The woman came to me with a complaint of bleeding between menses. She has no history of use of hormonal therapy. She has been spotting for 2 years and has had severe dyspareunia for the past 3 months. She has experienced no significant weight loss. I ordered transvaginal ultrasound and CT of the pelvis.
Results are pending.
Based on this patient's history and physical examination, the studies ordered are appropriate. The patient's bilateral inguinal lymphadenopathy could be due to metastatic disease, as part of the lymphatic drainage from the pelvis follows the round ligament from the uterus to the inguinal lymph nodes. With this patient's extensive family history of ovarian cancer and uterine cancer, another concern is the possibility of a hereditary cancer syndrome. Most, if not all, HBOC cases are thought to be due to a mutation in either the BRCA1 or BRCA2 gene. However, prior to testing, all patients should undergo extensive genetic counseling.