Differential Diagnosis for Complex Cervical Lesion with Endometrial Fluid and Persistent Menstrual Bleeding

• Single Most Likely Diagnosis
  • Residual trophoblastic tissue or retained products of conception: This is a common cause of persistent menstrual bleeding after an abortion, especially if the procedure was not completely successful. The presence of endometrial fluid and a complex lesion on the cervix supports this diagnosis, and the low but not negligible HCG level (0.8) could indicate some residual trophoblastic activity.
• Other Likely Diagnoses
  • Cervical polyp or fibroid: These benign growths can cause irregular menstrual bleeding and could be the complex lesion seen on imaging. Weight loss might not be directly related but could be a separate issue.
  • Infection (e.g., endometritis, pelvic inflammatory disease): An infection could cause persistent bleeding, weight loss, and might lead to the formation of a complex lesion due to inflammation and scarring. However, the transvaginal ultrasound being unremarkable makes this less likely unless the infection is early or not causing significant anatomical changes.
  • Atrophic vaginitis or other vaginal/cervical conditions: These could cause bleeding but are less likely to result in a complex lesion or significant weight loss.
• Do Not Miss Diagnoses
  • Choriocarcinoma or gestational trophoblastic neoplasia (GTN): Although the HCG is low, any level of HCG after an abortion should prompt consideration of GTN, especially with symptoms like persistent bleeding and weight loss. GTN can be life-threatening if not treated promptly.
  • Cervical cancer: This is a critical diagnosis not to miss, as it can present with abnormal vaginal bleeding and weight loss. A complex lesion on the cervix could be a tumor, and further investigation is necessary to rule out malignancy.
• Rare Diagnoses
  • Uterine arteriovenous malformation (AVM): This is a rare condition that could cause persistent menstrual bleeding due to abnormal blood vessel formation in the uterus. It might appear as a complex lesion on imaging.
  • Metastatic disease to the cervix or uterus: Although rare, cancers from other parts of the body can metastasize to the cervix or uterus, causing a complex lesion and abnormal bleeding. This would be more likely in someone with a known history of cancer.