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{{CMG}}; {{AE}}{{ZAS}}
{{CMG}}; {{AE}}{{ZAS}}
==Vaginal/Vulvar mass differential diagnosis==
{|
|- 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;" |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>
| style="background: #F5F5F5; padding: 5px;" |
* Postmenopausal
* Intermenstrual
* Postcoital
* Bleeding after 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
* Difficulty urinating
* 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 cells
| style="background: #F5F5F5; padding: 5px;" |±Chlamydia
| style="background: #F5F5F5; padding: 5px;" |
* Large cervical cancer
* Angiogenesis on Doppler sonography
* Bladder involvement
* Lymph node involvement
| style="background: #F5F5F5; padding: 5px;" |  '''T2-weighted MRI''' :
* Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
| style="background: #F5F5F5; padding: 5px;" |  '''PET/CT scan''':
* Detect tumor size
* Lymph node involvement,
* Metastases to bladder or rectum
| style="background: #F5F5F5; padding: 5px;" |
* CIN1: mild dysplasia
* CIN2: moderate dysplasia
* CIN3: high degree of dysplasia/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>
| style="background: #F5F5F5; padding: 5px;" |
* Postcoital
* 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 masses with or without cysts
* Filling the endocervical or vaginal canal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Epithelial cells with no nuclear atypia/mitoses
| style="background: #F5F5F5; padding: 5px;" |
* Hysteroscopy /Biopsy
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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
* 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/labor complications
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Large,irregular 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 MRI''':
* Hypointense masses
* Homogeneous
enhancement
* Red degeneration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Spindle shaped smooth muscle cells
* Mature adipocytes
* Extracellular matrix consist of collagen,fibronectin.
| style="background: #F5F5F5; padding: 5px;" |
* Clinical diagnosis/ and
* Ultrasound
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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>
| 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;" |
* Difficulty urinating
* Post-coital pain
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Larrge 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small tumor cells with large nuclei
* High mitoses and proliferation
| style="background: #F5F5F5; padding: 5px;" |
* Biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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>
| style="background: #F5F5F5; padding: 5px;" |
* Intermentrual
* Postmenopausal
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* Post-coital pain
* Fullness in pelvic
| style="background: #F5F5F5; padding: 5px;" | ±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical erosion(Ectropion)<ref name="pmid28460993">{{cite journal |vauthors=Mitchell L, King M, Brillhart H, Goldstein A |title=Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis |journal=Sex Med |volume=5 |issue=3 |pages=e212–e214 |date=September 2017 |pmid=28460993 |pmc=5562466 |doi=10.1016/j.esxm.2017.03.001 |url=}}</ref><ref name="pmid15166070">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref><ref name="SharmaOjha2013">{{cite journal|last1=Sharma|first1=Abhishek|last2=Ojha|first2=Ranapratap|last3=Sengupta|first3=Parama|last4=Chattopadhyay|first4=Sarbani|last5=Mondal|first5=Soumit|title=Cervical intramural pregnancy: Report of a rare case|journal=Nigerian Medical Journal|volume=54|issue=4|year=2013|pages=271|issn=0300-1652|doi=10.4103/0300-1652.119670}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Light bleeding after pelvic exam
* Spotting
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
* Post-coital pain
* Painful cramps
* 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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>
| style="background: #F5F5F5; padding: 5px;" |
* Intermenstrual bleeding
* Postcoital
* Bleeding after pelvic exam
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Itching
| style="background: #F5F5F5; padding: 5px;" |
* Pain during urination
* Pain during sex
* Painful menstruation
| style="background: #F5F5F5; padding: 5px;" |
* May have fever only
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Red,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
* Gonorrhea
* Herpes simplex
* Trichomonas vaginalis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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>
| style="background: #F5F5F5; padding: 5px;" |
* Heavy bleeidng
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Itching
| style="background: #F5F5F5; padding: 5px;" |
* Painful menstruation
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-                                           
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Pelvic inflammatory diseases<ref name="pmid30606817">{{cite journal |vauthors=Hoenderboom BM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, Land JA, van der Sande MAB, Morré SA, van den Broek IVF |title=Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial |journal=Sex Transm Infect |volume= |issue= |pages= |date=January 2019 |pmid=30606817 |doi=10.1136/sextrans-2018-053778 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Bleeding after sex
* Intermenstrual bleeding
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Itching/burning
| style="background: #F5F5F5; padding: 5px;" |
* Pain during sex
* Painful menstruation
* Burning sensation during urination
* Pain during bowel movement
| style="background: #F5F5F5; padding: 5px;" |
* Fever
| style="background: #F5F5F5; padding: 5px;" |±Abdominal
pain
* Pelvic pain
| style="background: #F5F5F5; padding: 5px;" |
* Vaginal/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
* Gonorrhea
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Endometriosis<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>
| style="background: #F5F5F5; padding: 5px;" |
* 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;" |
* Painful menstruation
* Burning/painful urination
* Painful bowel movement
* Pain during or after sex
* Infertility
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Tender 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*
| style="background: #F5F5F5; padding: 5px;" |
* Visual inspection by laparascopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adnemyosis<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>
| 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;" |
* Painful menstruation
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid mass protruding into the 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| 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>
| style="background: #F5F5F5; padding: 5px;" |
* Amennorhea
* Bleeding after 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 uterine
* Thickened endometrium
| style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''':   
* Hypointense large mass
'''T1-weighted MRI''':
* Partially hyperintense mass
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Necrotic hemorrhagic mass with chorionic villus
| style="background: #F5F5F5; padding: 5px;" |
* Hysterectomy and biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |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>
| style="background: #F5F5F5; padding: 5px;" |
* Postcoital 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| 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 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Intraepidermal adenocarcinoma which involves epidermis
| style="background: #F5F5F5; padding: 5px;" |
* Biopsy of lesion
|-
| 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>
| style="background: #F5F5F5; padding: 5px;" |
* 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;" |
* Vaginal lump
* Inguinal lymphadenopathy
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| 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="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;" |
* Postcoital bleeding
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
* Pain during sex
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 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;" |
| 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|}


==Differentiating [Disease name] from other Diseases==
==Differentiating [Disease name] from other Diseases==

Revision as of 13:40, 1 February 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]

Vaginal/Vulvar mass differential diagnosis

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
Cervical cancer[1][2][3][4][5][6]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam
 + + +
  • Burning during urination
  • Difficulty urinating
  • Pain during sex
 +

+

  • Cervical mass on exam
 + ±
  • Negative
  • Atypical cells
 ±Chlamydia
  • Large cervical cancer
  • Angiogenesis on Doppler sonography
  • Bladder involvement
  • Lymph node involvement
 T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
 PET/CT scan:
  • Detect tumor size
  • Lymph node involvement,
  • Metastases to bladder or rectum
  • CIN1: mild dysplasia
  • CIN2: moderate dysplasia
  • CIN3: high degree of dysplasia/metastases
  • Colposcopy/biopsy
Cervical polyp[7]
  • Postcoital
  • Intermenstrual
  • Postmenopausal
  • Bleeding after exam
 + − − − − −
  • Mass on exam
 − − − −
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
  • Epithelial cells with no nuclear atypia/mitoses
  • Hysteroscopy /Biopsy
Cervical leiomyoma[8][9][10][11][12][13][14][15]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
 + + −
  • Urinary retention
  • Constipation
  • Infertility
  • Bowel obstruction
  • Increase in pregnancy/labor complications
 − +
  • Large,irregular pelvic mass
 ±
− − −
  • Well circumscribed hyperechoic mass
 T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Spindle shaped smooth muscle cells
  • Mature adipocytes
  • Extracellular matrix consist of collagen,fibronectin.
  • Clinical diagnosis/ and
  • Ultrasound
Cervical lymphoma[16][17]
  • Postmenopausal bleeding
 − + −
  • Difficulty urinating
  • Post-coital pain
 + +
  • Larrge uterine/cervix mass
  • Irregularity
 + − − −
  • Well-defined, solid, concentric, hypoechoic mass
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
  • Biopsy
Cervical sarcoma[18]
  • Intermentrual
  • Postmenopausal
 ± + −
  • Post-coital pain
  • Fullness in pelvic
 ± +
  • Cervical mass
  • Lump protruding from vagina/vulva
 + − − −
  • Biopsy
Cervical erosion(Ectropion)[19][20][21]
  • Light bleeding after pelvic exam
  • Spotting
 + + ±
  • Post-coital pain
  • Painful cramps
  • Pain after sex
 − + − − − −
Cervicitis[22][23]
  • Intermenstrual bleeding
  • Postcoital
  • Bleeding after pelvic exam
 + +
  • Itching
  • Pain during urination
  • Pain during sex
  • Painful menstruation
  • May have fever only
  • Red,inflammed swollen cervix
  • Inflammation/irritation of vulva/vagina
 − − −
  • Chlamydia
  • Gonorrhea
  • Herpes simplex
  • Trichomonas vaginalis
IUD use[24]
  • Heavy bleeidng
 ± +
  • Itching
  • Painful menstruation
 − − − − ±
Pelvic inflammatory diseases[25]
  • Bleeding after sex
  • Intermenstrual bleeding
 + +
  • Itching/burning
  • Pain during sex
  • Painful menstruation
  • Burning sensation during urination
  • Pain during bowel movement
  • Fever
 ±Abdominal

pain

  • Pelvic pain
  • Vaginal/vulvar tender lesion depending on microbial cause
 − − −
  • Chlamydia
  • Gonorrhea
Endometriosis[26][27][28][29]
  • Heavy mentrual bleeding
 ±
  • Pelvic pain
  • Back pain
 −
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
 − +
  • Tender uterosacral nodularity
  • Immobile uterus
  • Cervical motion tenderness
  • Retroverted uterus
 − − −
  • Visual inspection by laparascopy
Adnemyosis[30]
  • Abnormal uterine bleeding
 − + −
  • Painful menstruation
 −
  • Polypoid mass protruding into the endocervical canal.
 − − −
Cervical ectopic pregnancy[31]
  • Amennorhea
  • Bleeding after pelvic exam
 − − −
  • Pelvic pain
 − +
  • Soft and disporportionally enlarged uterus.
 − −
  • Empty uterine
  • Thickened endometrium
 T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
  • Necrotic hemorrhagic mass with chorionic villus
  • Hysterectomy and biopsy
DES exposure (Clear cell adenocarcinoma)[32]
  • Postcoital bleeding
 + − − −
Paget's disease of vulva to cervix[33][34][35]
  • Bleeding from lesion
  • Oozing
 ± −
  • Itching/burning
  • Pain in vulva
 − −
−
  • Scaly eczematoid lesion in vulva.
  • Erythematous plaques with white scaling.
  • Inguinal lymphadenopathy in case of metastases.
 − − − −
  • Intraepidermal adenocarcinoma which involves epidermis
  • Biopsy of lesion
Vaginal cancer[36]
  • Postcoital bleeding

+

  • Tenesmus
  • Dysuria
  • Urinary frequency
  • Constipation
  • Pelvic pain
  • Vaginal lump
  • Inguinal lymphadenopathy
 − − −
Nabothian cyst[37][38][39]
  • Postcoital bleeding
 + − −
  • Pain during sex
 −
  • Cystic mass on exam
 − − − −
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images










Differentiating [Disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Diagnosis Gold standard Additional findings Others
Symptoms Physical examination
Lab Findings Imaging
Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan
Rectal carcinoma[40][41][42][43][44] LLQ Constipation/diarrhea + + NL Anemia FOBT+ mass/polyp Apple core apearance endoscopic/trnasrectal US detects tumor extent determine tumor stage colonoscopy with biopsy DRE & proctoscopy detects tumor localization & extension
Rectal polyp[45][46][47] + mucous diarrhea + + NL NL rectal mass/polyp NL NL/anemia NL FOBT+ Polyp N/A Polyp N/A colonoscopy with biopsy N/A
Anal cancer[48][49][50][51] +/- constipation/diarrhea + +/- NL NL lump/mass at anal opening NL NL/anemia N/A FOBT+ N/A N/A determines anal cancer depth into sphincter hypoattenuated necrotic mass on contrast CT Biopsy PET/CT detects localization of small anal tumors <2cm sentinal lymph node biopsy detects lymph node metastases
Hemorrhoids[52][53][54][55] +/- fecal incontinence/mucous discharge + - NL/weakness,irritability NL NL iron deficiency anemia N/A blood on stool outer surface done if colorectal cancer suspected N/A N/A N/A DRE + anoscopy anoscopy shows bulging purplish hue veins or dark, pink, glistening mass None
Rectal prolapse[56][57][58][59] Abdominal discomfort constipation/diarrhea +/- - NL NL intermittent rectum protrusion seen NL NL/anemia N/A mucous/blood in stool may be used for screening N/A reveals asymmetry & any sphincter defect N/A history & physical examination DRE shows patulous anus, attenuated sphincter tone & mass anal manometry to assess sphincter function
Foreign body[60][61][62][63] Anorectal pain and abdominal pain Constipation + - NL NL FOBT+ Foreign body Contraindicated Foreign body Foreign body Plain radiographs show presence of foreign body NL NL
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Prostatitis[64][65][66][67] LLQ/groin pain NL N/A - NL NL NL tender/enlarged prostate leukocytosis NL/↑ PSA N/A N/A N/A
  • focal hypoechoic regoin in peripheral prostate
  • fluid collection suggests abscess
 edematous/enlarged prostate N/A prostate biopsy & thermograms may also be done ↑ CRP
Fecal impaction[68][69][70][71] + constipation - +/- DRE shows fecal impaction NL mild leukocytosis N/A N/A N/A used in softening of stool & stimulation of evacuation N/A presence of fecal matter in colon DRE to detect fecal impaction abdominal radiograph to detect fecal loading
Anal stenosis[72][73][74] + constipation + +/- NL NL visual inspection shows stenosis NL NL N/A NL contraindicated N/A N/A N/A visual inspection with DRE incomplete evacuation None
Hypertrophied anal papillae[75][76][77][78] - NL +/- - NL NL firm & palpable papillae on digital examination NL NL N/A mixed with blood N/A smooth polyp located inside anal verge N/A N/A visual inspection with digital examination associated with anal fissure & anal skin tag None
Endometriosis[79][80][81] +/- Constipation - - Fatigue Mild tenderness Nodules in posterior fornix Tenderness on vaginal exam Anemia - - N/A N/A Lesions can be detected on usg Not required N/A N/A N/A
Uterine malignancy[82][83][84] - NL - + Pallor NL Pelvic mass Vaginal bleeding Anemia Hcg - N/A N/A Increased thickness of uterine wall >4mm N/A Endometrial biopsy N/A N/A
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Cervical malignancy[85] - Normal - + Pallor

Fatigue

NL Pelvic mass Anemia N/A FOBT - N/A N/A Cervical thickening detects metastasis Cone biopsy N/A N/A
Pelvic abscess[86][87] + Nil - +/- Fluctuating mass Vaginal discharge in females leucocytosis - FOBT - N/A N/A Location and consistency of abscess Location and consistency of abscess N/A N/A N/A
Pelvic sarcoma[88][89][90] + NL/constipation +/- +/- NL/cachetic with fever presence of mass NL N/A leukocytosis NL N/A N/A N/A well circusmscribed, multinodular/infiltrating mass of soft tissue attenuation CT/MRI/Biopsy PET with FDG used for staging None

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