40f Co severe hypogatric pain sudden onset no fever vomiting no urinary complaints kco intramural 25mm uterine fibroid; ho irregular menses 2-3 month back treated with duoluton L cynomycin 100mg initially then crina ncr 10mg pausext dotarin later for 21 days after this Pt had pv bleeding for 2 days then on 3rd day above mention abdominal pain followed by passage of this thing per vaginally at night...my question is what is this? ???????

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This looks like a decidual cast.If you have preserved in formalin,then send it for histopathological examination. Such passage of total endometrial tissue in toto is also seen in membranous dysmenorrhea where patient has intense cramping pain due to passage of intact endometrial cast through an undilated cervix. Histology clears the diagnosis.

Though she is tubectomised,still think of ectopic.do histopathological evaluation.
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1. Urine pregnancy test to b done to rule out pregnancy and possibility of incomplete abortion which is extruded now. 2. Second possibility is decidual cast. Confirm with histopathology.

TL was done 20 y back
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Most likely, membranous dysmenorrhoea.prolonged progesterone stimulation of endometrium causes this,it is cast off with severe dysmenorrhoea.it looks like poc,decidual cast.send the membrane for HP exam. I had a similar case,h/o menorrhagia. One day she came to my opd ,with similar thick membrane like tissue in a pad of cotton.she too had severe pain in lower abd which disappeared after passing such a piece of membrane.thanks.

Most probably this is retained products of conception. Cast can't be this big. Go for UPT Please inform us about h/p report of this specimen.

It may be expulsion of pedunculated intrauterine fibroid polyp.necrosis lead to expulsion and all above symptoms. Do HPE.

Along with membranous decidual cast I also keep possibilities of placental site trophoblastic tumour for which serum beta hcg level is to be done and these tumour intensely stain with antibodies to HPL .

(m. Histopatho logical report is confirmatory diagnosis
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It looks like decidual cast. It is membranous dysmenorrhoea due to prolonged use of progesterone. Do histopathology to confirm.

I agree with dr Trupti. Chances of expulsion of necrosed (iu ) polyp r there.

Decidual cast...

Decidual cast

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