Registrar: Pictorial Case Study

The case - A 59-year-old woman presented with fresh red vaginal bleeding over the past two days. She had had very slight spotting two weeks earlier. She had no pain and was otherwise asymptomatic.

 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?


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.

Differential diagnosis
Endometrial carcinoma
- 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.

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