The patient is a 53-year-old gravida 8, para 8-0-1-8. Six months ago, she noted that she when she was up against a cupboard her abdomen was firm. She noted no weight change, although she did have occasional nausea, fatigue, and early satiety.

PAST GYNECOLOGIC HISTORY: All Pap smears normal. All mammograms normal. Menarche at 13 years of age, regular cycles lasting seven days. Last menstrual period five months ago with progression prior to her last menstrual period of increasingly light periods.

PAST OBSTETRICAL HISTORY: Gravida 8, para 8-0-1-8, NSVD at term times eight with one SAB.

GENERAL: Alert and oriented, well groomed, in no acute distress.

CARDIOVASCULAR: Normal rate, regular rhythm. No murmurs, rubs, or gallops.

LUNGS: Clear to auscultation bilaterally.

NECK: No adenopathy or thyroid enlargement.
GI: Soft, mildly obese, vague fullness in the suprapubic area.

Groin: No adenopathy.

PELVIC: Normal external genitalia. Speculum exam reveals well-estrogenized vaginal mucosa. The cervix is normal in appearance and parous. Bimanual exam reveals a regular, hard, enlarged mass, approximately 8 x 6 cm, in the midline that is mobile, mildly tender. Rectovaginal septum is free of disease.

	CT scan of 10-30-02.

1. What do you see?

2. What is your differential diagnosis?

3. What other tests do you want?