Benign Pelvic Masses
C.M. is a 35 year old African American female, G1 P1001 who presents to you
complaining of heavy menstrual bleeding. Her LMP is 3 1/2 weeks ago. She indicates that
she has had to change her pads every hour during the first three days of her menstrual
period for the past four months. She also notes that she will bleed for up to 7 days,
which has increased from 4 to 5 days. She describes mild dysmenorrhea and some lower
abdominal pressure. She denies intermenstrual bleeding as well as post coital bleeding.
She also denies fever, chills, nausea or vomiting. She denies dysuria, but has noted
increased frequency and urgency of urination. Her weight has been stable, although she has
noted the waistbands of her pants and skirts are tighter.
The patient's past medical history is negative for any chronic medical illness. She takes
no medications.
The patient's past surgical history is significant for cholecystectomy at age 32 and 1°
c/s 7 years ago.
The patient's obstetrical hx is significant for delivery of term male infant via 1° c/s 7
years ago.
The patient's gynecological hx is significant for menarche at 12 X 28 day cycles X 4-5
days. She had used oral contraceptive pills for past 6 years, but stopped last year
because she wants another child.
The patient is a non-smoker and occasionally drinks wine or cocktail with dinner. She has
never used recreational drugs.
Physical examination of this patient shows her to be 5'6", 158 lbs, with normal blood
pressure. HEENT- slightly pale sclera; LUNGS- clear; HEART- NSR; BREASTS- symmetrical, no
discoloration or retraction, no fixed masses, although symmetrical glandular thickening is
noted; ABDOMEN, soft, nontender with solid nontender mass, palpated arising from the
pelvis to the umbilicus. Pelvic exam: NL external female genitalia; Vagina pink without
lesions; Cervix, somewhat difficult to assess on speculum exam, because it's retracted
superior to the symphysis pubis, but no obvious lesions noted. Uterus is irregularly
enlarged to umbilicus (approximately 9-10 cm across); The adnexa/ovaries are not palpated
due to large uterine mass; The rectal exam confirms large pelvic mass.
Differential Diagnosis Listing