Vaginal cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Vaginal cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Vaginal_cancer]]
 
{{CMG}}


{{CMG}} {{AE}} {{sali}}
==Overview==
==Overview==
Vaginal cancer must be differentiated from [[cervical carcinoma]], [[rectal carcinoma]], [[Uterine cancer|uterine carcinoma]], vaginal [[lymphoma]], vaginal [[cyst]], vaginal node of endometriosis, and [[uterine fibroids]].
Vaginal cancer must be differentiated from [[cervical carcinoma]], [[rectal carcinoma]], [[Uterine cancer|uterine carcinoma]], vaginal [[lymphoma]], vaginal [[cyst]], vaginal node of endometriosis, and [[uterine fibroids]].
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Other differential considerations include:
Other differential considerations include:


* Vaginal [[lymphoma]]


Diseases with similar symptoms are the following:  
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="7" 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="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal
vaginal bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal vaginal dyscharge
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic
pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Itching or
burning of the vulva
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Genitourinary/ Gastrointestinal symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal
mass
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HPV
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pap smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |STI Panel
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT Scan
|-
| 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;" |
* [[coitus|Postcoital]] [[bleeding]]
| style="background: #F5F5F5; padding: 5px;" |
+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus]]
* [[Dysuria]]
* [[Urinary frequency]]
* [[Constipation]]
* [[Pelvic pain]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[vagina|Vaginal]] [[lump]]
* Inguinal [[lymphadenopathy]]
| style="background: #F5F5F5; padding: 5px;" |
* In case of [[metastases]] to internal organs
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |'''[[Ultrasound]]:'''
* [[Hydronephrosis]] in case of [[pelvis|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;" |
* Provide information about size shape and location of [[tumor]]
* Detects [[metastases]]
* Detects [[lymph node]] involvement
| style="background: #F5F5F5; padding: 5px;" |'''[[Biopsy]] findings:'''
* [[Squamous cell carcinoma]] of [[vagina]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
|-
| 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;" |
* [[Postmenopausal]]
* [[Menstrual|Intermenstrual]]
* [[Coitus|Postcoital]]
* [[Bleeding]] after [[Pelvic examination|pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Burning during urination]]
* [[Dysuria|Difficulty urinating]]
* [[Dyspareunia|Pain during sex]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
+
| style="background: #F5F5F5; padding: 5px;" |
* [[Cervical]] mass on exam
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
* Negative
* Atypical [[Cell (biology)|cells]]
| style="background: #F5F5F5; padding: 5px;" |±[[Chlamydia]]
| style="background: #F5F5F5; padding: 5px;" |
* Large [[cervical cancer]]
 
* [[Angiogenesis]] on [[Doppler sonography]]
 
* [[Urinary bladder|Bladder]] involvement
 
* [[Lymph node]] involvement
| style="background: #F5F5F5; padding: 5px;" |  '''T2-weighted [[Magnetic resonance imaging|MRI]]''' :
* Ovoid, heterogeneous [[tumor]] distending the cervical canal with stromal involvement.
| style="background: #F5F5F5; padding: 5px;" |  '''[[Positron emission tomography|PET]]/[[Computed tomography|CT scan]]''':
* Detect [[tumor]] size
* [[Lymph node]] involvement,
* [[Metastasis|Metastases]] to [[Urinary bladder|bladder]] or [[rectum]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Cervical intraepithelial neoplasia|CIN1]]: mild [[dysplasia]]
 
* [[Cervical intraepithelial neoplasia|CIN2]]: moderate [[dysplasia]]
 
* [[Cervical intraepithelial neoplasia|CIN3]]: high degree of [[dysplasia]]/[[Metastasis|metastases]]
| style="background: #F5F5F5; padding: 5px;" |
* [[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><ref>{{Cite journal
| author = [[Irene Pecorella]], [[Marco Monti]], [[Maria Luisa Framarino Dei Malatesta]] & [[Gaia Ciardi]]
| title = Polyp of the uterine cervix with heterologous fatty tissue
| journal = [[Indian journal of pathology & microbiology]]
| volume = 61
| issue = 4
| pages = 593–595
| year = 2018
| month = October-December
| doi = 10.4103/IJPM.IJPM_105_17
| pmid = 30303160
}}</ref><ref>{{Cite journal
| author = [[Seema Anushka Tirlapur]], [[Adewale Adeyemo]], [[Neil O'Gorman]] & [[Dan Selo-Ojeme]]
| title = Clinico-pathological study of cervical polyps
| journal = [[Archives of gynecology and obstetrics]]
| volume = 282
| issue = 5
| pages = 535–538
| year = 2010
| month = November
| doi = 10.1007/s00404-010-1364-x
| pmid = 20091045
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Coitus|Postcoital]]
* [[Abnormal uterine bleeding|Intermenstrual]]
* [[Postmenopausal]]
* [[Bleeding]] after 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;" | −
| style="background: #F5F5F5; padding: 5px;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[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;" |
* Hyper/hypoechogenic [[Mass|masses]] with or without [[Cyst|cysts]]
* Filling the [[Endocervix|endocervical]] or [[Vagina|vaginal canal]]
| style="background: #F5F5F5; padding: 5px;" |May reveal presence of [[tumor]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT contrast]] may show presence of a well defined [[mass]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Epithelial cells]] with no [[nuclear]] [[atypia]]/[[Mitosis|mitoses]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hysteroscopy]] /[[Biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leiomyoma|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>
| style="background: #F5F5F5; padding: 5px;" |
* Heavy/prolonged [[menstrual bleeding]]
* [[Abnormal uterine bleeding|Intermenstrual bleeding]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Urinary retention]]
* [[Constipation]]
* [[Infertility]]
* [[Bowel obstruction]]
* Increase in [[pregnancy]]/[[Childbirth|labor]] complications
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Large,irregular [[Pelvic masses|pelvic mass]]
| 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;" |
* Well circumscribed hyperechoic [[mass]]
| style="background: #F5F5F5; padding: 5px;" |'''T2-weighted [[Magnetic resonance imaging|MRI]]''':
* Hypointense [[Mass|masses]]
* Homogeneous
enhancement
* Red degeneration
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
* Spindle shaped [[smooth muscle cells]]
* Mature [[Adipocyte|adipocytes]]
* [[Extracellular matrix]] consist of [[collagen]],[[fibronectin]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Clinical]] [[diagnosis]]/ and
 
* [[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;" |
* [[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysuria|Difficulty urinating]]
 
* [[Coitus|Post-coital]] [[pain]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Large [[Uterus|uterine]]/[[cervix]] [[mass]]
 
* Irregularity
| 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;" |
* Well-defined, solid, concentric, hypoechoic [[mass]]
| style="background: #F5F5F5; padding: 5px;" |'''[[Magnetic resonance imaging|MRI:]]'''
* [[Myometrium|Intramyometrial]] infiltrative nodules
| style="background: #F5F5F5; padding: 5px;" |Diffuse heterogeneous [[Uterus|uterine]]/[[Cervix|cervical]] [[mass]] & hypoechoic enlarged [[iliac lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |
* Small [[Tumor cell|tumor cells]] with large [[nuclei]]
* High [[Mitosis|mitoses]] and [[proliferation]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
* [[Diffuse large B cell lymphoma|diffuse large B-Cell lymphoma (DLBCL)]] most frequent type.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoma|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;" |
* [[Abnormal uterine bleeding|Intermentrual]]
* [[Postmenopausal]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Coitus|Post-coital]] [[pain]]
* Fullness in [[pelvis]]
| style="background: #F5F5F5; padding: 5px;" | ±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Cervix|Cervical]] [[mass]]
* [[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;" |
* [[Endometrium|Endometrial]] [[mass]] with heterogeneous echogenicity
| style="background: #F5F5F5; padding: 5px;" |'''[[Magnetic resonance imaging|MRI]]:'''
* [[Endometrium|Endometrial]] polypoid [[mass]]
* Hypointense hypervascular solid components
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Mitotic index]]
* [[Cell (biology)|Cellular]] [[atypia]]
* [[Coagulative necrosis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical erosion|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;" |
* Light [[bleeding]] after [[Pelvic examination|pelvic exam]]
* Spotting
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
* [[Coitus|Post-coital]] [[pain]]
* Painful [[Cramp|cramps]]
* [[Dyspareunia|Pain after sex]]
| 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;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Squamous metaplasia]]
* [[Ectasia|Vascular ectasia]]
* [[Lymphocytic]] [[Infiltration (medical)|infiltration]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Colposcopy]] and [[biopsy]]
|-
| 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>
| style="background: #F5F5F5; padding: 5px;" |
* [[Abnormal uterine bleeding|Intermenstrual bleeding]]
* [[Coitus|Postcoital]]
* [[Bleeding]] after [[Pelvic examination|pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Itching]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysuria|Pain during urination]]
 
* [[Dyspareunia|Pain during sex]]
* [[Dysmenorrhea|Painful menstruation]]
| style="background: #F5F5F5; padding: 5px;" |
* May have [[fever]] only
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Red,[[Inflammation|inflammed]] swollen [[cervix]]
* [[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;" |
* [[Chlamydia infection|Chlamydia]]
* [[Gonorrhea]]
* [[Herpes simplex]]
* [[Trichomonas vaginalis]]
| style="background: #F5F5F5; padding: 5px;" |To detect [[complications]] like [[PID]]
| 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;" |
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
|-
| 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>{{Cite journal
| author = [[D. Reinprayoon]], [[S. Taneepanichskul]], [[S. Niruthisard]] & [[S. Suwajanakon]]
| title = Uterine histopathologic changes after Cu-Fix intrauterine device insertion
| journal = [[Contraception]]
| volume = 59
| issue = 1
| pages = 63–65
| year = 1999
| month = January
| pmid = 10342087
}}</ref><ref>{{Cite journal
| author = [[Seyma Fadiloglu]], [[B. Dilbaz]], [[E. Fadiloglu]] & [[S. Dilbaz]]
| title = Relationship between copper IUD complications and ultrasonographic findings
| journal = [[Archives of gynecology and obstetrics]]
| volume = 297
| issue = 4
| pages = 989–996
| year = 2018
| month = April
| doi = 10.1007/s00404-018-4711-y
| pmid = 29428979
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Heavy [[bleeding]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Itching]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysmenorrhea|Painful menstruation]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Strings of [[Intrauterine device|IUD]] device
* Signs of [[inflammation]]
* [[Discharge]]
* [[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;" |To detect [[Intrauterine device|IUD]] location and [[pregnancy]]
| 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;" |[[Physical examination|Physical exam]] and [[ultrasound]]
|-                                           
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic inflammatory disease|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>
| style="background: #F5F5F5; padding: 5px;" |
* [[Coitus|Postcoital]] [[bleeding]]


*Vaginal [[cyst]]
* [[Abnormal uterine bleeding|Intermenstrual bleeding]]
*Vaginal node of endometriosis
| style="background: #F5F5F5; padding: 5px;" | +
*[[Uterine fibroids]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Itching]]/burning
| style="background: #F5F5F5; padding: 5px;" |
* [[Dyspareunia|Pain during sex]]
* [[Dysmenorrhea|Painful menstruation]]
* [[Burning during urination|Burning sensation during urination]]
* [[Pain]] during [[bowel movement]]
| style="background: #F5F5F5; padding: 5px;" |
* Fever
| style="background: #F5F5F5; padding: 5px;" |±[[Abdominal pain|Abdominal]]
 
[[Abdominal pain|pain]]
* [[Pelvic pain]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Vagina|Vaginal]]/[[Vulva|vulvar]]  tender lesion depending on microbial cause
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Chlamydia infection|Chlamydia]]
* [[Gonorrhea]]
| style="background: #F5F5F5; padding: 5px;" |
* Enlarged [[fallopian tubes]]
* [[Abscess]]
* [[Hyperaemia|Hyperemia]]
* [[Ectopic pregnancy]]/[[ovarian cyst]]/[[abscess]]
| style="background: #F5F5F5; padding: 5px;" |Thickened fluid filled [[fallopian tubes]]
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |May show [[endometritis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Pelvic inflammatory disease diagnostic criteria|CDC diagnostic criteria of PID]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[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>
| style="background: #F5F5F5; padding: 5px;" |
* [[Menometrorrhagia|Heavy mentrual bleeding]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
* [[Pelvic pain]]
* [[Back pain]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysmenorrhea|Painful menstruation]]
* [[Dysuria|Burning/painful urination]]
* Painful [[bowel movement]]
* [[Dyspareunia|Pain during or after sex]]
* [[Infertility]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenderness|Tender]] [[Uterosacral ligaments|uterosacral]] nodularity
* Immobile [[uterus]]
* [[Cervical 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;" |
* Unilocular/multilocular [[Cyst|cysts]] contating thin/thick septations
* Increased [[vascularity]] showing increased doppler flow
| style="background: #F5F5F5; padding: 5px;" |
* Hyperintensity on T1 weighted images
* Hypointensity on T2 weighted images
| style="background: #F5F5F5; padding: 5px;" |
* [[Catamenial pneumothorax]], [[hemothorax]] & [[Pulmonary nodule|lung nodules]]
| style="background: #F5F5F5; padding: 5px;" |Presence of [[Endometrium|endometrial tissue]] outside the [[uterus]]
| style="background: #F5F5F5; padding: 5px;" |
* Visual [[Inspection (medicine)|inspection]] by [[laparoscopy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyosis]]<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>{{Cite journal
| author = [[Courtney A. Woodfield]], [[Evan S. Siegelman]], [[Beverly G. Coleman]] & [[Drew A. Torigian]]
| title = CT features of adenomyosis
| journal = [[European journal of radiology]]
| volume = 72
| issue = 3
| pages = 464–469
| year = 2009
| month = December
| doi = 10.1016/j.ejrad.2008.08.002
| pmid = 18804933
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Abnormal uterine bleeding]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysmenorrhea|Painful menstruation]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid [[mass]] protruding into the [[Endocervix|endocervical canal.]]
| 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;" |
* [[Transvaginal ultrasound|Transvaginal US]] shows poorly marginated hypoechoic & heterogenous areas within [[myometrium]]
* [[Myometrium|Myometrial]] [[Cyst|cysts]]
* Globular/enlarged [[uterus]] with asymmetry
| style="background: #F5F5F5; padding: 5px;" |'''[[Magnetic resonance imaging|MRI]]:'''
* Thickened junctional zone
| style="background: #F5F5F5; padding: 5px;" |
* [[Enlarged uterus|Uterine enlargement]]
* Thickened inner [[myometrium]]
* [[Myometrium|Myometrial]] [[Cyst|cysts]]
| style="background: #F5F5F5; padding: 5px;" |
* Presence of [[ectopic]] [[Endometrium|endometrial]] [[Gland|glands]] into the [[myometrium]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Histology]] findings post [[hysterectomy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ectopic pregnancy|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;" |
* [[Amenorrhea]]
* [[Bleeding]] after [[Pelvic examination|pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |−
| 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;" |
* 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;" |
* Empty [[uterus]]
 
* Thickened [[endometrium]]
| style="background: #F5F5F5; padding: 5px;" | '''T2-weighted [[Magnetic resonance imaging|MRI]]''':   
* Hypointense large [[mass]]
'''T1-weighted [[Magnetic resonance imaging|MRI]]''':
* Partially hyperintense [[mass]]
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
* [[Necrosis|Necrotic]] [[hemorrhagic]] [[mass]] with [[chorionic villus]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hysterectomy]] and [[biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[DES|DES exposure]] (Clear cell adenocarcinoma)<ref name="pmid28275694">{{cite journal |vauthors=Tantitamit T, Hamontri S, Rangsiratanakul L |title=Clear cell adenocarcinoma of the cervix in second generation young women who are without maternal exposure to diethylstilbestrol: A case report |journal=Gynecol Oncol Rep |volume=20 |issue= |pages=34–36 |date=May 2017 |pmid=28275694 |pmc=5328756 |doi=10.1016/j.gore.2017.02.008 |url=}}</ref><ref>{{Cite journal
| author = [[Subrata Pal]], [[Sritanu Jana]] & [[Kingshuk Bose]]
| title = Clear cell carcinoma of cervix in a postmenopausal woman: A case report
| journal = [[Journal of mid-life health]]
| volume = 6
| issue = 2
| pages = 85–87
| year = 2015
| month = April-June
| doi = 10.4103/0976-7800.158964
| pmid = 26167060
}}</ref><ref>{{Cite journal
| author = [[Mary G. Dandulakis]], [[Aidas J. Mattis]], [[Andrea R. Hagemann]] & [[Ian S. Hagemann]]
| title = Cervical clear cell adenocarcinoma with an exceptionally low proliferation index: Report of a case
| journal = [[Gynecologic oncology reports]]
| volume = 23
| pages = 16–19
| year = 2018
| month = February
| doi = 10.1016/j.gore.2017.12.006
| pmid = 29326971
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Coitus|Postcoital]] [[bleeding]]
* [[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Abdominal pain]]
* [[Melena|Blood in feces]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Normal looking [[cervix]]
* [[Cervical]] exophytic lesions
* Barrel shaped [[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;" |To determine [[Uterus|uterine]] extent
| style="background: #F5F5F5; padding: 5px;" |To detect [[Metastasis|metastases]]
| style="background: #F5F5F5; padding: 5px;" |
* Irregular dense [[mass]] occupying inferior lip of [[cervix]] and [[posterior fornix]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Tumor cell|Tumor cells]] with abundant clear [[cytoplasm]] and round [[nuclei]]
* [[Nucleus]] show hyperchromasia, moderate [[pleomorphism]] & prominent [[nucleoli]]
| 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>
| style="background: #F5F5F5; padding: 5px;" |
* [[Bleeding]] from [[lesion]]
* [[Oozing]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Itching]]/burning
* [[Pain]] in [[vulva]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
*
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* Scaly [[eczema|eczematoid]] lesion in [[vulva]].
* [[Erythematous plaques]] with white scaling.
* 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;" |N/A
| style="background: #F5F5F5; padding: 5px;" |'''[[MRI]]:'''
* Hyperintense on diffusion weighted images
| style="background: #F5F5F5; padding: 5px;" |
* May show bilateral enlarged [[inguinal lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |
* Thickened [[vulva|vulvar]] [[skin]]
* "Cake-icing effect", [[pathognomonic]] for [[vulva|vulva]]vulvar paget's disease
* Intraepidermal [[adenocarcinoma]] which involves [[epidermis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[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;" |
* [[Coitus|Postcoital]] [[bleeding]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Dyspareunia|Pain during sex]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Cyst|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;" |
* An echoic well defined [[Cyst|cystic]] [[Mass|masses]]
| style="background: #F5F5F5; padding: 5px;" |
* Intermediate or slightly high signal intensity on T1-weighted 
* High signal intensity on T2-weighted images
| style="background: #F5F5F5; padding: 5px;" |
* Small [[Cyst|cysts]] not visible on [[Computed tomography|CT]]
* Large [[Cyst|cysts]] seen as focal low attenuation region
| style="background: #F5F5F5; padding: 5px;" |
* Multiple [[benign]] [[Cyst|cystic]] [[Mass|masses]], usually few millimeters in diameter
| style="background: #F5F5F5; padding: 5px;" |
* [[Histological]] exam if large [[cystic]] [[Mass|masses]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rectal cancer]]<ref>{{Cite journal
| author = [[Chiara Molinari]], [[Federica Matteucci]], [[Paola Caroli]] & [[Alessandro Passardi]]
| title = Biomarkers and Molecular Imaging as Predictors of Response to Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer
| journal = [[Clinical colorectal cancer]]
| volume = 14
| issue = 4
| pages = 227–238
| year = 2015
| month = December
| doi = 10.1016/j.clcc.2015.05.014
| pmid = 26170142
}}</ref><ref>{{Cite journal
| author = [[William Hamilton]] & [[Deborah Sharp]]
| title = Diagnosis of colorectal cancer in primary care: the evidence base for guidelines
| journal = [[Family practice]]
| volume = 21
| issue = 1
| pages = 99–106
| year = 2004
| month = February
| pmid = 14760054
}}</ref><ref>{{Cite journal
| author = [[Wolfgang B. Gaertner]], [[Mary R. Kwaan]], [[Robert D. Madoff]] & [[Genevieve B. Melton]]
| title = Rectal cancer: An evidence-based update for primary care providers
| journal = [[World journal of gastroenterology]]
| volume = 21
| issue = 25
| pages = 7659–7671
| year = 2015
| month = July
| doi = 10.3748/wjg.v21.i25.7659
| pmid = 26167068
}}</ref><ref>{{Cite journal
| author = [[V. Raman Muthusamy]] & [[Kenneth J. Chang]]
| title = Optimal methods for staging rectal cancer
| journal = [[Clinical cancer research : an official journal of the American Association for Cancer Research]]
| volume = 13
| issue = 22 Pt 2
| pages = 6877s–6884s
| year = 2007
| month = November
| doi = 10.1158/1078-0432.CCR-07-1137
| pmid = 18006793
}}</ref><ref>{{Cite journal
| author = [[Mohammad Sadegh Fazeli]] & [[Mohammad Reza Keramati]]
| title = Rectal cancer: a review
| journal = [[Medical journal of the Islamic Republic of Iran]]
| volume = 29
| pages = 171
| year = 2015
| month =
| pmid = 26034724
}}</ref>
| 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;" |
* [[Constipation]]/[[diarrhea]]
* [[Absent bowel sounds]]
* [[Rectal mass]]/[[bleeding]]
* [[Abdominal tenderness]]
| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]] +
| style="background: #F5F5F5; padding: 5px;" |[[Left lower quadrant abdominal pain resident survival guide|LLQ]] +
| style="background: #F5F5F5; padding: 5px;" |NL
| 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;" |[[Endoscopic ultrasound|Endoscopic]]/[[Transrectal ultrasonography|transrectal US]] detects [[tumor]] extent
| style="background: #F5F5F5; padding: 5px;" |Determine [[tumor]] stage
| style="background: #F5F5F5; padding: 5px;" |Determine [[tumor]] stage
| style="background: #F5F5F5; padding: 5px;" |
* Sheets or cords of [[malignant]] [[cells]]
* [[Cell (biology)|Cellular]] [[atypia]] & [[pleomorphism]]
* High [[Mitosis|mitotic rate]]
* [[Necrosis|Necrotic]] debris in [[Gland|glandular]] lumina
| style="background: #F5F5F5; padding: 5px;" |[[Colonoscopy]] with [[biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine leiomyoma|Submucous uterine leiomyoma]]<ref>{{Cite journal
| author = [[Jacques Donnez]] & [[Marie-Madeleine Dolmans]]
| title = Uterine fibroid management: from the present to the future
| journal = [[Human reproduction update]]
| volume = 22
| issue = 6
| pages = 665–686
| year = 2016
| month = November
| doi = 10.1093/humupd/dmw023
| pmid = 27466209
}}</ref><ref>{{Cite journal
| author = [[Mohamed Sabry]] & [[Ayman Al-Hendy]]
| title = Medical treatment of uterine leiomyoma
| journal = [[Reproductive sciences (Thousand Oaks, Calif.)]]
| volume = 19
| issue = 4
| pages = 339–353
| year = 2012
| month = April
| doi = 10.1177/1933719111432867
| pmid = 22378865
}}</ref><ref>{{Cite journal
| author = [[Sahana Gupta]], [[Jude Jose]] & [[Isaac Manyonda]]
| title = Clinical presentation of fibroids
| journal = [[Best practice & research. Clinical obstetrics & gynaecology]]
| volume = 22
| issue = 4
| pages = 615–626
| year = 2008
| month = August
| doi = 10.1016/j.bpobgyn.2008.01.008
| pmid = 18372219
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Menorrhagia]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
* [[Polyuria|Urinary frequency]]/[[Urinary incontinence|incontinence]]
* [[Hydronephrosis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |Enlarged, irregular, firm, nontender [[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;" |
* [[Transvaginal ultrasound|Trans vaginal US]]: well defined hypoechoic
* Saline US: for [[submucous]] [[Leiomyoma|fibroids]]/polypoi
| style="background: #F5F5F5; padding: 5px;" |Provides information on no: of [[Leiomyoma|fibroids]], size, vascularization, relationship with [[Endometrium|endometrial cavity]] & [[Serosa|serosal surface]]
| style="background: #F5F5F5; padding: 5px;" |Not required
| style="background: #F5F5F5; padding: 5px;" |Not required
| style="background: #F5F5F5; padding: 5px;" |[[Physical examination]] with [[Ultrasound]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine cancer]]<ref name="pmid16055605">{{cite journal |vauthors= |title=ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer |journal=Obstet Gynecol |volume=106 |issue=2 |pages=413–25 |date=August 2005 |pmid=16055605 |doi= |url=}}</ref><ref name="pmid195920792">{{cite journal |vauthors=Boruta DM, Gehrig PA, Fader AN, Olawaiye AB |title=Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review |journal=Gynecol. Oncol. |volume=115 |issue=1 |pages=142–153 |date=October 2009 |pmid=19592079 |doi=10.1016/j.ygyno.2009.06.011 |url=}}</ref><ref name="pmid6822361">{{cite journal |vauthors=Bokhman JV |title=Two pathogenetic types of endometrial carcinoma |journal=Gynecol. Oncol. |volume=15 |issue=1 |pages=10–7 |date=February 1983 |pmid=6822361 |doi= |url=}}</ref><ref name="pmid20628804">{{cite journal |vauthors=Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F |title=Factors associated with Type I and Type II endometrial cancer |journal=Cancer Causes Control |volume=21 |issue=11 |pages=1851–6 |date=November 2010 |pmid=20628804 |pmc=2962676 |doi=10.1007/s10552-010-9612-8 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Menorrhagia|Menometorrhagia]]
* [[Abnormal uterine bleeding|Intermenstrual bleeding]]
* [[Coitus|Postcoital]] [[bleeding]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* [[Polyuria]]
* [[Dysuria]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
* [[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Enlarged [[uterus]]
* [[Lymphadenopathy]]
* Mesenteric nodules ([[Metastasis|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;" |Thickened [[Endometrium|endometrial lining]] >4cm
| style="background: #F5F5F5; padding: 5px;" |
* [[Endometrium|Endometrial]] thickening
* [[Lymph node]] involvement
* [[Pelvis|Pelvic]] [[Metastasis|metastases]]
| style="background: #F5F5F5; padding: 5px;" |Not required
| style="background: #F5F5F5; padding: 5px;" |
* [[Endometrium|Endometrial]] [[malignant]] [[Cell (biology)|cells]]
* Low grade type 1
* High grade type 2
| style="background: #F5F5F5; padding: 5px;" |[[Histologic]] [[diagnosis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Vaginal [[lymphoma]]<ref>{{Cite journal
| author = [[Vera Silva]], [[Paulo Correia]], [[Nuno Oliveira]] & [[Luis Sa]]
| title = Primary Vaginal Non-Hodgkin's Lymphoma: Report of a Rare Clinical Entity
| journal = [[Clinics and practice]]
| volume = 5
| issue = 4
| pages = 821
| year = 2015
| month = November
| doi = 10.4081/cp.2015.821
| pmid = 26918105
}}</ref><ref>{{Cite journal
| author = [[Feng Wang]], [[Xuquan Jing]], [[Bo Liu]], [[Xue Meng]], [[Xindong Sun]], [[Yongsheng Gao]], [[Linlin Wang]] & [[Zheng Fu]]
| title = Primary non-Hodgkin's lymphoma of the vagina: A case report
| journal = [[Oncology letters]]
| volume = 15
| issue = 3
| pages = 3504–3507
| year = 2018
| month = March
| doi = 10.3892/ol.2018.7805
| pmid = 29556272
}}</ref><ref>{{Cite journal
| author = [[Salvatore Guastafierro]], [[Amando Tedeschi]], [[Clelia Criscuolo]], [[Maria Celentano]], [[Luigi Cobellis]], [[Raffaele Rossiello]] & [[Umberto Falcone]]
| title = Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature
| journal = [[Acta haematologica]]
| volume = 128
| issue = 1
| pages = 33–38
| year = 2012
| month =
| doi = 10.1159/000337336
| pmid = 22584110
}}</ref>
| 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;" |[[Abdominal pain|Abdominal]]/[[pelvic pain]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Palpable]] [[mass]] between [[rectum]] & [[vagina]]
| 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;" |Diffuse [[mass]] in external [[Cervix|cervical]] orifice & invading the [[vagina]]
| style="background: #F5F5F5; padding: 5px;" |Diffuse [[mass]] in external [[Cervix|cervical]] orifice & invading the [[vagina]]
| style="background: #F5F5F5; padding: 5px;" |Not required
| style="background: #F5F5F5; padding: 5px;" |[[CD20]] & [[CD79|CD79a]] positive
| style="background: #F5F5F5; padding: 5px;" |[[Immunohistochemistry]] & [[biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Vaginal [[polyp]]<ref>{{Cite journal
| author = [[A. I. al-Nafussi]], [[G. Rebello]], [[D. Hughes]] & [[K. Blessing]]
| title = Benign vaginal polyp: a histological, histochemical and immunohistochemical study of 20 polyps with comparison to normal vaginal subepithelial layer
| journal = [[Histopathology]]
| volume = 20
| issue = 2
| pages = 145–150
| year = 1992
| month = February
| pmid = 1302457
}}</ref><ref>{{Cite journal
| author = [[Sunil Kumar Samal]], [[Setu Rathod]] & [[Seetesh Ghose]]
| title = Fibroepithelial Polyps of the Vagina in Pregnancy
| journal = [[Journal of clinical and diagnostic research : JCDR]]
| volume = 9
| issue = 10
| pages = QJ01–QJ02
| year = 2015
| month = October
| doi = 10.7860/JCDR/2015/13329.6656
| pmid = 26557576
}}</ref><ref>{{Cite journal
| author = [[M. Petrova]], [[J. Laco]], [[K. Cervicek]] & [[M. Tomsova]]
| title = &#91;Tubulo-squamous polyp of the vagina&#93;
| journal = [[Ceska gynekologie]]
| volume = 80
| issue = 3
| pages = 173–175
| year = 2015
| month = June
| pmid = 26087210
}}</ref><ref>{{Cite journal
| author = [[Alexis Heller]], [[Adanna Ukazu]] & [[Qing Wang]]
| title = Pseudosarcomatous Vaginal Polyp
| journal = [[International journal of surgical pathology]]
| volume = 25
| issue = 1
| pages = 54–55
| year = 2017
| month = February
| doi = 10.1177/1066896916666676
| pmid =}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Dyspareunia]]
* [[Coitus|Postcoidal]] [[bleeding]]
* [[Dysuria]]
* [[Constipation]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Mass]] protruding from [[vagina]]
| 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;" |To exclude [[Uterus|uterine]] [[hyperplasia]]/[[Uterine cancer|carcinoma]]
| style="background: #F5F5F5; padding: 5px;" |To determine the extent
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |[[Benign]] [[Tissue (biology)|tissue]]/[[premalignant]] [[Cell (biology)|cells]]
| style="background: #F5F5F5; padding: 5px;" |[[Excisional biopsy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vagina|Vaginal adenosis]]<ref>{{Cite journal
| author = [[Marguerite B. Vigliani]]
| title = A Report of Two Cases of Age-Related Changes in Cervical Morphology in Postmenopausal Women with Vaginal Adenosis
| journal = [[Case reports in obstetrics and gynecology]]
| volume = 2017
| pages = 9523853
| year = 2017
| month =
| doi = 10.1155/2017/9523853
| pmid = 28316850
}}</ref><ref>{{Cite journal
| author = [[Tiantian Han]], [[Ying Jin]], [[Yan Li]], [[Yalan Bi]] & [[Lingya Pan]]
| title = Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden: A retrospective study
| journal = [[Medicine]]
| volume = 97
| issue = 49
| pages = e13470
| year = 2018
| month = December
| doi = 10.1097/MD.0000000000013470
| pmid = 30544435
}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Abnormal uterine bleeding|Intermenstrual bleeding]]
* [[Postmenopausal 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;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Palpable]] [[Cyst|cysts]],nodularity or [[Ulcer|ulcers]]
| 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;" |Columnar cells in the [[ectocervix]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] with [[Histopathology|histopathological]] examination
|}


==References==
==References==
{{Reflist|2}}
[[Category:Gynecology]]

Latest revision as of 22:04, 28 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

Overview

Vaginal cancer must be differentiated from cervical carcinoma, rectal carcinoma, uterine carcinoma, vaginal lymphoma, vaginal cyst, vaginal node of endometriosis, and uterine fibroids.

Differential diagnosis

For large lesions consider invasion of the vagina by:

Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.

Other differential considerations include:


Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Abnormal vaginal dyscharge Pelvic

pain

Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal

mass

HPV Pap smear STI Panel Ultrasound MRI CT Scan
Vaginal cancer[1][2][3][4]

+

+ +/- +/- + Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
Biopsy findings:
Cervical cancer[5][6][7][8][9][10][11][12] + + + +

+

+ ± ±Chlamydia T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
PET/CT scan:
Cervical polyp[13][14][15] + May reveal presence of tumor CT contrast may show presence of a well defined mass
Cervical leiomyoma[16][17][18][19][20][21][22][23] + + + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
N/A
Cervical lymphoma[24][25][26] + + +
  • Irregularity
+
  • Well-defined, solid, concentric, hypoechoic mass
MRI: Diffuse heterogeneous uterine/cervical mass & hypoechoic enlarged iliac lymph nodes
Cervical sarcoma[27][28][29][30] ± + ± + + MRI: N/A
Cervical erosion(Ectropion)[31][32][33][34][35] + + ± + - N/A N/A N/A
Cervicitis[36][37][38][39] + + +/- To detect complications like PID N/A N/A N/A
IUD use[40][41][42] ± + +/- ± To detect IUD location and pregnancy N/A N/A N/A Physical exam and ultrasound
Pelvic inflammatory diseases[43][44] + +
  • Fever
±Abdominal

pain

Thickened fluid filled fallopian tubes N/A May show endometritis
Endometriosis[45][46][47][48][49][50] ± + +
  • Unilocular/multilocular cysts contating thin/thick septations
  • Increased vascularity showing increased doppler flow
  • Hyperintensity on T1 weighted images
  • Hypointensity on T2 weighted images
Presence of endometrial tissue outside the uterus
Adenomyosis[51][52][53][54][55] + +/- +/- MRI:
  • Thickened junctional zone
Cervical ectopic pregnancy[56][57] + T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
N/A
DES exposure (Clear cell adenocarcinoma)[58][59][60] + +/- +/- +/- + - To determine uterine extent To detect metastases
Paget's disease of vulva to cervix[61][62][63] ±
N/A MRI:
  • Hyperintense on diffusion weighted images
Nabothian cyst[64][65][66][67] + -
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images
  • Small cysts not visible on CT
  • Large cysts seen as focal low attenuation region
Rectal cancer[68][69][70][71][72] - - + - Weight loss + LLQ + NL + - - +/- Endoscopic/transrectal US detects tumor extent Determine tumor stage Determine tumor stage Colonoscopy with biopsy
Submucous uterine leiomyoma[73][74][75] Menorrhagia - + - - + Enlarged, irregular, firm, nontender uterus + - - - Provides information on no: of fibroids, size, vascularization, relationship with endometrial cavity & serosal surface Not required Not required Physical examination with Ultrasound
Uterine cancer[76][77][78][79] + + - + + - - - Thickened endometrial lining >4cm Not required Histologic diagnosis
Vaginal lymphoma[80][81][82] + + + + Abdominal/pelvic pain - + Palpable mass between rectum & vagina +/- - - - Diffuse mass in external cervical orifice & invading the vagina Diffuse mass in external cervical orifice & invading the vagina Not required CD20 & CD79a positive Immunohistochemistry & biopsy
Vaginal polyp[83][84][85][86] Postmenopausal bleeding + + + - + Mass protruding from vagina +/- - - - To exclude uterine hyperplasia/carcinoma To determine the extent N/A Benign tissue/premalignant cells Excisional biopsy
Vaginal adenosis[87][88] +/- +/- +/- - - - Palpable cysts,nodularity or ulcers - - - - N/A N/A N/A Columnar cells in the ectocervix Biopsy with histopathological examination

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