Uterine fibroids – differential diagnosis
Uterine fibroids – differential diagnosis of uterine fibroids
The methodology of differential diagnosis in women with uterine myoma
Uterine fibroids, which was complicated by severe bleeding in women of childbearing age should be differentiated from the pregnancy, estrogenprodutsiruyuschey ovarian tumors, dysfunctional uterine bleeding, internal endometriosis, endometrial cancer, as well as chorionepithelioma and hydatidiform mole.
During pregnancy the uterus becomes soft consistency, if there is a beginning abortion, there is increased tone of the myometrium, and a small opening of the cervix. Bleeding with a strong does not happen. In the history of these patients will be instructed to delay menstruation.
Combination of uterine fibroids and pregnancy
It is possible the combination of pregnancy and uterine fibroids. Diagnostic help in this case renders the discovery of the ovum during the ultrasound of the pelvic organs and identify the blood or urine human chorionic gonadotropin.
During a dysfunctional uterus bleeding does not increase as significantly as in the uterine (up to 6 to 7 weeks of pregnancy), and is not lumpy, and the flat surface. When uterine bleeding are cyclical in nature, and with anovulation, the underlying dysfunctional uterine bleeding, they usually begin after a delay of menses (acyclic). It should be noted that in the uterine metrorrhagia may develop on the background of anovulatory menstrual cycles.
Ovarian neoplasms Estrogenprodutsiruyuschie (Tecom, follikulomy) are accompanied by phenomena hyperestrogenia manifesting acyclic bleeding in women of childbearing age who had previously correct menstrual cycle. The uterus in the presence of such tumors is increased slightly and has a flat surface. An examination of one of the ovaries are mobile, solid consistency spherical or oval-shaped swelling on the stem, which often need to differentiate with subserous myoma node on a narrow basis. Diagnosis by ultrasonography, laparoscopy, x-rays in a pneumoperitoneum.
When the inner surface of the uterus endometriosis remains smooth, increasing its size is less pronounced than in the uterine and varies depending on the phases of the menstrual cycle. During hysterosalpingography in the presence of internal endometriosis can detect the characteristic aquifer shadows caused by the penetration of contrast material from the uterus into the mouth of the endometrial glands. Endometriosis is often widespread and affects not only the different parts of the genital organs, but also goes beyond the pelvis. We should not lose sight of the fact that, on average, 25% of patients have a combination of fibroids and endometriosis of the uterus.
In cancer of the endometrium are rare severe bleeding, the uterus does not reach a significant size. Clarify the diagnosis can hysterosalpingography, hysteroscopy and diagnostic curettage of the mucous with the data of histological examination. It is possible a combination of uterine and endometrial cancer.
Having chorionepithelioma (malignant tumor growing from the developing blastocyst trophoblast) is accompanied by acyclic uterine bleeding and the appearance of whiter. The uterus with slightly increased in size, sharply marked positive reaction to chorionic gonadotropin. The diagnosis is confirmed histologically.
In hydatidiform mole identified common features characteristic of pregnancy and are absent in patients with myoma. The uterus is tugoelasticheskuyu consistency, increases very rapidly, outpacing the pregnancy.
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