Asha Gopi Nath1, Subitha Kandamuthan2, Beenakumari Raghavan3, Fiji Raj4
PRESENTATION OF CASE
A 52-year-old postmenopausal lady was referred to our hospital as a case of postmenopausal bleeding with increased serum bHCG. She was a P3 L2 A1. First one was a spontaneous abortion, then two full-term normal deliveries and one neonatal death due to congenital heart disease. She had attained menopause one and a half years back. She developed acute onset of breathlessness three weeks back for which she consulted a local hospital and it subsided with symptomatic treatment. Next day, she had postmenopausal bleeding, one episode with history of passing clots followed by spotting per vaginum, which was persisting. There was no history of any hormonal intake or trauma or any history of passing vesicles or nausea or vomiting.
She attained menarche at 14 years of age. She had regular cycles and attained menopause 1½ years back. She had underwent a cholecystectomy 10 years back.
General condition stable. Pulse rate 74 per minute. BP 130/80. Respiratory rate 14 per minute. Afebrile. Breast and thyroid normal. Gynaecological examination, vulva and vagina appeared normal. Cervix was healthy. OS closed. Blood-stained discharge was present. Uterus was enlarged to 18 weeks size, soft and nontender and fornices were free.
DIFFERENTIAL
DIAGNOS E S
Since, she was a postmenopausal lady presenting with bleeding, the following diagnosis were considered-
1. Carcinoma endometrium.
2. Functioning ovarian tumour.
3. Vesicular mole.
4. Choriocarcinoma.
