Endometrial cancer differential diagnosis: Difference between revisions

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Revision as of 18:32, 13 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]; Monalisa Dmello, M.B,B.S., M.D. [3]Roukoz A. Karam, M.D.[4]

Overview

In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.

Differentiating Endometrial Cancer From Other Diseases

In early stages endometrial cancer must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.^[1]

Diseases	Clinical manifestations				Para-clinical findings							Gold standard
	Symptoms			Physical examination	Para-clinical findings
	Symptoms			Physical examination	Lab Findings			Imaging		Pap Smear	Histopathology
	Bleeding	Pelvic Pain/pressure/ discomfort	Other	Abdomino-pelvic examination	Hb	B-HCG	CA-125	Ultrasound	MRI	Pap Smear	Histopathology
Endometrial cancer^[2]^[3]^[4]^[5]	Menorrhagia Metrorrhagia in premenopausal women Postcoital bleeding Intermenstrual bleeding	±	Polyuria and dysuria (due to compression) Fatigue Weight loss	Enlarged fixed uterus Vaginal bleeding Vaginal discharge Lymphadenopathy Mesenteric nodules (metastasis)	↓	–	+	A thickened endometrial lining >4mm	Endometrial thickening Lymph node involvement Pelvic metastasis	Atypical glandular cells	Endometrial malignant cells Low grade Type I High grade Type II	Biopsy
Uterine leiomyosarcoma^[6]^[7]^[8]^[9]	May have menorrhagia Intermenstrual bleeding	±	Abdominal pain Urinary symptoms Abdominal distension Asymptomatic	Abdominal distension Enlarged or normal sized uterus Lymphadenopathy	↓	–	+	Uterine mass Lymph node metastases	Shows details of uterine mass boundaries, extent and spread	Negative	Epithiloid shaped smooth muscle cells showing: High mitotic index Cellular atypia Coagulative necrosis Two variants of leiomyosarcoma: Epithelioid leiomyosarcoma Myxoid leiomyosarcoma (bland features)	Biopsy
Diseases	Bleeding	Pelvic Pain/pressure/ discomfort	Other	Pelvic examination	Hb	B-HCG	CA-125	Ultrasound	MRI	Pap Smear	Histopathology	Gold standard
Uterine leiomyoma^[10]^[11]^[12]	May have menorrhagia May have intermenstrual bleeding	+	Asymptomatic Dysmenorrhea (most common symptoms) Infertility Obstetric complications Obstructive symptoms (due to compression) Dyspareunia Torsion or degeneration	Enlarged mobile uterus Irregular contour Large fibroid uteri may cause abdominal distention	↓ or Nl	–	–	Transvaginal ultrasound shows: Hypoechoic, well-circumscribed round masses Location of fibroid: Submucosal, intramural, subserosal, and cervical fibroids	"Popcorn" calcification in the fibroid (degeneration) Differentiaites between leiomyomas, adenomyosis and adenomyomas	Normal	Normal appearing bundle of epithiloid shape smooth muscle cells with normal mitotic index	Imaging and histologic analysis
Uterine carcinosarcomas (Malignant mixed mullerian tumour (MMMT) of the uterus)^[13]^[14]^[15]^[16]	May have menorrhagia May have intermenstrual bleeding	±	Classical triad: Pain Bleeding Rapidly enlarging uterus	Enlarged uterus Pelvic mass Mass protruding through the cervical os Involvement of the cervix	↓	–	+	Enlarged uterine cavity Hyperechoic mass in uterus and cervix	Heterogenous bulky polypoid mass with intense enhancement		Biphasic: High grade carcinomatous (epithelial) contents Stromal sarcomatous (connective tissue)	Biopsy
Cervical cancer^[17]^[18]	Menorrhagia Intermenstrual bleeding Postcoital bleeding Vaginal passage of bleeding	± Pressure-related bowel and bladder symptoms	Copious malodorous vaginal discharge Hematuria	Enlarged uterus Concomitant cervical lesions Abdominal distention	↓	–	±	To evaluate tumor size, extent and parametrial invasion Usually not needed for diagnosis	To evaluate tumor size, local extent and staging	Squamous cell carcinoma Low-grade squamous intraepithelial lesions (LSILs) High-grade squamous intraepithelial lesions (HSILs) Adenocarcinoma Atypical glandular cells (AGC) Endocervical adenocarcinoma in situ (AIS)	Squamous cell carcinoma Adenocarcinoma Adenosquamous cervical tumors	Colposcopy and biopsy
Diseases	Bleeding	Pelvic Pain/pressure/ discomfort	Other	Pelvic examination	Hb	B-HCG	CA-125	Ultrasound	MRI	Pap Smear	Histopathology	Gold standard
Metastasis	Menorrhagia Intermenstrual bleeding	±	Asymptomatic Obstetric complications Dysmenorrhea (most common symptoms) Obstructive symptoms (due to urinary bladder and bowel compression) Dyspareunia	Enlarged uterus Abdominal distention	↓	–	–	Enlarged uterine cavity Hyperechoic mass in uterus and cervix	Shows involvement of uterus, lymph nodes, parmetrial area, and surrounding area	Normal May show malignant metastatic cells	Not recommended It may show the malignant cells of the primary site	Biopsy and histopathology analysis of the primary site of the tumor
Endometrial polyp^[19]^[20]	Menorrhagia Intermenstrual bleeding Postmenopausal bleeding	–	Asymptomatic Endometrial polyp prolapses (visible on speculum examination protruding through cervical os)	Normal sized uterus with smooth surface	↓	–	+ or Nl	Incidentally found on pelvic ultrasound (most common)	MRI will show polyp size and dimension in detail Not required for diagnosis	Normal	Localized hyperplastic growth of endometrial glands and stroma around a vessel	Imaging Histologic evaluation
Endometrial hyperplasia^[21]^[22]^[23]^[24]	Menorrhagia Intermenstrual bleeding Postmenopausal bleeding	–	Asymptomatic	Normal sized uterus with smooth surface	↓	–	+	Determines endometrial thickness Rules out other abnormalities	Thick endometrial lining	Abnormal glandular or endometrial cells on pap smear	Non-neoplastic changes: Disordered endometrial growth Benign hyperplasia Simple hyperplasia Complex hyperplasia without atypia Precancerous changes: Endometrial intraepithelial neoplasms Atypical complex hyperplasia	Endometrial sampling
Uterine adenomyoma^[25]^[26]^[27]	–	±	Dysmenorrhea Subfertility	Diffusely enlarged tender boggy uterus with smooth surface Uterus may develop masses	↓	–	+	Snow storm appearance in diffuse adenomyosis Shows a uterine mass in case of adenoma	Identifies diffuse or focal adenomyosis from leiomyoma	Mostly normal may show glandular cells in cervical cytology	Endometrial glands in myometrium of uterus	Imaging Histologic diagnosis
Diseases	Bleeding	Pelvic Pain/pressure/ discomfort	Other	Pelvic examination	Hb	B-HCG	CA-125	Ultrasound	MRI	Pap Smear	Histopathology	Gold standard
Hematometra (blood within the uterine cavity) ^[28]^[29]	–	+ Cramping cyclic pain	Dysmenorrhea Amenorrhea Hypotension Vasovagal syncope	Firm and enlarged uterus Adenaxal tenderness Pelvic examination may be restricted due to pain	↓	–	–	Echogenic fluid in the uterine cavity occluding cervical os	Not required	Normal	Biopsy is not required for diagnosis	Ultrasound
Gestational trophoblastic disease^[30]^[31]	May have menorrhagia May have intermenstrual bleeding	+	Metastatic symptoms in case of cancer: Pulmonary symptoms Dyspnea Chest pain Cough Hemoptysis Vaginal metastases Vaginal bleeding Purulent vaginal discharge Central nervous system metastases Asymptomatic Neurologic signs	Irregularly sized boggy enlarged uterus Adnexal fullness Abdominal distention	↓	±	+	US shows dilated grape like structures Diffuse hydropic swelling Multiples echoes Cystic spaces invading edometrium and myometrium (in case of invasive disease)	MRI defines the extent of primary lesion, invasion and distant metastasis	Pap smear shows trophoblasric cells	Biopsy and histologic analysis confirms the diagnoses depending on the type of lesion benign or malignant it may sow dilated grape like villous structures or invasive malignant lesions	Imaging Histologic diagnosis
Incomplete abortion	Intermenstrual bleeding Vaginal bleeding	+	Abdominal pain/ cramps	Enlarges uterus Abdominal distention	N/↓	±	+↓	Uterus shows fetus with absent cardiac activity in lower part of uterus	MRI is not required for the diagnoses	Pap smear is not done for the diagnoses	Suction biopsy and histology shows fetal and placental tissues	Imaging Histologic diagnosis
Pregnancy	Absent menstrual cycle May have intermenstrual bleeding	+	Nausea Fatigue	Enlarged gravid uterus Abdominal distention	–	+	–	Fetus inside uterine cavity	Not needed once ultrasound determines pregnancy	Normal or may show cervical cells	Not needed once ultrasound May show Fetal tissues	Imaging (ransvaginal ultrasound)
Diseases	Bleeding	Pelvic Pain/pressure/ discomfort	Other	Pelvic examination	Hb	B-HCG	CA-125	Ultrasound	MRI	Pap Smear	Histopathology	Gold standard

References

↑ Hippisley-Cox J, Coupland C (2011). "Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm". BMJ. 344: d8009. doi:10.1136/bmj.d8009. PMC 3251328. PMID 22217630.
↑ "ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer". Obstet Gynecol. 106 (2): 413–25. August 2005. PMID 16055605.
↑ Boruta DM, Gehrig PA, Fader AN, Olawaiye AB (October 2009). "Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review". Gynecol. Oncol. 115 (1): 142–153. doi:10.1016/j.ygyno.2009.06.011. PMID 19592079.
↑ Bokhman JV (February 1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.
↑ Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F (November 2010). "Factors associated with Type I and Type II endometrial cancer". Cancer Causes Control. 21 (11): 1851–6. doi:10.1007/s10552-010-9612-8. PMC 2962676. PMID 20628804.
↑ Nordal RR, Thoresen SO (May 1997). "Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality". Eur. J. Cancer. 33 (6): 907–11. PMID 9291814.
↑ Goto A, Takeuchi S, Sugimura K, Maruo T (2002). "Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus". Int. J. Gynecol. Cancer. 12 (4): 354–61. PMID 12144683.
↑ Bell SW, Kempson RL, Hendrickson MR (June 1994). "Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases". Am. J. Surg. Pathol. 18 (6): 535–58. PMID 8179071.
↑ Karpathiou G, Sivridis E, Giatromanolaki A (2010). "Myxoid leiomyosarcoma of the uterus: a diagnostic challenge". Eur. J. Gynaecol. Oncol. 31 (4): 446–8. PMID 20882892.
↑ Stewart EA (April 2015). "Clinical practice. Uterine fibroids". N. Engl. J. Med. 372 (17): 1646–55. doi:10.1056/NEJMcp1411029. PMID 25901428.
↑ Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F (March 2002). "Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas". Am. J. Obstet. Gynecol. 186 (3): 409–15. PMID 11904599.
↑ Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA, Vogelzang RL (November 2002). "The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids". J Vasc Interv Radiol. 13 (11): 1149–53. PMID 12427815.
↑ Chaffer CL, San Juan BP, Lim E, Weinberg RA (December 2016). "EMT, cell plasticity and metastasis". Cancer Metastasis Rev. 35 (4): 645–654. doi:10.1007/s10555-016-9648-7. PMID 27878502.
↑ Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, Black J, Cocco E, Choi J, Zammataro L, Predolini F, Bonazzoli E, Bi M, Buza N, Hui P, Wong S, Abu-Khalaf M, Ravaggi A, Bignotti E, Bandiera E, Romani C, Todeschini P, Tassi R, Zanotti L, Odicino F, Pecorelli S, Donzelli C, Ardighieri L, Facchetti F, Falchetti M, Silasi DA, Ratner E, Azodi M, Schwartz PE, Mane S, Angioli R, Terranova C, Quick CM, Edraki B, Bilgüvar K, Lee M, Choi M, Stiegler AL, Boggon TJ, Schlessinger J, Lifton RP, Santin AD (October 2016). "Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition". Proc. Natl. Acad. Sci. U.S.A. 113 (43): 12238–12243. doi:10.1073/pnas.1614120113. PMC 5087050. PMID 27791010.
↑ Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ (March 2004). "Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome". Int. J. Radiat. Oncol. Biol. Phys. 58 (3): 786–96. doi:10.1016/S0360-3016(03)01561-X. PMID 14967435.
↑ Teo SY, Babagbemi KT, Peters HE, Mortele KJ (July 2008). "Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI". AJR Am J Roentgenol. 191 (1): 278–83. doi:10.2214/AJR.07.3281. PMID 18562759.
↑ "Pap and HPV Testing - National Cancer Institute".
↑ Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S (August 2000). "FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology". Int J Gynaecol Obstet. 70 (2): 209–62. PMID 11041682.
↑ Kim KR, Peng R, Ro JY, Robboy SJ (August 2004). "A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium". Am. J. Surg. Pathol. 28 (8): 1057–62. PMID 15252313.
↑ Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J (2011). "Diagnosis and management of endometrial polyps: a critical review of the literature". J Minim Invasive Gynecol. 18 (5): 569–81. doi:10.1016/j.jmig.2011.05.018. PMID 21783430.
↑ Emons G, Beckmann MW, Schmidt D, Mallmann P (February 2015). "New WHO Classification of Endometrial Hyperplasias". Geburtshilfe Frauenheilkd. 75 (2): 135–136. doi:10.1055/s-0034-1396256. PMC 4361167. PMID 25797956.
↑ Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D (October 2007). "2006 consensus guidelines for the management of women with abnormal cervical screening tests". J Low Genit Tract Dis. 11 (4): 201–22. doi:10.1097/LGT.0b013e3181585870. PMID 17917566.
↑ Espindola D, Kennedy KA, Fischer EG (December 2007). "Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia". Obstet. Gynecol. Clin. North Am. 34 (4): 717–37, ix. doi:10.1016/j.ogc.2007.09.001. PMID 18061866.
↑ Montgomery BE, Daum GS, Dunton CJ (May 2004). "Endometrial hyperplasia: a review". Obstet Gynecol Surv. 59 (5): 368–78. PMID 15097798.
↑ McElin TW, Bird CC (1974). "Adenomyosis of the uterus". Obstet Gynecol Annu. 3: 425–41. PMID 4608783.
↑ Maheshwari A, Gurunath S, Fatima F, Bhattacharya S (July 2012). "Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes". Hum. Reprod. Update. 18 (4): 374–92. doi:10.1093/humupd/dms006. PMID 22442261.
↑ Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH (October 1999). "Diffuse and focal adenomyosis: MR imaging findings". Radiographics. 19 Spec No: S161–70. doi:10.1148/radiographics.19.suppl_1.g99oc03s161. PMID 10517452.
↑ McCausland AM, McCausland VM (2007). "Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention". J Minim Invasive Gynecol. 14 (4): 399–406. doi:10.1016/j.jmig.2007.04.004. PMID 17630156.
↑ U Nayak A, Swarup A, G S J, N S (April 2010). "Hematometra and acute abdomen". J Emerg Trauma Shock. 3 (2): 191–2. doi:10.4103/0974-2700.62117. PMC 2884455. PMID 20606801. Vancouver style error: name (help)
↑ Bakri YN, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA (March 1994). "Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure". J Reprod Med. 39 (3): 175–8. PMID 8035373.
↑ Lurain JR (December 2010). "Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole". Am. J. Obstet. Gynecol. 203 (6): 531–9. doi:10.1016/j.ajog.2010.06.073. PMID 20728069.

[pmid22217630-1] Hippisley-Cox J, Coupland C (2011). "Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm". BMJ. 344: d8009. doi:10.1136/bmj.d8009. PMC 3251328. PMID 22217630.

[pmid16055605-2] "ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer". Obstet Gynecol. 106 (2): 413–25. August 2005. PMID 16055605.

[pmid195920792-3] Boruta DM, Gehrig PA, Fader AN, Olawaiye AB (October 2009). "Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review". Gynecol. Oncol. 115 (1): 142–153. doi:10.1016/j.ygyno.2009.06.011. PMID 19592079.

[pmid6822361-4] Bokhman JV (February 1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.

[pmid20628804-5] Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F (November 2010). "Factors associated with Type I and Type II endometrial cancer". Cancer Causes Control. 21 (11): 1851–6. doi:10.1007/s10552-010-9612-8. PMC 2962676. PMID 20628804.

[pmid9291814-6] Nordal RR, Thoresen SO (May 1997). "Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality". Eur. J. Cancer. 33 (6): 907–11. PMID 9291814.

[pmid12144683-7] Goto A, Takeuchi S, Sugimura K, Maruo T (2002). "Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus". Int. J. Gynecol. Cancer. 12 (4): 354–61. PMID 12144683.

[pmid8179071-8] Bell SW, Kempson RL, Hendrickson MR (June 1994). "Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases". Am. J. Surg. Pathol. 18 (6): 535–58. PMID 8179071.

[pmid20882892-9] Karpathiou G, Sivridis E, Giatromanolaki A (2010). "Myxoid leiomyosarcoma of the uterus: a diagnostic challenge". Eur. J. Gynaecol. Oncol. 31 (4): 446–8. PMID 20882892.

[pmid25901428-10] Stewart EA (April 2015). "Clinical practice. Uterine fibroids". N. Engl. J. Med. 372 (17): 1646–55. doi:10.1056/NEJMcp1411029. PMID 25901428.

[pmid11904599-11] Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F (March 2002). "Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas". Am. J. Obstet. Gynecol. 186 (3): 409–15. PMID 11904599.

[pmid12427815-12] Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA, Vogelzang RL (November 2002). "The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids". J Vasc Interv Radiol. 13 (11): 1149–53. PMID 12427815.

[pmid27878502-13] Chaffer CL, San Juan BP, Lim E, Weinberg RA (December 2016). "EMT, cell plasticity and metastasis". Cancer Metastasis Rev. 35 (4): 645–654. doi:10.1007/s10555-016-9648-7. PMID 27878502.

[pmid27791010-14] Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, Black J, Cocco E, Choi J, Zammataro L, Predolini F, Bonazzoli E, Bi M, Buza N, Hui P, Wong S, Abu-Khalaf M, Ravaggi A, Bignotti E, Bandiera E, Romani C, Todeschini P, Tassi R, Zanotti L, Odicino F, Pecorelli S, Donzelli C, Ardighieri L, Facchetti F, Falchetti M, Silasi DA, Ratner E, Azodi M, Schwartz PE, Mane S, Angioli R, Terranova C, Quick CM, Edraki B, Bilgüvar K, Lee M, Choi M, Stiegler AL, Boggon TJ, Schlessinger J, Lifton RP, Santin AD (October 2016). "Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition". Proc. Natl. Acad. Sci. U.S.A. 113 (43): 12238–12243. doi:10.1073/pnas.1614120113. PMC 5087050. PMID 27791010.

[pmid14967435-15] Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ (March 2004). "Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome". Int. J. Radiat. Oncol. Biol. Phys. 58 (3): 786–96. doi:10.1016/S0360-3016(03)01561-X. PMID 14967435.

[pmid18562759-16] Teo SY, Babagbemi KT, Peters HE, Mortele KJ (July 2008). "Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI". AJR Am J Roentgenol. 191 (1): 278–83. doi:10.2214/AJR.07.3281. PMID 18562759.

[urlPap_and_HPV_Testing_-_National_Cancer_Institute-17] "Pap and HPV Testing - National Cancer Institute".

[pmid11041682-18] Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S (August 2000). "FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology". Int J Gynaecol Obstet. 70 (2): 209–62. PMID 11041682.

[pmid15252313-19] Kim KR, Peng R, Ro JY, Robboy SJ (August 2004). "A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium". Am. J. Surg. Pathol. 28 (8): 1057–62. PMID 15252313.

[pmid21783430-20] Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J (2011). "Diagnosis and management of endometrial polyps: a critical review of the literature". J Minim Invasive Gynecol. 18 (5): 569–81. doi:10.1016/j.jmig.2011.05.018. PMID 21783430.

[pmid25797956-21] Emons G, Beckmann MW, Schmidt D, Mallmann P (February 2015). "New WHO Classification of Endometrial Hyperplasias". Geburtshilfe Frauenheilkd. 75 (2): 135–136. doi:10.1055/s-0034-1396256. PMC 4361167. PMID 25797956.

[pmid17917566-22] Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D (October 2007). "2006 consensus guidelines for the management of women with abnormal cervical screening tests". J Low Genit Tract Dis. 11 (4): 201–22. doi:10.1097/LGT.0b013e3181585870. PMID 17917566.

[pmid18061866-23] Espindola D, Kennedy KA, Fischer EG (December 2007). "Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia". Obstet. Gynecol. Clin. North Am. 34 (4): 717–37, ix. doi:10.1016/j.ogc.2007.09.001. PMID 18061866.

[pmid15097798-24] Montgomery BE, Daum GS, Dunton CJ (May 2004). "Endometrial hyperplasia: a review". Obstet Gynecol Surv. 59 (5): 368–78. PMID 15097798.

[pmid4608783-25] McElin TW, Bird CC (1974). "Adenomyosis of the uterus". Obstet Gynecol Annu. 3: 425–41. PMID 4608783.

[pmid22442261-26] Maheshwari A, Gurunath S, Fatima F, Bhattacharya S (July 2012). "Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes". Hum. Reprod. Update. 18 (4): 374–92. doi:10.1093/humupd/dms006. PMID 22442261.

[pmid10517452-27] Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH (October 1999). "Diffuse and focal adenomyosis: MR imaging findings". Radiographics. 19 Spec No: S161–70. doi:10.1148/radiographics.19.suppl_1.g99oc03s161. PMID 10517452.

[pmid17630156-28] McCausland AM, McCausland VM (2007). "Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention". J Minim Invasive Gynecol. 14 (4): 399–406. doi:10.1016/j.jmig.2007.04.004. PMID 17630156.

[pmid20606801-29] U Nayak A, Swarup A, G S J, N S (April 2010). "Hematometra and acute abdomen". J Emerg Trauma Shock. 3 (2): 191–2. doi:10.4103/0974-2700.62117. PMC 2884455. PMID 20606801. Vancouver style error: name (help)

[pmid8035373-30] Bakri YN, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA (March 1994). "Pulmonary metastases of gestational trophoblastic tumor. Risk factors for early respiratory failure". J Reprod Med. 39 (3): 175–8. PMID 8035373.

[pmid20728069-31] Lurain JR (December 2010). "Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole". Am. J. Obstet. Gynecol. 203 (6): 531–9. doi:10.1016/j.ajog.2010.06.073. PMID 20728069.

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 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
-! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
+! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
 ! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
 ! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
 |-
 ! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
-! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
 |-
 ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
@@ Line 27: / Line 27: @@
 discomfort
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdomino-pelvic examination
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG
@@ Line 47: / Line 46: @@
 * [[Weight loss|Weight loss]]
 | align="left" style="background:#F5F5F5;" + |
-* Enlarged [[uterus]]
+* Enlarged fixed  [[uterus]]
 * [[Vaginal bleeding]]
 * [[Vaginal discharge]]
 * [[Lymphadenopathy]]
 * [[Mesentery|Mesenteric]] nodules ([[metastasis]])
-| align="left" style="background:#F5F5F5;" + |
-* Enlarged fixed [[uterus]]
 | align="center" style="background:#F5F5F5;" + |[[Anemia|↓]]
 | align="center" style="background:#F5F5F5;" + |–
@@ Line 83: / Line 80: @@
 * Asymptomatic
 | align="left" style="background:#F5F5F5;" + |
+* [[Abdominal distension]]
 * Enlarged or normal sized [[uterus]]
-* [[Lymphadenopathy]]
-| align="left" style="background:#F5F5F5;" + |
-* [[Abdominal distension]]
 * [[Lymphadenopathy]]
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+
+| align="center" style="background:#F5F5F5;" + | +
 | align="left" style="background:#F5F5F5;" + |
 * [[Uterus|Uterine]] mass
@@ Line 115: / Line 110: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG
@@ Line 141: / Line 135: @@
 * Enlarged mobile [[uterus]]
 * Irregular contour
-| align="left" style="background:#F5F5F5;" + |
-* Usually normal
 * Large fibroid uteri may cause [[abdominal distention]]
 | align="center" style="background:#F5F5F5;" + |↓ or Nl
@@ Line 176: / Line 168: @@
 * Mass protruding through the [[cervical os]]
 * Involvement of the [[cervix]]
-| align="left" style="background:#F5F5F5;" + |
-* Normal
-* May show [[abdominal distention]] if [[tumor]] size is large
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+
+| align="center" style="background:#F5F5F5;" + | +
 | align="left" style="background:#F5F5F5;" + |
 * Enlarged [[uterine]] cavity
@@ Line 202: / Line 191: @@
 * [[Vaginal]] passage of [[bleeding]]
 | align="center" style="background:#F5F5F5;" + |±
+Pressure-related [[bowel]] and [[bladder]] symptoms
 | align="left" style="background:#F5F5F5;" + |
 * Copious malodorous [[vaginal discharge]]
-* Pressure-related [[bowel]] and [[bladder]] symptoms
 * [[Hematuria]]
 | align="left" style="background:#F5F5F5;" + |
 * Enlarged [[uterus]]
 * Concomitant [[cervical]] lesions
-| align="left" style="background:#F5F5F5;" + |
 * [[Abdominal distention]]
 | align="center" style="background:#F5F5F5;" + |↓
@@ Line 239: / Line 227: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG
@@ Line 262: / Line 249: @@
 | align="left" style="background:#F5F5F5;" + |
 * Enlarged [[uterus]]
-| align="left" style="background:#F5F5F5;" + |
 * [[Abdominal distention]]
 | align="center" style="background:#F5F5F5;" + |↓
@@ Line 292: / Line 278: @@
 | align="left" style="background:#F5F5F5;" + |
 * Normal sized [[uterus]] with smooth surface
-| align="left" style="background:#F5F5F5;" + |
-* Normal
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+ or Nl
+| align="center" style="background:#F5F5F5;" + | + or Nl
 | align="left" style="background:#F5F5F5;" + |
 * Incidentally found on [[pelvic ultrasound]] (most common)
@@ Line 320: / Line 304: @@
 | align="left" style="background:#F5F5F5;" + |
 * Normal sized [[uterus with smooth surface]]
-| align="left" style="background:#F5F5F5;" + |
-* Normal
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+
+| align="center" style="background:#F5F5F5;" + | +
 | align="left" style="background:#F5F5F5;" + |
 * Determines [[endometrial]] thickness
@@ Line 353: / Line 335: @@
 * Diffusely enlarged tender boggy [[uterus]] with smooth surface
 * [[Uterus]] may develop masses
-| align="left" style="background:#F5F5F5;" + |
-* Normal
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+
+| align="center" style="background:#F5F5F5;" + | +
 | align="left" style="background:#F5F5F5;" + |
 * Snow storm appearance in diffuse adenomyosis
@@ Line 377: / Line 357: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG
@@ Line 390: / Line 369: @@
 <ref name="pmid17630156">{{cite journal |vauthors=McCausland AM, McCausland VM |title=Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention |journal=J Minim Invasive Gynecol |volume=14 |issue=4 |pages=399–406 |date=2007 |pmid=17630156 |doi=10.1016/j.jmig.2007.04.004 |url=}}</ref><ref name="pmid20606801">{{cite journal |vauthors=U Nayak A, Swarup A, G S J, N S |title=Hematometra and acute abdomen |journal=J Emerg Trauma Shock |volume=3 |issue=2 |pages=191–2 |date=April 2010 |pmid=20606801 |pmc=2884455 |doi=10.4103/0974-2700.62117 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" + |–
-| align="center" style="background:#F5F5F5;" + |+ (Cramping cyclic pain)
+| align="center" style="background:#F5F5F5;" + | +
+Cramping cyclic [[pain]]
 | align="left" style="background:#F5F5F5;" + |
 * [[Dysmenorrhea]]
@@ Line 400: / Line 380: @@
 * Adenaxal [[tenderness]]
 * [[Pelvic examination]] may be restricted due to [[pain]]
-| align="left" style="background:#F5F5F5;" + |
-* Normal
 | align="center" style="background:#F5F5F5;" + |↓
 | align="center" style="background:#F5F5F5;" + |–
@@ Line 436: / Line 414: @@
 * Irregularly sized boggy enlarged uterus
 * Adnexal fullness
-| style="background: #F5F5F5; padding: 5px;" |
 * Abdominal distention
 | style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
@@ Line 466: / Line 443: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Enlarges uterus
-| style="background: #F5F5F5; padding: 5px;" |
 * Abdominal distention
 | style="background: #F5F5F5; padding: 5px;" |N/[[Anemia|↓]]
@@ Line 494: / Line 470: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Enlarged gravid uterus
-| style="background: #F5F5F5; padding: 5px;" |
 * Abdominal distention
 | style="background: #F5F5F5; padding: 5px;" | –
@@ Line 517: / Line 492: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic examination
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal examination
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B-HCG

Endometrial cancer differential diagnosis: Difference between revisions

Revision as of 18:32, 13 February 2019

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Differentiating Endometrial Cancer From Other Diseases

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