Differential Diagnosis
- Single most likely diagnosis
- Cervical cancer: The patient's history of abnormal uterine bleeding (AUB) for 3 months, significant weight loss, and decreased appetite are concerning symptoms for malignancy. The complex hypodense lesion in the cervix on CT, despite an unremarkable transvaginal ultrasound, further supports this diagnosis. Microcytic anemia could be related to chronic blood loss or malignancy-related anemia of chronic disease.
- Other Likely diagnoses
- Cervical sarcoma or other cervical tumors: Although less common than cervical cancer, these could also explain the patient's symptoms and imaging findings.
- Invasive mole or choriocarcinoma: Although the last HCG was low (0.8), the history of recent chemical abortion and the presence of a complex lesion in the cervix could suggest a gestational trophoblastic disease, especially if the HCG level was recently higher or if there are other symptoms such as vaginal bleeding.
- Advanced cervical infection or abscess: This could cause significant symptoms and weight loss, although the imaging findings might not fully align with a simple infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Metastatic disease to the cervix: Although rare, metastases to the cervix from other primary sites (e.g., gastrointestinal, breast) could present similarly and have a significant impact on prognosis and treatment.
- Lymphoma involving the cervix: This is a rare condition but could explain the patient's systemic symptoms and the cervical lesion.
- Gestational trophoblastic neoplasia (GTN) with brain or other metastases: If the patient's HCG levels were significantly elevated before the chemical abortion, GTN with metastases could explain the systemic symptoms and weight loss.
- Rare diagnoses
- Cervical lymphoma or leukemia: These are rare conditions that could present with a cervical mass and systemic symptoms.
- Cervical melanoma: This is a rare and aggressive tumor that could explain the patient's symptoms and imaging findings.
- Other rare cervical tumors (e.g., carcinoid, adenosarcoma): These are uncommon and might not be initially suspected but could be considered in the differential diagnosis based on the patient's presentation and imaging findings.