[Expert Solution]: Clinical Case: A 42-year old African American…

Clinical Case: A 42-year old African American G3 P3 woman presents with a history of abnormal bleeding and pelvic pain. She was well until approximately age 35, when she began developing dysmenorrhea and progressive abnormal uterine (AUB) bleeding. The dysmenorrhea was not fully relieved by NSAIDs. Over the next several years, the dysmenorrhea and AUB became more severe. She then developed intermenstrual bleeding and spotting, as well as pelvic pain, which she describes as a constant feeling of pressure. She also complains of urinary frequency. Her past gynecological history is otherwise noncontributory. She delivered three children by cesarean section, the last with a tubal ligation at age 30. Her past medical history is unremarkable. Physical examination reveals a well-developed, well-nourished woman in no distress. Vital signs and general physical exam are unremarkable. Abdominal examination reveals an irregular sized mass extending halfway between the pubic symphysis and umbilicus and to the right of the midline. Pelvic exam reveals a normal appearing vagina and cervix. The uterus is markedly enlarged and irregular, especially on the right side where it appears to reach the lateral pelvic sidewalls. The adnexa are not palpable given the size of the mass. Beta HCG is negative. CBC reveals hemoglobin of 10.3 and hematocrit of 31.2%. Serum ferritin confirms mild iron deficiency anemia. Pap smear is reported negative for malignancy, adequate for evaluation. Ultrasound shows a large irregular mass, filling the pelvis and extending into the lower abdomen. The mass does extend into the right side of the pelvis. There is mild hydronephrosis on that side. The ovaries are not visualized. Endometrial biopsy reveals proliferative endometrium. Discussion: 1. What is the likely cause of the mass? 2. What risk factors does the patient present with to suspect this condition? 3. What signs and symptoms does the patient present with to suspect this condition? 4. Discuss the likely management for women with this condition? 5. What are the treatment options for women diagnosed with this condition? What are the indications for each of these treatment options?