A 13-year-old girl is brought to the office due to lower abdom inal pain for the past 4 days

A 13-year-old girl is brought to the office due to lower abdom inal pain for the past 4 days. The patient has rectal pain with bowel

movements, but no melena or frank blood. She has had this pain several times over the past year, but it usually resolves after 2 or 3

days. She has no fever, chills, nausea, vomiting, loss of appetite, dysuria, hematuria, or abnormal vaginal discharge. The patient has

no chronic medical conditions or previous surgeries. She ha:s not reached menarche and has never been sexually active.

Temperature is 36.7 C (98 F) and blood pressure is 110/70 mm Hg BMI is 24 kg/m2

• Physical examination shows a nondistended

abdomen without rebound or guarding There is lower abdominal tenderness to deep palpation in the midline. The external genitalia

are Tanner stage 3. On pelvic examination, a smooth, firm mass is protruding between the labia majora. Which of the following is the

most likely diagnosis?

  • QA Cervical leiomyoma
  • 0 B. Choriocarcinoma
  • 0 C. Complete mullerian agenesis
  • 0 D. Foreign body
  • 0 E. l mperforate hymen
  • 0 F. Pelvic organ prolapse
  • 0 G. Sarcoma botryoides

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