Cervical cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cervical cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Cervical_cancer]]
{{CMG}} {{AE}} {{Nnasiri}}  
{{CMG}} {{AE}} {{Nnasiri}}  
==Overview==
==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 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 differential diagnosis==
* Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:
* Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:<ref name="MwakaOrach2016">{{cite journal|last1=Mwaka|first1=Amos D.|last2=Orach|first2=Christopher G.|last3=Were|first3=Edward M.|last4=Lyratzopoulos|first4=Georgios|last5=Wabinga|first5=Henry|last6=Roland|first6=Martin|title=Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda|journal=Health Expectations|volume=19|issue=4|year=2016|pages=854–867|issn=13696513|doi=10.1111/hex.12382}}</ref><ref name="DonovanBoyington2014">{{cite journal|last1=Donovan|first1=Kristine A.|last2=Boyington|first2=Alice R.|last3=Judson|first3=Patricia L.|last4=Wyman|first4=Jean F.|title=Bladder and bowel symptoms in cervical and endometrial cancer survivors|journal=Psycho-Oncology|volume=23|issue=6|year=2014|pages=672–678|issn=10579249|doi=10.1002/pon.3461}}</ref><ref name="KimKang2010">{{cite journal|last1=Kim|first1=Soo Hyun|last2=Kang|first2=Sokbom|last3=Kim|first3=Yong-Man|last4=Kim|first4=Byoung-Gie|last5=Seong|first5=Seok Ju|last6=Cha|first6=Soon Do|last7=Park|first7=Chan-Yong|last8=Yun|first8=Young Ho|title=Prevalence and Predictors of Anxiety and Depression Among Cervical Cancer Survivors in Korea|journal=International Journal of Gynecological Cancer|volume=20|issue=6|year=2010|pages=1017–1024|issn=1048-891X|doi=10.1111/IGC.0b013e3181e4a704}}</ref>
 
:* [[Cervical polyp]]
:* [[Cervical polyp]]
:* Cervical [[leiomyoma]]
:* Cervical [[leiomyoma]]
:* Cervical lymphoma
:* Cervical [[lymphoma]]
:* Cervical sarcoma
:* Cervical [[sarcoma]]
:* Metastases to the cervix
:* Metastases to the cervix
:* Cervical [[ectopic pregnancy]]  
:* Cervical [[ectopic pregnancy]]  
:* Cervicitis
:* [[Cervicitis]]
:* Cervical erosion ( Ectropion )  
:* [[Cervical erosion]] ( [[Ectropion]] )  
:* IUD use  
:* [[IUD]] use  
:* Pelvic inflammatory disease  
:* [[Pelvic inflammatory disease]]
:* Endometriosis  
:* [[Endometriosis]]
:* Adenomyosis  
:* [[Adenomyosis]]
:* Nabothian cyst  
:* [[Nabothian cyst]]
{|
{|
! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis
! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis
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* Intermenstrual
* Intermenstrual
* Postcoital  
* Postcoital  
* Bleeding after pelvic exam
* Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dysuria
* [[Dysuria]]
* Urinary hesitancy  
* [[Urinary hesitancy]]
* Dyspareunia
* [[Dyspareunia]]
* Vaginal discharge
* [[Vaginal discharge]]
* Itching or burning of the vulva
* Itching or burning of the vulva
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Cervical mass on exam
* Cervical mass on exam
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |± [[Human papilloma virus|HPV]]
| style="background: #F5F5F5; padding: 5px;" |± [[Human papilloma virus|HPV]]  
* Atypical cells on [[Pap smear]]  
* Atypical cells on [[Pap smear]]  
* STI: ±Chlamydia
* '''[[STI]]''': ± [[Chlamydia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* ↑ [[CA-125]]
* ↑ [[CA-125]]
* Leukomoid reaction
* Leukomoid reaction
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Large cervical cancer
* Large [[cervical cancer]]


* Angiogenesis on Doppler sonography
* [[Angiogenesis]] on [[Doppler sonography]]


* Bladder involvement
* [[Bladder]] involvement


* 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.  '''PET/CT scan''':
* 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;" |[[Cervical intraepithelial neoplasia|'''Cervical intraepithelial neoplasia''']]:
* CIN1: mild dysplasia
* CIN1: mild [[dysplasia]]


* CIN2: moderate dysplasia
* CIN2: moderate [[dysplasia]]


* CIN3: high degree of dysplasia/metastases
* CIN3: high degree of [[dysplasia]]/[[metastases]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 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: #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>
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* Postcoital  
* Postcoital  
* Intermenstrual  
* Intermenstrual  
* Postmenopausal  
* [[Postmenopausal]]
* Bleeding after exam
* Bleeding after exam
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Vaginal discharge
* [[Vaginal discharge]]
* Dyspareunia
* [[Dyspareunia]]
| style="background: #F5F5F5; padding: 5px;" | −
| style="background: #F5F5F5; padding: 5px;" | −
| style="background: #F5F5F5; padding: 5px;" | −
| style="background: #F5F5F5; padding: 5px;" | −
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* ↓ [[RBC]] count
* ↓ [[RBC]] count
* ↓ Hb, ↓ [[Hematocrit|Hct]]  
* ↓ [[Hemoglobin]], ↓ [[Hematocrit|Hct]]  
* ↓ Serum Iron
* ↓ 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
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Epithelial cells with no nuclear atypia/mitoses
* [[Epithelial cells]] with no nuclear [[atypia]]/[[mitoses]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Hysteroscopy /Biopsy
* [[Hysteroscopy]] /[[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* 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
* [[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;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Large,irregular pelvic mass
* Large,irregular [[Pelvic masses|pelvic mass]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |±
*  
*  
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* Red degeneration
* Red degeneration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Spindle shaped smooth muscle cells  
* Spindle shaped [[Muscle cells|smooth muscle cells]]
* Mature adipocytes
* Mature [[adipocytes]]
* Extracellular matrix consist of collagen,fibronectin.
* Extracellular matrix consist of [[collagen]],[[fibronectin]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Clinical diagnosis/ and
* Clinical diagnosis/ and
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Larrge uterine/cervix mass
* Larrge [[uterine]]/[[cervix]] mass


* Irregularity
* Irregularity
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| style="background: #F5F5F5; padding: 5px;" |'''Pap smear:'''
| style="background: #F5F5F5; padding: 5px;" |'''Pap smear:'''
* Small round blue cells  
* Small round blue cells  
* High nuclear/cytoplasm ratio,  
* High [[nuclear]]/[[cytoplasm]] ratio,  
* Scant cytoplasm
* Scant cytoplasm
| style="background: #F5F5F5; padding: 5px;" |'''Immunohistochemistry markers:'''
| style="background: #F5F5F5; padding: 5px;" |'''Immunohistochemistry markers:'''
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| 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.
* [[Diffuse large B-cell lymphoma|diffuse large B-Cell lymphoma]] ([[DLBCL]]) most frequent type.
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Post-coital pain
* Post-coital pain
* Fullness in pelvic
* Fullness in [[pelvic]]
* Vaginal discharge
* [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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* Positive for for [[S-100]] and [[vimentin]] and are negative for [[desmin]], [[myoglobin]] and [[actin]].
* 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  
* [[Endometrial]] mass with heterogeneous echogenicity  
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
* Endometrial polypoid mass
* [[Endometrial]] polypoid mass
* Hypointense hypervascular solid components
* Hypointense hypervascular solid components
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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! 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: #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;" |
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* [[Squamous metaplasia]]
* [[Squamous metaplasia]]


* Vascular ectasia
* [[Vascular ectasia of the colon|Vascular ectasia]]
* [[Lymphocytic]] infiltration
* [[Lymphocytic]] infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Postcoital
* Postcoital


* Bleeding after pelvic exam
* Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pain during urination
* Pain during urination
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* 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;" |'''STI panel:'''
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
* [[Chlamydia]]
* [[Chlamydia]]


* Gonorrhea
* [[Gonorrhea]]
* [[Herpes simplex]]
* [[Herpes simplex]]
* [[Trichomonas vaginalis]]
* [[Trichomonas vaginalis]]
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| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''


May be detected as retention cysts in cervix.
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.  
* Non-specific, [[lymphocytic]] infiltration may be seen in microscopic histology.  


* Koilocytic changes in case of HPV as cause of chronic cervicitis.
* [[Koilocyte|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)
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pelvic pain
* [[Pelvic pain]]
* Back pain
* [[Back pain]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tender [[Uterosacral ligament|uterosacral]] nodularity
* Tender [[Uterosacral ligament|uterosacral]] nodularity
* Immobile uterus
* Immobile [[uterus]]
* [[Cervical|Cervica]]<nowiki/>l motion tenderness
* [[Cervical|Cervica]]<nowiki/>l motion tenderness
* Retroverted uterus
* Retroverted uterus
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(limited value)
(limited value)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Ground glass echogenicity of the cyst fluid (Endonetrioma)
* Ground glass echogenicity of the cyst fluid ([[Endometrioma]])
* Cysts are unilocular
* Cysts are unilocular
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* MRI findings is variable, depending upon the sites of endometriosis such as peritoneal implants, ovarian endometrioma, pelvic endometriosis.  
* [[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.
* [[Endometrial]] type glands and [[stroma]] presence is charracteristic [[histology]] findings, suggestive for [[endometriosis]].


*  
*  
Line 367: Line 368:
* [[Fever]]
* [[Fever]]


* Pelvic pain
* [[Pelvic pain]]


* [[Dyspareunia]]
* [[Dyspareunia]]
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pelvic pain
* [[Pelvic pain]]


* Cervical motion tenderness
* [[Cervical motion tenderness]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Oral temperature >101F
* Oral temperature >101F
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Vaginal/vulvar tender lesion depending on microbial causes
* Vaginal/vulvar tender lesion depending on [[microbial]] causes
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
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*  
*  
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Thickened, fluid-filled tubes with or without free [[pelvic]] or tuboovarian complex
* Thickened, fluid-filled tubes with or without free [[pelvic]] or tubo-ovarian complex
| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:'''
* Inflammation in pelvic soft tissue
* Inflammation in pelvic soft tissue


* Hydrosalpinx
* [[Hydrosalpinx]]


* Tubo-ovarian abscess in chronic PID.
* [[Tubo-ovarian abscess]] in chronic [[PID]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Inflamed, purulent fallopian tubes
* Inflamed, purulent [[fallopian tubes]]


*
*
Line 411: Line 412:
* Clinical diagnosis is gold standard for diagnosing [[PID]]
* Clinical diagnosis is gold standard for diagnosing [[PID]]


* [[Laparoscopy]] is confirmatory in acute salpengitis
* [[Laparoscopy]] is confirmatory in acute [[salpingitis]]
|-
|-
! 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: #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>
Line 422: Line 423:
| 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 [[Endocervix|endocervical canal]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Enlarged uterus may present as abdominal mass
* 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;" |
Line 431: Line 432:
* Subendometrial striations
* Subendometrial striations
* Myometrial cysts  
* Myometrial cysts  
* Asymetrical thickness in myometrium walls
* Asymetrical thickness in [[myometrium]] walls
* Heterogenous exhotexture of myometrum
* Heterogenous echotexture of [[myometrium]]
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
* Thickened junctional zone  
* Thickened junctional zone  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Presence of ectopic endometrial glands into the myometrium.
* Presence of ectopic [[endometrial]] glands into the myometrium.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Histology findings post hysterectomy
* [[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: #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>
Line 451: Line 452:
| 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;" |−
Line 457: Line 458:
* ↑ β-[[HCG]]
* ↑ β-[[HCG]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Empty uterine  
* Empty [[uterine]]


* Thickened endometrium
* Thickened [[endometrium]]
| style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''':     
| style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''':     
* Hypointense large mass
* Hypointense large mass
Line 465: Line 466:
* 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  
Line 473: Line 474:
* Postcoital bleeding
* Postcoital bleeding
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tenesmus
* [[Tenesmus]]
* [[Dysuria]]
* [[Dysuria]]
* Urinary frequency
* [[Urinary frequency]]
* [[Constipation]]
* [[Constipation]]
* Pelvic pain
* [[Pelvic pain]]
* [[Vaginal discharge]]
* [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
Line 485: Line 486:
* Ill-defined vaginal ulcer
* Ill-defined vaginal ulcer


* Vaginal lump
* Vaginal [[lump]]
* Inguinal [[lymphadenopathy]]
* [[Inguinal]] [[lymphadenopathy]]
* Edema and ulceration of vaginal wall
* [[Edema]] and ulceration of vaginal wall
* Foul-odor blood tinged vaginal discharge
* Foul-odor blood tinged [[vaginal discharge]]
* [[Vaginal prolapse]]
* [[Vaginal prolapse]]
* [[Cystocele]]
* [[Cystocele]]
Line 500: Line 501:
* ↓ [[RBC]] count
* ↓ [[RBC]] count
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* [[Hydronephrosis]] in case of pelvic metastases  
* [[Hydronephrosis]] in case of pelvic [[metastases]]
* Multiple liver metastases
* Multiple [[liver]] metastases
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
* Isointense on T1-weighted images
* Isointense on T1-weighted images
Line 508: Line 509:
* [[Squamous cell carcinoma]] of vagina
* [[Squamous cell carcinoma]] of vagina
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Biopsy
* [[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: #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
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* ±Vaginal discharge
* ± [[Vaginal discharge]]


* Pain in vulva
* Pain in vulva
Line 526: Line 526:
| 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)
* Positive for [[cytokeratin]](CK7)


* Negative for S-100 and Melan-A
* Negative for [[S-100]] and Melan-A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
Line 541: Line 541:
* "Cake-icing effect", pathognomic for vulvar paget's disease
* "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: #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>  
Line 552: Line 552:
* [[Vaginal discharge]]
* [[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
* In very rare cases depending upon the size of cyst it can cause [[abdominal pain]] and [[amenorrhea]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
Line 571: Line 571:
* Multiple benign cystic masses, usually few milimieters in diameter.  
* 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
* [[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: #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>
Line 577: Line 577:
* Heavy bleeidng  
* Heavy bleeidng  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Painful menstruation
* Painful [[menstruation]]
* ±Vaginal discharge
* ± [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
* In cases of uterine rupture and far migration of IUD, it can cause adhesion, bowel obstruction, perforation.
* In cases of [[uterine]] rupture and far migration of [[IUD]], it can cause [[adhesion]], [[bowel obstruction]], [[perforation]].
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* May have decreased RBC count  
* May have decreased [[RBC]] count  
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* Linear echogenic intrauterine structures
* Linear echogenic intrauterine structures
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* Transvaginal ultrasound
* [[Transvaginal ultrasound]]
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:primary care]]
[[Category:Up-To-Date]]
 
{{WH}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gynecology]]

Latest revision as of 20:51, 29 July 2020

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:[1][2][3]
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[4][5][6][7][8][9][10][11]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam

+

+ +
  • Cervical mass on exam
 + ± HPV T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
Cervical intraepithelial neoplasia:
Cervical polyp[12] − − −
  • Mass on exam
 − −
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
Cervical leiomyoma[13][14][15][16][17][18][19][20][21]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
 + + − ±
−
  • Well circumscribed hyperechoic mass
 T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Clinical diagnosis/ and
Cervical lymphoma[22][23][24]
  • Difficulty urinating
  • Post-coital pain
 + + +
  • Irregularity
 + Pap smear: Immunohistochemistry markers:
  • Well-defined, solid, concentric, hypoechoic mass
 MRI:
  • Intramyometrial infiltrative nodules
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
Cervical sarcoma[25][26][27][28] + + ±
  • Cervical mass
  • Lump protruding from vagina/vulva
 + − Leiomyosarcoma markers: MRI:
  • Endometrial polypoid mass
  • Hypointense hypervascular solid components
Cervical erosion(Ectropion)[29][30][31][32][33]
  • Post-coital pain
  • Painful cramps
 + + −
  • Red, glandular area around os of cervix
 − − N/A N/A N/A
Cervicitis[34][35][36][37][38]
  • Intermenstrual bleeding
  • Postcoital
  • Pain during urination
 + +
  • May have fever only
 − STI panel:
MRI:

May be detected as retention cysts in cervix.

  • Non-specific, lymphocytic infiltration may be seen in microscopic histology.
  • Koilocytic changes in case of HPV as cause of chronic cervicitis.
Endometriosis[39][40][41][42][43][44][45]
  • Heavy mentrual bleeding
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
  • Watery vaginal discharge
 + − + −

(limited value)

  • Ground glass echogenicity of the cyst fluid (Endometrioma)
  • Cysts are unilocular
Pelvic inflammatory diseases[46][47][48][49]
  • Bleeding after sex
  • Intermenstrual bleeding
 +
  • Oral temperature >101F
  • Vaginal/vulvar tender lesion depending on microbial causes
 − STI panel:
  • ↑ WBC
  • Oral temperature >101F
 Ultrasound:
  • Thickened, fluid-filled tubes with or without free pelvic or tubo-ovarian complex
 MRI findings:
  • Inflammation in pelvic soft tissue
  • Clinical diagnosis is gold standard for diagnosing PID
Adenemyosis[50][51][52][53][54][55]
  • Abnormal uterine bleeding
  • Painful menstruation
 + + − −
  • Subendometrial striations
  • Myometrial cysts
  • Asymetrical thickness in myometrium walls
  • Heterogenous echotexture of myometrium
 MRI:
  • Thickened junctional zone
  • Presence of ectopic endometrial glands into the myometrium.
Cervical ectopic pregnancy[56][57] + − −
  • Soft and disporportionally enlarged uterus.
 ± − T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
Vaginal cancer[58][59][60][61]
  • Postcoital bleeding
 + + ±
  • Ill-defined vaginal ulcer
  • In case of metastases to internal organs
 Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
 Biopsy findings:
Paget's disease of vulva to cervix[62][63][64][65][66]
  • Bleeding from lesion
  • Pain in vulva
  • Itching or burning sensation in vulva
 − − −
− −
  • Negative for S-100 and Melan-A
 N/A MRI:
  • Hyperintense on diffusion weighted imaging
  • Thick vulvar skin
  • "Cake-icing effect", pathognomic for vulvar paget's disease
Nabothian cyst[67][68][69][70]
  • Postcoital bleeding
 − −
  • Majority of them are asymptomatic due to their small size( few milimeters)
 − − N/A
  • Anechoic well defined cystic lesions
 T1-weighted
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
  • Benign cystic lesion
  • Multiple benign cystic masses, usually few milimieters in diameter.
IUD use[71][72][73]
  • Heavy bleeidng
 + + −
  • Normal
 − −
  • May have decreased RBC count
  • Linear echogenic intrauterine structures
 N/A N/A

References

  1. ↑ Mwaka, Amos D.; Orach, Christopher G.; Were, Edward M.; Lyratzopoulos, Georgios; Wabinga, Henry; Roland, Martin (2016). "Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda". Health Expectations. 19 (4): 854–867. doi:10.1111/hex.12382. ISSN 1369-6513.
  2. ↑ Donovan, Kristine A.; Boyington, Alice R.; Judson, Patricia L.; Wyman, Jean F. (2014). "Bladder and bowel symptoms in cervical and endometrial cancer survivors". Psycho-Oncology. 23 (6): 672–678. doi:10.1002/pon.3461. ISSN 1057-9249.
  3. ↑ Kim, Soo Hyun; Kang, Sokbom; Kim, Yong-Man; Kim, Byoung-Gie; Seong, Seok Ju; Cha, Soon Do; Park, Chan-Yong; Yun, Young Ho (2010). "Prevalence and Predictors of Anxiety and Depression Among Cervical Cancer Survivors in Korea". International Journal of Gynecological Cancer. 20 (6): 1017–1024. doi:10.1111/IGC.0b013e3181e4a704. ISSN 1048-891X.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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)
  7. ↑ . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)
  8. ↑ Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ . doi:10.1097/IGC.0b013e31825a97f6. Check |doi= value (help). Missing or empty |title= (help)
  29. ↑ 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.
  30. ↑ 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.
  31. ↑ 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.
  32. ↑ . doi:10.12865/CHSJ.42.02.11. Missing or empty |title= (help)
  33. ↑ 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.
  34. ↑ 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.
  35. ↑ Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
  36. ↑ Meyer T (August 2016). "Diagnostic Procedures to Detect Chlamydia trachomatis Infections". Microorganisms. 4 (3). doi:10.3390/microorganisms4030025. PMID 27681919.
  37. ↑ 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.
  38. ↑ 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.
  39. ↑ 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.
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ 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.
  43. ↑ Bedaiwy MA, Falcone T (February 2004). "Laboratory testing for endometriosis". Clin. Chim. Acta. 340 (1–2): 41–56. PMID 14734195.
  44. ↑ 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.
  45. ↑ . doi:10.1148/rg.314105193. Check |doi= value (help). Missing or empty |title= (help)
  46. ↑ 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)
  47. ↑ 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.
  48. ↑ 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.
  49. ↑ 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.
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  54. ↑ 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.
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  56. ↑ 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.
  57. ↑ 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.
  58. ↑ 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.
  59. ↑ 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.
  60. ↑ 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.
  61. ↑ 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.
  62. ↑ 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.
  63. ↑ 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.
  64. ↑ 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.
  65. ↑ 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.
  66. ↑ 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.
  67. ↑ 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.
  68. ↑ 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.
  69. ↑ 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.
  70. ↑ 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.
  71. ↑ Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.
  72. ↑ 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.
  73. ↑ . doi:10.5489/cuaj.11100. Check |doi= value (help). Missing or empty |title= (help)

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