Passage of Tissue-like Material in Patient with Long-term IUD Use

Case at a Glance

A 30-year-old female with PCOS and 10-year Mirena IUD use presented with spontaneous passage of fleshy tissue measuring 1.5-2cm from the vagina, without associated pain.

Patient's Story

The patient discovered a flesh-colored tissue mass approximately 1.5-2cm in length on toilet paper after urination. She reported no associated pain during passage. The patient has a 10-year history of Mirena IUD use and reports amenorrhea since insertion. She has a known diagnosis of polycystic ovary syndrome (PCOS). Upon examination of the tissue, she noted a small nodular component that could be separated from the main mass.

Initial Assessment

Patient presented with concern regarding spontaneous passage of tissue from the vaginal canal. Physical examination of the passed tissue revealed a fleshy, pale-colored mass with what appeared to be a small cystic component. Patient denied fever, pelvic pain, abnormal bleeding, or other constitutional symptoms.

The Diagnostic Journey

Initial differential diagnosis included decidual cast, particularly given the patient's IUD use which can predispose to this condition. However, closer examination of the tissue raised concern for potential foreign body incorporation, as metallic artifacts and linear structures were noted within the tissue matrix. The patient's long-term IUD use and the unusual appearance of the tissue prompted further investigation.

Final Diagnosis

Suspected decidual cast with possible incorporated foreign material, likely related to long-term intrauterine device use. The tissue showed characteristics consistent with endometrial decidualization with concerning features suggesting possible IUD component incorporation.

Treatment Plan

1. Histopathological examination of the passed tissue to confirm diagnosis and rule out malignancy
2. Pelvic ultrasound to assess IUD position and integrity
3. Gynecological examination to evaluate for retained foreign material
4. Consider IUD removal if device integrity is compromised
5. Patient counseling regarding findings and follow-up care

Outcome and Follow-up

Patient was advised to seek immediate gynecological evaluation. Tissue was preserved for pathological analysis. Follow-up imaging was recommended to assess current IUD status and rule out device migration or fragmentation. Patient education provided regarding warning signs requiring urgent medical attention.