She went through the menopause at the age of 50 and has had no bleeding since. She had four pregnancies and no previous gynaecological history. However, she had never had a cervical smear.
Examination of the abdomen was normal while on vaginal examination there was blood obviously coming from inside the cervical canal. The rest of the pelvic examination was normal.
- What is the diagnosis, management and differential diagnosis?
DIAGNOSIS AND MANAGEMENT
A cervical smear showed severe dyskaryosis with suspicion of invasive cells. The patient was seen at the colposcopy clinic where a loop biopsy was taken, which showed poorly differentiated squamous carcinoma. No spread was found on MRI or CT scans of the abdomen and pelvis and she underwent a radical hysterectomy with bilateral salpingo-oophorectomy and pelvic node dissection.
Possible different diagnoses
- Endometrial carcinoma.
- Endometrial hyperplasia.
- Cervical polyp or endometrial polyp.
- Atrophic vulvovaginitis.
- Post-menopausal bleeding.
- Watery discharge, which becomes heavier or pink with time.
- Less common symptoms include abdominal, back or leg pain, post-coital
bleeding and haematuria, change in bowel habits and weight loss.