Differential Diagnosis for 47 yo Female with Heavy Menses and Uterus Enlargement

• Single Most Likely Diagnosis
  • Uterine Leiomyomas (Fibroids): This is the most likely diagnosis given the description of multiple, smooth, spherical, firm masses within an enlarged uterus, which is a classic presentation for uterine fibroids. These benign tumors are common in women of reproductive age and can cause heavy menstrual bleeding and uterine enlargement.
• Other Likely Diagnoses
  • Adenomyosis: This condition, where endometrial tissue grows into the uterine wall, can cause uterine enlargement and heavy menses. While it doesn't typically present with distinct masses, it can coexist with fibroids and contribute to symptoms.
  • Uterine Hyperplasia: Although less likely to cause distinct masses, uterine hyperplasia can lead to uterine enlargement and heavy bleeding, especially in the context of hormonal imbalances.
• Do Not Miss Diagnoses
  • Uterine Sarcoma: Although rare, uterine sarcomas can present with uterine enlargement and masses. Given the potential for malignancy, it's crucial to consider this diagnosis to ensure timely and appropriate management.
  • Uterine Cancer (Endometrial Cancer): While the presence of multiple, smooth masses is more suggestive of benign conditions, endometrial cancer can cause uterine enlargement and irregular bleeding. It's essential to rule out malignancy, especially in older women or those with risk factors.
• Rare Diagnoses
  • Uterine Lymphangiomas: These are rare, benign tumors that could potentially cause uterine enlargement and masses, though they are much less common than fibroids.
  • Metastatic Disease to the Uterus: Rarely, cancers from other parts of the body can metastasize to the uterus, causing enlargement and masses. This would be an unusual presentation for metastatic disease but should be considered in patients with known primary malignancies.