Cervical cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]

Overview

Cervical cancer must be differentiated from other diseases that cause abnormal vaginal bleeding, such as cervical polyp, cervical leiomyoma, invasion of the cervix from primary uterine malignancy, vaginal cancer, cervical lymphoma, metastases to cervix, and cervical ectopic pregnancy.

Cervical cancer differential diagnosis

  • Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:[1][2][3]
Abnormal Uterine bleeidng differential diagnosis
Ob-Gyn neoplasm and diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Other Genitourinary/ Gastrointestinal symptoms Abdominal pain Pelvic

pain

B symptoms Gynecological examinations Abdominal

mass

HPV

Pap smear

STI panel

Other labs Ultrasound Other

imagings

Cervical cancer[4][5][6][7][8][9][10][11]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam

+

+ +
  • Cervical mass on exam
+ ± HPV T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
Cervical intraepithelial neoplasia:
Cervical polyp[12]
  • Mass on exam
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
Cervical leiomyoma[13][14][15][16][17][18][19][20][21]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
+ + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Clinical diagnosis/ and
Cervical lymphoma[22][23][24]
  • Difficulty urinating
  • Post-coital pain
+ + +
  • Irregularity
+ Pap smear: Immunohistochemistry markers:
  • Well-defined, solid, concentric, hypoechoic mass
MRI:
  • Intramyometrial infiltrative nodules
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
Cervical sarcoma[25][26][27][28] + + ±
  • Cervical mass
  • Lump protruding from vagina/vulva
+ Leiomyosarcoma markers: MRI:
  • Endometrial polypoid mass
  • Hypointense hypervascular solid components
Cervical erosion(Ectropion)[29][30][31][32][33]
  • Post-coital pain
  • Painful cramps
+ +
  • Red, glandular area around os of cervix
N/A N/A N/A
Cervicitis[34][35][36][37][38]
  • Intermenstrual bleeding
  • Postcoital
  • Pain during urination
+ +
  • May have fever only
STI panel:
MRI:

May be detected as retention cysts in cervix.

  • Non-specific, lymphocytic infiltration may be seen in microscopic histology.
  • Koilocytic changes in case of HPV as cause of chronic cervicitis.
Endometriosis[39][40][41][42][43][44][45]
  • Heavy mentrual bleeding
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
  • Watery vaginal discharge
+ +

(limited value)

  • Ground glass echogenicity of the cyst fluid (Endometrioma)
  • Cysts are unilocular
Pelvic inflammatory diseases[46][47][48][49]
  • Bleeding after sex
  • Intermenstrual bleeding
+
  • Oral temperature >101F
  • Vaginal/vulvar tender lesion depending on microbial causes
STI panel:
  • WBC
  • Oral temperature >101F
Ultrasound:
  • Thickened, fluid-filled tubes with or without free pelvic or tubo-ovarian complex
MRI findings:
  • Inflammation in pelvic soft tissue
  • Clinical diagnosis is gold standard for diagnosing PID
Adenemyosis[50][51][52][53][54][55]
  • Abnormal uterine bleeding
  • Painful menstruation
+ +
  • Subendometrial striations
  • Myometrial cysts
  • Asymetrical thickness in myometrium walls
  • Heterogenous echotexture of myometrium
MRI:
  • Thickened junctional zone
  • Presence of ectopic endometrial glands into the myometrium.
Cervical ectopic pregnancy[56][57] +
  • Soft and disporportionally enlarged uterus.
± T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
Vaginal cancer[58][59][60][61]
  • Postcoital bleeding
+ + ±
  • Ill-defined vaginal ulcer
  • In case of metastases to internal organs
Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
Biopsy findings:
Paget's disease of vulva to cervix[62][63][64][65][66]
  • Bleeding from lesion
  • Pain in vulva
  • Itching or burning sensation in vulva
  • Negative for S-100 and Melan-A
N/A MRI:
  • Hyperintense on diffusion weighted imaging
  • Thick vulvar skin
  • "Cake-icing effect", pathognomic for vulvar paget's disease
Nabothian cyst[67][68][69][70]
  • Postcoital bleeding
  • Majority of them are asymptomatic due to their small size( few milimeters)
N/A
  • Anechoic well defined cystic lesions
T1-weighted
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
  • Benign cystic lesion
  • Multiple benign cystic masses, usually few milimieters in diameter.
IUD use[71][72][73]
  • Heavy bleeidng
+ +
  • Normal
  • May have decreased RBC count
  • Linear echogenic intrauterine structures
N/A N/A

References

  1. Mwaka, Amos D.; Orach, Christopher G.; Were, Edward M.; Lyratzopoulos, Georgios; Wabinga, Henry; Roland, Martin (2016). "Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda". Health Expectations. 19 (4): 854–867. doi:10.1111/hex.12382. ISSN 1369-6513.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  2. Donovan, Kristine A.; Boyington, Alice R.; Judson, Patricia L.; Wyman, Jean F. (2014). "Bladder and bowel symptoms in cervical and endometrial cancer survivors". Psycho-Oncology. 23 (6): 672–678. doi:10.1002/pon.3461. ISSN 1057-9249.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  3. Kim, Soo Hyun; Kang, Sokbom; Kim, Yong-Man; Kim, Byoung-Gie; Seong, Seok Ju; Cha, Soon Do; Park, Chan-Yong; Yun, Young Ho (2010). "Prevalence and Predictors of Anxiety and Depression Among Cervical Cancer Survivors in Korea". International Journal of Gynecological Cancer. 20 (6): 1017–1024. doi:10.1111/IGC.0b013e3181e4a704. ISSN 1048-891X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  4. Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  5. Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  6. Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  7. . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  8. Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  9. Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  10. Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  11. Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  12. Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  13. Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  14. Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  15. Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  16. Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  17. Coronado GD, Marshall LM, Schwartz SM (May 2000). "Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study". Obstet Gynecol. 95 (5): 764–9. PMID 10775744.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  18. Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  19. El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  20. Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  21. Yokoyama Y, Shinohara A, Hirokawa M, Maeda N (2003). "Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma". Gynecol. Obstet. Invest. 56 (4): 179–83. doi:10.1159/000074104. PMID 14564105.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  22. Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  23. Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  24. Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD (September 2006). "Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature". Leuk. Lymphoma. 47 (9): 1894–901. doi:10.1080/10428190600687653. PMID 17065003.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  25. Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (November 2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  26. Khosla, Divya; Gupta, Ruchi; Srinivasan, Radhika; Patel, Firuza D.; Rajwanshi, Arvind (2012). "Sarcomas of Uterine Cervix". International Journal of Gynecological Cancer. 22 (6): 1026–1030. doi:10.1097/IGC.0b013e31825a97f6. ISSN 1048-891X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  27. Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA (December 2015). "Imaging Features of Uncommon Gynecologic Cancers". AJR Am J Roentgenol. 205 (6): 1346–59. doi:10.2214/AJR.14.12695. PMC 5502476. PMID 26587944.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  28. . doi:10.1097/IGC.0b013e31825a97f6. Check |doi= value (help). Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  29. Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  30. Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  31. Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  32. . doi:10.12865/CHSJ.42.02.11. Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  33. Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  34. Mattson SK, Polk JP, Nyirjesy P (July 2016). "Chronic Cervicitis: Presenting Features and Response to Therapy". J Low Genit Tract Dis. 20 (3): e30–3. doi:10.1097/LGT.0000000000000225. PMID 27243142.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  35. Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  36. Meyer T (August 2016). "Diagnostic Procedures to Detect Chlamydia trachomatis Infections". Microorganisms. 4 (3). doi:10.3390/microorganisms4030025. PMID 27681919.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  37. Woods, Jennifer L.; Bailey, Sarabeth L.; Hensel, Devon J.; Scurlock, Amy M. (2011). "Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?". Journal of Pediatric and Adolescent Gynecology. 24 (6): 359–364. doi:10.1016/j.jpag.2011.06.006. ISSN 1083-3188.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  38. Jayakumar, Naveen Kumar Bhagavathula (2015). "Cervicitis: How Often Is It Non-specific!". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2015/11594.5673. ISSN 2249-782X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  39. Hsu AL, Khachikyan I, Stratton P (June 2010). "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol. 53 (2): 413–9. doi:10.1097/GRF.0b013e3181db7ce8. PMC 2880548. PMID 20436318.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  40. Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  41. Datta S, Kunde K (July 2008). "From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy". J Obstet Gynaecol. 28 (5): 552–3. doi:10.1080/01443610802247352. PMID 18850447.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  42. Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  43. Bedaiwy MA, Falcone T (February 2004). "Laboratory testing for endometriosis". Clin. Chim. Acta. 340 (1–2): 41–56. PMID 14734195.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  44. Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D (June 2010). "Endometriomas: their ultrasound characteristics". Ultrasound Obstet Gynecol. 35 (6): 730–40. doi:10.1002/uog.7668. PMID 20503240.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  45. . doi:10.1148/rg.314105193. Check |doi= value (help). Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  46. Hoenderboom BM, van Benthem B, van Bergen J, Dukers-Muijrers N, Götz HM, Hoebe C, Hogewoning AA, Land JA, van der Sande M, Morré SA, van den Broek I (January 2019). "Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial". Sex Transm Infect. doi:10.1136/sextrans-2018-053778. PMID 30606817. Vancouver style error: initials (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  47. Jaiyeoba O, Soper DE (2011). "A practical approach to the diagnosis of pelvic inflammatory disease". Infect Dis Obstet Gynecol. 2011: 753037. doi:10.1155/2011/753037. PMC 3148590. PMID 21822367.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  48. Czeyda-Pommersheim, Ferenc; Kalb, Bobby; Costello, James; Liau, Joy; Meshksar, Arash; Arif Tiwari, Hina; Martin, Diego (2016). "MRI in pelvic inflammatory disease: a pictorial review". Abdominal Radiology. 42 (3): 935–950. doi:10.1007/s00261-016-1004-4. ISSN 2366-004X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  49. Mitchell, Caroline; Prabhu, Malavika (2013). "Pelvic Inflammatory Disease". Infectious Disease Clinics of North America. 27 (4): 793–809. doi:10.1016/j.idc.2013.08.004. ISSN 0891-5520.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  50. Filip G, Balzano A, Cagnacci A (November 2018). "Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance". Minerva Ginecol. doi:10.23736/S0026-4784.18.04291-0. PMID 30486633.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  51. Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  52. Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  53. Zhou Y, Wu B, Li H (October 1996). "[The value of serum CA125 assays in the diagnosis of uterine adenomyosis]". Zhonghua Fu Chan Ke Za Zhi (in Chinese). 31 (10): 590–3. PMID 9275451.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  54. Tamai, Ken; Togashi, Kaori; Ito, Tsuyoshi; Morisawa, Nobuko; Fujiwara, Toshitaka; Koyama, Takashi (2005). "MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls". RadioGraphics. 25 (1): 21–40. doi:10.1148/rg.251045060. ISSN 0271-5333.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  55. Dartmouth, Katherine (2014). "A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis". Ultrasound. 22 (3): 148–157. doi:10.1177/1742271X14528837. ISSN 1742-271X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  56. Mouhajer M, Obed S, Okpala AM (June 2017). "Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis". Ghana Med J. 51 (2): 94–97. PMC 5611908. PMID 28955106.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  57. Rathod, Setu; Samal, SunilKumar (2015). "Cervical ectopic pregnancy". Journal of Natural Science, Biology and Medicine. 6 (1): 257. doi:10.4103/0976-9668.149221. ISSN 0976-9668.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  58. Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  59. Miccò, Maura; Sala, Evis; Lakhman, Yulia; Hricak, Hedvig; Vargas, Hebert Alberto (2015). "Imaging Features of Uncommon Gynecologic Cancers". American Journal of Roentgenology. 205 (6): 1346–1359. doi:10.2214/AJR.14.12695. ISSN 0361-803X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  60. Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin; Choi, Ook-Hwan (2013). "A Case of Vaginal Cancer with Uterine Prolapse". Journal of Menopausal Medicine. 19 (3): 139. doi:10.6118/jmm.2013.19.3.139. ISSN 2288-6478.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  61. Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C (2006). "Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report". Eur. J. Gynaecol. Oncol. 27 (5): 528–30. PMID 17139994.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  62. van der Linden, M.; Meeuwis, K.A.P.; Bulten, J.; Bosse, T.; van Poelgeest, M.I.E.; de Hullu, J.A. (2016). "Paget disease of the vulva". Critical Reviews in Oncology/Hematology. 101: 60–74. doi:10.1016/j.critrevonc.2016.03.008. ISSN 1040-8428.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  63. Lloyd J, Evans DJ, Flanagan AM (July 1999). "Extension of extramammary Paget disease of the vulva to the cervix". J. Clin. Pathol. 52 (7): 538–40. PMC 501500. PMID 10605411.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  64. Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ (January 2010). "Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course". Int. J. Gynecol. Pathol. 29 (1): 69–78. doi:10.1097/PGP.0b013e3181b1cc5e. PMID 19952933.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  65. Asmouki, Hamid; Oumouloud, Rachid; Aboulfalah, Abderrahim; Soummani, Abderraouf; Marrat, Abdelouahed (2012). "Paget's Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report". Case Reports in Oncological Medicine. 2012: 1–4. doi:10.1155/2012/854827. ISSN 2090-6706.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  66. Gonçalves Amorim, Andressa; Batista Fraga Mendes, Brunelle; Neves Ferreira, Rodrigo; Chambô Filho, Antônio (2015). "Paget Disease of the Vulva: Diagnosis by Immunohistochemistry". Case Reports in Dermatological Medicine. 2015: 1–5. doi:10.1155/2015/162483. ISSN 2090-6463.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  67. Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  68. Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  69. Torky, Haitham A. (2016). "Huge Nabothian cyst causing Hematometra (case report)". European Journal of Obstetrics & Gynecology and Reproductive Biology. 207: 238–240. doi:10.1016/j.ejogrb.2016.10.042. ISSN 0301-2115.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  70. Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  71. Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  72. Nowitzki, Kristina M.; Hoimes, Matthew L.; Chen, Byron; Zheng, Larry Z.; Kim, Young H. (2015). "Ultrasonography of intrauterine devices". Ultrasonography. 34 (3): 183–194. doi:10.14366/usg.15010. ISSN 2288-5919.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  73. . doi:10.5489/cuaj.11100. Check |doi= value (help). Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

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