Differential Diagnosis for Abnormal Uterine Bleeding
Single Most Likely Diagnosis
- Endometrial Adenocarcinoma: This is the most likely diagnosis given the patient's symptoms of abnormal uterine bleeding, including heavy bleeding with passage of large clots, and the endometrial biopsy results showing endometrial adenocarcinoma. The patient's age, obesity (BMI 39 kg/m2), and history of unopposed estrogen exposure (due to estrogen/progestin-containing oral contraceptives) also increase her risk for endometrial cancer.
Other Likely Diagnoses
- Uterine Leiomyomas (Fibroids): The patient's symptoms of heavy bleeding and passage of large clots could be consistent with uterine fibroids, especially given her age and history of abnormal uterine bleeding.
- Endometrial Hyperplasia: This condition, characterized by excessive proliferation of the endometrium, can cause abnormal uterine bleeding and is a risk factor for endometrial cancer. The patient's history of unopposed estrogen exposure and obesity increase her risk for endometrial hyperplasia.
- Hormonal Imbalance: The patient's symptoms could be related to hormonal changes, particularly anovulatory cycles, which are common in perimenopausal women and can cause irregular and heavy bleeding.
Do Not Miss Diagnoses
- Ovarian Cancer: Although less likely, ovarian cancer can cause abnormal uterine bleeding, and it is essential to consider this diagnosis, especially given the patient's age and smoking history.
- Cervical Cancer: Although the patient has a history of normal Pap tests, it is crucial to rule out cervical cancer, especially given her history of cervical conization and abnormal Pap test in the past.
- Bleeding Disorders: Conditions such as von Willebrand disease or other coagulopathies can cause heavy menstrual bleeding and should be considered, especially if the patient has a history of easy bruising or bleeding.
Rare Diagnoses
- Uterine Sarcoma: This is a rare type of cancer that can cause abnormal uterine bleeding, but it is much less common than endometrial adenocarcinoma or uterine leiomyomas.
- Gestational Trophoblastic Disease: This rare condition can cause abnormal uterine bleeding, but it is typically associated with a history of pregnancy or molar pregnancy, which is not mentioned in the patient's history.
- Arteriovenous Malformation: This rare condition can cause abnormal uterine bleeding, but it is typically associated with other symptoms such as pelvic pain or a palpable mass, which are not mentioned in the patient's history.