Differential Diagnosis
- Single most likely diagnosis
- Nabothian cyst: This is the most likely diagnosis given the patient's history and the pelvic examination findings. Nabothian cysts are benign, mucus-filled cysts that form on the surface of the cervix, often as a result of cervical trauma or inflammation, which could be related to her previous cervical conization. They are common in reproductive-aged women and are usually asymptomatic.
- Other Likely diagnoses
- Cervical polyp: These are growths on the cervical canal that can be caused by chronic inflammation or hormonal changes. They are common and usually benign but can cause abnormal vaginal bleeding.
- Cervical ectropion: This condition involves the glandular cells lining the cervical canal being everted to the outside of the cervix, which can cause an abnormal appearance on pelvic examination. It's often seen in young women and those on hormonal contraceptives.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cervical cancer: Although the patient has had a history of normal Pap tests since her cervical conization, any abnormality on the cervix warrants consideration of cervical cancer, especially given her history of an abnormal Pap test and conization. It's crucial to ensure that any new or persistent cervical lesions are biopsied.
- Endometrial cancer: While less directly related to the pelvic examination findings, the patient's age, type 1 diabetes (which increases the risk of endometrial cancer), and slightly elevated BMI are risk factors for endometrial cancer. Any postmenopausal or irregular bleeding would necessitate further investigation, but given her recent menstrual period, this is less likely at the moment.
- Rare diagnoses
- Cervical sarcoma: These are rare malignant tumors of the cervix. Given the rarity and the patient's lack of symptoms or significant risk factors beyond her previous cervical procedure, this would be a less likely consideration without further diagnostic evidence.
- Malignant transformation of a Nabothian cyst: While Nabothian cysts are benign, there have been rare reports of malignant transformation. This would be an extremely rare occurrence and not a primary consideration without other suspicious findings or symptoms.