A54-year-old premenopausalwoman, G3 P3, was referred to the gynecology outpatientclinic dueto abnormal uterine bleeding and sonographic suspicion ofadenomyosisand leiomyomas. In the past 2 years, she noticed shortening ofthe menstrualcyclesand menorrhagia. She was obese (bodymass index: 39 kg/cm2)and had chronic hypertension, depression,and fibromyalgia. She was medicated with duloxetine 30 mg/day, trazodone 100 mg,and olmesartan hidroclorotiazida 40/12.5 mg. On physicalexamination, the patient had a globuscervixwith no visiblelesions. Bimanual palpationwas impossible dueto the patient's biotype. Pelvic magneticresonanceimaging revealed an uterus sized 155 mm× 104 mm× 90 mmwith three nodules in the uterine wallsuggestive of leiomyoma; the biggestsized 72 mmat theright portion ofthefundus,another leftanterior sized 45 mm,and onerightsized 40 mm,all ofthem FIGO type 5; thickening ofthejunction zone dueto probableadenomyosis;and an agglomerate ofcysticformationsat the uterinecervixwith a totallargest diameter of 50 mm[Figure 1]and [Figure 2].{Figure 1}{Figure 2} Meanwhile, screening for human papillomavirus (HPV)cervical detection came out positivefor HPV33 and 52,and reflectivecervicalcytology revealed low-gradesquamous intraepitheliallesion (LSIL). Colposcopywasadequate, with atype 3 transformation zone,and no abnormal findings were observed. Theendocervicalcurettage was negativeto dysplasia or malignancy. Aloop electrosurgicalexcision procedurefollowed, and histology revealed LSIL involved inmucous.
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