Differential Diagnosis for Abnormal Uterine Bleeding
The patient presents with abnormal uterine bleeding, irregular episodes of bleeding and spotting, abdominal bloating, daily breast tenderness, and a large left adnexal mass. The following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Endometriosis with Ovarian Endometrioma: The presence of a complex ovarian mass, irregular endometrial stripe, and symptoms such as abdominal bloating, breast tenderness, and abnormal uterine bleeding are consistent with endometriosis. The patient's desire to conceive and nulliparous status also support this diagnosis, as endometriosis is a common cause of infertility.
- Other Likely Diagnoses
- Polycystic Ovary Syndrome (PCOS): The patient's irregular menstrual cycles, abdominal bloating, and breast tenderness could be indicative of PCOS. However, the presence of a large adnexal mass is not typical of PCOS.
- Uterine Fibroids: The irregular endometrial stripe and abnormal uterine bleeding could be caused by uterine fibroids. However, the presence of a large adnexal mass is not consistent with this diagnosis.
- Ovarian Cyst: The complex ovarian mass could be a simple or complex ovarian cyst. However, the patient's symptoms and the presence of an irregular endometrial stripe suggest a more complex condition.
- Do Not Miss Diagnoses
- Ovarian Torsion: Although the patient does not have acute severe pain, ovarian torsion is a life-threatening condition that requires prompt diagnosis and treatment. The presence of a large adnexal mass increases the risk of torsion.
- Ovarian Cancer: Although the patient is relatively young, ovarian cancer is a possibility, especially with a complex ovarian mass. A thorough evaluation and follow-up are necessary to rule out this diagnosis.
- Ectopic Pregnancy: Although the urine pregnancy test is negative, a false-negative result is possible, especially in early pregnancy. Ectopic pregnancy is a life-threatening condition that requires prompt diagnosis and treatment.
- Rare Diagnoses
- Adenomyosis: The patient's symptoms, such as abnormal uterine bleeding and breast tenderness, could be indicative of adenomyosis. However, this condition is less common and typically presents with more severe symptoms.
- Germ Cell Tumor: The complex ovarian mass could be a germ cell tumor, although this is a rare diagnosis, especially in a 42-year-old woman.