last5=Kim|first5=Young H.|title=Ultrasonography of intrauterine devices|journal=Ultrasonography|volume=34|issue=3|year=2015|pages=183–194|issn=2288-5919|doi=10.14366/usg.15010}}</ref><ref>{{cite journal|doi=10.5489/cuaj.11100.}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Heavy bleeidng | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Painful menstruation | |||
| style="background: # | * ±Vaginal discharge | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
* In cases of uterine rupture and far migration of IUD, it can cause adhesion, bowel obstruction, perforation. | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Normal | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* May have decreased RBC count | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Linear echogenic intrauterine structures | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |N/A | ||
| style="background: #F5F5F5; padding: 5px;" |N/A | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
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* | * Transvaginal ultrasound | ||
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==References== | ==References== | ||
Revision as of 15:04, 7 February 2019
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Cervical cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cervical cancer differential diagnosis On the Web |
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American Roentgen Ray Society Images of Cervical cancer differential diagnosis |
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Risk calculators and risk factors for Cervical cancer differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]
Overview
Cervical cancer must be differentiated from other diseases that cause abnormal vaginal bleeding, such as cervical polyp, cervical leiomyoma, invasion of the cervix from primary uterine malignancy, vaginal cancer, cervical lymphoma, metastases to cervix, and cervical ectopic pregnancy.
Cervical cancer differential diagnosis
- Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:
- Cervical polyp
- Cervical leiomyoma
- Cervical lymphoma
- Cervical sarcoma
- Metastases to the cervix
- Cervical ectopic pregnancy
- Cervicitis
- Cervical erosion ( Ectropion )
- IUD use
- Pelvic inflammatory disease
- Endometriosis
- Adenomyosis
- Postcoital bleeding
- Clear cell adenocarcinoma
| Abnormal Uterine bleeidng differential diagnosis | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ob-Gyn neoplasm and diseases | Clinical manifestations | Para-clinical findings | Gold standard | ||||||||||||||
| Symptoms | Physical exam | Lab Findings | Imaging | Histopathology | |||||||||||||
| Abnormal
vaginal bleeding |
Other Genitourinary/ Gastrointestinal symptoms | Abdominal pain | Pelvic
pain |
B symptoms | Gynecological examinations | Abdominal
mass |
HPV
Pap smear STI panel |
Other labs | Ultrasound | Other
imagings | |||||||
| Cervical cancer[1][2][3][4][5][6][7][8] |
|
|
+ |
+ | + |
|
+ | ± HPV
|
|
|
T2-weighted MRI : |
|
| ||||
| Cervical polyp[9] |
|
|
− | − | − |
|
− | − |
|
|
|
||||||
| Cervical leiomyoma[10][11][12][13][14][15][16][17][18] |
|
|
+ | + | − |
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±
|
− |
|
T2-weighted MRI:
enhancement
|
|
| |||||
| Cervical lymphoma[19][20][21] |
|
+ | + | + |
|
+ | Pap smear:
|
Immunohistochemistry markers: |
|
MRI:
|
|
| |||||
| Cervical sarcoma[22][23][24][25] |
|
|
+ | + | ± |
|
+ | − | Leiomyosarcoma markers: |
|
MRI:
|
|
|||||
| Cervical erosion(Ectropion)[26][27][28][29][30] |
|
|
+ | + | − |
|
− | − | N/A | N/A | N/A |
|
|
||||
| Cervicitis[31][32][33][34][35] |
|
|
+ | + |
|
|
− | STI panel:
|
|
MRI:
May be detected as retention cysts in cervix. |
|
||||||
| Endometrial carcinoma[36][37][38][39][40] |
bleeding |
|
+ | + | ± |
|
+ | − |
|
|
T1-weighted MRI:
T2-weighted MRI:
|
Type I endometrioid endometrial carcinomas (EECs):
Type II non-endometrioid endometrial carcinomas (NEECs):
|
|
||||
| Endometrial hyperplasia[41][42][43] |
|
|
|
+ | − |
|
± | − | N/A |
|
T1-weighted MRI:
|
|
|
||||
| Endometriosis[44][45][46][47][48][49][50] |
|
|
+ |
|
− |
|
+ | − |
(limited value) |
|
|
|
|
||||
| Pelvic inflammatory diseases[51][52][53][54] |
|
|
+ |
|
|
|
− | STI panel: |
|
Ultrasound:
|
MRI findings:
|
|
| ||||
| Adenemyosis[55][56][57][58][59][60] |
|
|
+ | + | − |
|
|
− |
|
|
MRI:
|
|
| ||||
| Cervical ectopic pregnancy[61][62] |
|
+ | − | − |
|
± | − |
|
|
T2-weighted MRI:
T1-weighted MRI:
|
|
| |||||
| Vaginal cancer[63][64][65][66] |
|
|
+ | + | ± |
|
|
|
|
Ultrasound:
|
MRI:
|
Biopsy findings:
|
| ||||
| Paget's disease of vulva to cervix[67][68][69][70][71] |
|
|
− | − | −
|
|
− | − |
|
N/A | MRI:
|
|
| ||||
| Nabothian cyst[72][73][74][75] |
|
|
|
− | − |
|
− | − | N/A |
|
T1-weighted
|
|
| ||||
| IUD use[76][77][78] |
|
|
+
|
+ | − |
|
− | − |
|
|
N/A | N/A |
| ||||
References
- ↑ Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
- ↑ Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.
- ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
- ↑ . doi:10.1097/PAS.0000000000000498. Check
|doi=value (help). Missing or empty|title=(help) - ↑ Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
- ↑ Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.
- ↑ Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
- ↑ Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
- ↑ Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
- ↑ Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.
- ↑ Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.
- ↑ Coronado GD, Marshall LM, Schwartz SM (May 2000). "Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study". Obstet Gynecol. 95 (5): 764–9. PMID 10775744.
- ↑ Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
- ↑ El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.
- ↑ Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.
- ↑ Yokoyama Y, Shinohara A, Hirokawa M, Maeda N (2003). "Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma". Gynecol. Obstet. Invest. 56 (4): 179–83. doi:10.1159/000074104. PMID 14564105.
- ↑ Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.
- ↑ Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.
- ↑ Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD (September 2006). "Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature". Leuk. Lymphoma. 47 (9): 1894–901. doi:10.1080/10428190600687653. PMID 17065003.
- ↑ Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (November 2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.
- ↑ Khosla, Divya; Gupta, Ruchi; Srinivasan, Radhika; Patel, Firuza D.; Rajwanshi, Arvind (2012). "Sarcomas of Uterine Cervix". International Journal of Gynecological Cancer. 22 (6): 1026–1030. doi:10.1097/IGC.0b013e31825a97f6. ISSN 1048-891X.
- ↑ Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA (December 2015). "Imaging Features of Uncommon Gynecologic Cancers". AJR Am J Roentgenol. 205 (6): 1346–59. doi:10.2214/AJR.14.12695. PMC 5502476. PMID 26587944.
- ↑ . doi:10.1097/IGC.0b013e31825a97f6. Check
|doi=value (help). Missing or empty|title=(help) - ↑ Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.
- ↑ . doi:10.12865/CHSJ.42.02.11. Missing or empty
|title=(help) - ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
- ↑ Mattson SK, Polk JP, Nyirjesy P (July 2016). "Chronic Cervicitis: Presenting Features and Response to Therapy". J Low Genit Tract Dis. 20 (3): e30–3. doi:10.1097/LGT.0000000000000225. PMID 27243142.
- ↑ Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
- ↑ Meyer T (August 2016). "Diagnostic Procedures to Detect Chlamydia trachomatis Infections". Microorganisms. 4 (3). doi:10.3390/microorganisms4030025. PMID 27681919.
- ↑ Woods, Jennifer L.; Bailey, Sarabeth L.; Hensel, Devon J.; Scurlock, Amy M. (2011). "Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?". Journal of Pediatric and Adolescent Gynecology. 24 (6): 359–364. doi:10.1016/j.jpag.2011.06.006. ISSN 1083-3188.
- ↑ Jayakumar, Naveen Kumar Bhagavathula (2015). "Cervicitis: How Often Is It Non-specific!". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2015/11594.5673. ISSN 2249-782X.
- ↑ Bakour SH, Dwarakanath LS, Khan KS, Newton JR, Gupta JK (May 1999). "The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenopausal bleeding". Acta Obstet Gynecol Scand. 78 (5): 447–51. PMID 10326893.
- ↑ Beddy, Peter; O'Neill, Ailbhe C.; Yamamoto, Adam K.; Addley, Helen C.; Reinhold, Caroline; Sala, Evis (2012). "FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging". RadioGraphics. 32 (1): 241–254. doi:10.1148/rg.321115045. ISSN 0271-5333.
- ↑ Byun JM, Jeong DH, Kim YN, Cho EB, Cha JE, Sung MS, Lee KB, Kim KT (November 2015). "Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge". Obstet Gynecol Sci. 58 (6): 468–74. doi:10.5468/ogs.2015.58.6.468. PMID 26623410.
- ↑ Wan-Nor-Asyikeen WA, Siti-Azrin AH, Jalil NA, Othman NH, Zain AA (2016). "Endometrial Cancer in Hospital Universiti Sains Malaysia". Asian Pac. J. Cancer Prev. 17 (6): 2867–70. PMID 27356704.
- ↑ Horn LC, Meinel A, Handzel R, Einenkel J (August 2007). "Histopathology of endometrial hyperplasia and endometrial carcinoma: an update". Ann Diagn Pathol. 11 (4): 297–311. doi:10.1016/j.anndiagpath.2007.05.002. PMID 17630117.
- ↑ Palmer, Julia E; Perunovic, Branko; Tidy, John A (2008). "Endometrial hyperplasia". The Obstetrician & Gynaecologist. 10 (4): 211–216. doi:10.1576/toag.10.4.211.27436. ISSN 1467-2561.
- ↑ Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, Voigt LF, Weiss NS (June 2009). "Incidence of endometrial hyperplasia". Am. J. Obstet. Gynecol. 200 (6): 678.e1–6. doi:10.1016/j.ajog.2009.02.032. PMC 2692753. PMID 19393600.
- ↑ Novac L, Grigore T, Cernea N, Niculescu M, Cotarcea S (2005). "Incidence of endometrial carcinoma in patients with endometrial hyperplasia". Eur. J. Gynaecol. Oncol. 26 (5): 561–3. PMID 16285581.
- ↑ Hsu AL, Khachikyan I, Stratton P (June 2010). "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol. 53 (2): 413–9. doi:10.1097/GRF.0b013e3181db7ce8. PMC 2880548. PMID 20436318.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Datta S, Kunde K (July 2008). "From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy". J Obstet Gynaecol. 28 (5): 552–3. doi:10.1080/01443610802247352. PMID 18850447.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Bedaiwy MA, Falcone T (February 2004). "Laboratory testing for endometriosis". Clin. Chim. Acta. 340 (1–2): 41–56. PMID 14734195.
- ↑ Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D (June 2010). "Endometriomas: their ultrasound characteristics". Ultrasound Obstet Gynecol. 35 (6): 730–40. doi:10.1002/uog.7668. PMID 20503240.
- ↑ . doi:10.1148/rg.314105193. Check
|doi=value (help). Missing or empty|title=(help) - ↑ Hoenderboom BM, van Benthem B, van Bergen J, Dukers-Muijrers N, Götz HM, Hoebe C, Hogewoning AA, Land JA, van der Sande M, Morré SA, van den Broek I (January 2019). "Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial". Sex Transm Infect. doi:10.1136/sextrans-2018-053778. PMID 30606817. Vancouver style error: initials (help)
- ↑ Jaiyeoba O, Soper DE (2011). "A practical approach to the diagnosis of pelvic inflammatory disease". Infect Dis Obstet Gynecol. 2011: 753037. doi:10.1155/2011/753037. PMC 3148590. PMID 21822367.
- ↑ Czeyda-Pommersheim, Ferenc; Kalb, Bobby; Costello, James; Liau, Joy; Meshksar, Arash; Arif Tiwari, Hina; Martin, Diego (2016). "MRI in pelvic inflammatory disease: a pictorial review". Abdominal Radiology. 42 (3): 935–950. doi:10.1007/s00261-016-1004-4. ISSN 2366-004X.
- ↑ Mitchell, Caroline; Prabhu, Malavika (2013). "Pelvic Inflammatory Disease". Infectious Disease Clinics of North America. 27 (4): 793–809. doi:10.1016/j.idc.2013.08.004. ISSN 0891-5520.
- ↑ Filip G, Balzano A, Cagnacci A (November 2018). "Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance". Minerva Ginecol. doi:10.23736/S0026-4784.18.04291-0. PMID 30486633.
- ↑ Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.
- ↑ Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.
- ↑ Zhou Y, Wu B, Li H (October 1996). "[The value of serum CA125 assays in the diagnosis of uterine adenomyosis]". Zhonghua Fu Chan Ke Za Zhi (in Chinese). 31 (10): 590–3. PMID 9275451.
- ↑ Tamai, Ken; Togashi, Kaori; Ito, Tsuyoshi; Morisawa, Nobuko; Fujiwara, Toshitaka; Koyama, Takashi (2005). "MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls". RadioGraphics. 25 (1): 21–40. doi:10.1148/rg.251045060. ISSN 0271-5333.
- ↑ Dartmouth, Katherine (2014). "A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis". Ultrasound. 22 (3): 148–157. doi:10.1177/1742271X14528837. ISSN 1742-271X.
- ↑ Mouhajer M, Obed S, Okpala AM (June 2017). "Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis". Ghana Med J. 51 (2): 94–97. PMC 5611908. PMID 28955106.
- ↑ Rathod, Setu; Samal, SunilKumar (2015). "Cervical ectopic pregnancy". Journal of Natural Science, Biology and Medicine. 6 (1): 257. doi:10.4103/0976-9668.149221. ISSN 0976-9668.
- ↑ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
- ↑ Miccò, Maura; Sala, Evis; Lakhman, Yulia; Hricak, Hedvig; Vargas, Hebert Alberto (2015). "Imaging Features of Uncommon Gynecologic Cancers". American Journal of Roentgenology. 205 (6): 1346–1359. doi:10.2214/AJR.14.12695. ISSN 0361-803X.
- ↑ Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin; Choi, Ook-Hwan (2013). "A Case of Vaginal Cancer with Uterine Prolapse". Journal of Menopausal Medicine. 19 (3): 139. doi:10.6118/jmm.2013.19.3.139. ISSN 2288-6478.
- ↑ Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C (2006). "Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report". Eur. J. Gynaecol. Oncol. 27 (5): 528–30. PMID 17139994.
- ↑ van der Linden, M.; Meeuwis, K.A.P.; Bulten, J.; Bosse, T.; van Poelgeest, M.I.E.; de Hullu, J.A. (2016). "Paget disease of the vulva". Critical Reviews in Oncology/Hematology. 101: 60–74. doi:10.1016/j.critrevonc.2016.03.008. ISSN 1040-8428.
- ↑ Lloyd J, Evans DJ, Flanagan AM (July 1999). "Extension of extramammary Paget disease of the vulva to the cervix". J. Clin. Pathol. 52 (7): 538–40. PMC 501500. PMID 10605411.
- ↑ Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ (January 2010). "Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course". Int. J. Gynecol. Pathol. 29 (1): 69–78. doi:10.1097/PGP.0b013e3181b1cc5e. PMID 19952933.
- ↑ Asmouki, Hamid; Oumouloud, Rachid; Aboulfalah, Abderrahim; Soummani, Abderraouf; Marrat, Abdelouahed (2012). "Paget's Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report". Case Reports in Oncological Medicine. 2012: 1–4. doi:10.1155/2012/854827. ISSN 2090-6706.
- ↑ Gonçalves Amorim, Andressa; Batista Fraga Mendes, Brunelle; Neves Ferreira, Rodrigo; Chambô Filho, Antônio (2015). "Paget Disease of the Vulva: Diagnosis by Immunohistochemistry". Case Reports in Dermatological Medicine. 2015: 1–5. doi:10.1155/2015/162483. ISSN 2090-6463.
- ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
- ↑ Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.
- ↑ Torky, Haitham A. (2016). "Huge Nabothian cyst causing Hematometra (case report)". European Journal of Obstetrics & Gynecology and Reproductive Biology. 207: 238–240. doi:10.1016/j.ejogrb.2016.10.042. ISSN 0301-2115.
- ↑ Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.
- ↑ Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.
- ↑ Nowitzki, Kristina M.; Hoimes, Matthew L.; Chen, Byron; Zheng, Larry Z.; Kim, Young H. (2015). "Ultrasonography of intrauterine devices". Ultrasonography. 34 (3): 183–194. doi:10.14366/usg.15010. ISSN 2288-5919.
- ↑ . doi:10.5489/cuaj.11100. Check
|doi=value (help). Missing or empty|title=(help)