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Case 13
45 year old G3P3 (3003) complained of progressive increase in the amount & duration of her menses since 2 years ago. LMP: 1
week ago; Menses still regular. Abdominal examination: (+) firm nodular, non-tender movable mass in the hypogastric area,
the upper pole of which is halfway between the symphysis pubis & umbilicus. Speculum examination: cervix was pink,
smooth, w/ minimal bloody mucoid discharge from the os. IE: cervix – firm long closed, movable, non-tender; Uterus: nodular,
firm, enlarged to about 3 months size, movable, non-tender, Adnexa: no mass nor tenderness
DDX:
1. Adenomyoma, Adenomyosis
To rule out: No progressive dysmenorrhea felt to be
persistent orincreasing intensity
2. Cancer
To rule out: Weight loss, RF
Malignant Myoma
Leiomyosacoma
Degeneration: Sarcomatous (Others: During pregnancy)
For menopausal who have been regularly menstruating
Incidence: 0.7 %
3. Adnexal pathology:
Ovarian enlargement in the hypogastrium can be
pedunculated to the point in the midline by IE.
WORK-UPS:
TVS : will not change the management but you can still
request for treatment planning to map out where the
myomas are & dictate the difficulty (big myoma) at the
posterior part compared from fundal or anterior part for
the patient