Dispersed

A 40 year old lady presents with intermittent vaginal bleeding and irregular menstruation for two months. She also complains of an intermittent non-productive cough for six months.

She has had two previous pregnancies, which were uncomplicated. Her last delivery was approximately a year ago. She is not on any contraceptives.

Select Relevant Investigations
Transvaginal Ultrasound Scan

Performed

An ill-defined intrauterine mass is noted. Multiple small and unilocular cysts are noted in both ovaries.
Chest X-Ray

Performed

The chest x-ray shows a few shadows in both lung fields.
Tuberculin test & Sputum smear

Performed

The tuberculin test is negative.

3 early morning sputum smears are obtained (following nebulization) - all are negative for acid-fast bacilli.
Serum beta-hCG levels

Performed

The serum beta-hCG level is 450,000 mIU/ml (normal range in non-pregnant females: < 5.0 mIU/ml)

Select Relevant Management
Chemotherapy
Pelvic Radiotherapy
Exploratory laparotomy
Antituberculous therapy