Re: AGUS
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Apr 29 06:56:24 2005
Why laparoscopic instead of vaginal?
Vaginal should be the default with laparoscopic being done only if
vaginal can't be for some reason.
On 4/28/05, Rafael Haciski <haciski@earthlink.net> wrote:
> I agree with Dr. Siegel (except for the OR)
> .. generous LEEP in office
> .. hysteroscopy through the now open canal, with biopsy as needed
> .. endocervical curettage
>
> And if no cancer found then schedule for hysterectomy (my preference
> laparoscopic, with BSO)
>
> Rafael C. Haciski MD FACOG
> Bradenton FL
>
> On Apr 28, 2005, at 22:10, Garry E. Siegel, M.D. wrote:
>
> > Hey, check out the ASCCP guidelines. http://www.asccp.org/
> >
> > Before you do a TVH and find an undiagnosed cancer (unlikely, but. .
> > .), if you cannot access her cervix due to stenosis, why not do an OR
> > visit:
> >
> > 1. Cold knife cone--unless you feel the cervix is "cleared" and it
> > doesn't need evaulation.
> > 2. ECC
> > 3. Hysteroscopy/endometrial curettage
> >
> > Unless I'm missing something, you have an unexplained AGUS smear (CIN
> > doesn't fully cover that) and you've not been able to evaluate the
> > endometrium or the endocervix.
> >
> > Garry
> >
> > At Thu, 28 Apr 2005, Joanne Bulley, MD wrote:
> >>
> >> My thoughts run the same way as you and Efrain
> >>
> >> Joanne
> >>
> >> At Thu, 28 Apr 2005, ainsron wrote:
> >>>
> >>> Cone or LEEP. Consider TVH.
> >>>
> >>> Ronald E. Ainsworth
> >>>
> >>> -----Original Message-----
> >>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> >>> Joanne
> >>> Bulley, MD
> >>> Sent: Thursday, April 28, 2005 2:36 PM
> >>> To: Multiple recipients of list OB-GYN-L
> >>> Subject: AGUS
> >>>
> >>> 48 yo G0 s/p Cryosurgery of cervix prior to 1993. (presume CIN)
> >>> VIN 3 (carcinoma in situ) of vulva at posterior introitus excised
> >>> 1998.
> >>> Vulvar coploscopies normal since then.
> >>>
> >>> Pap 3/04 AGUS (possible adenocarcinoma in situ)
> >>> LEEP (cervical stenosis from cryo precluded any office evaluation)
> >>> path: CIN 1 - mild dysplasia with severe cervicitis, comparison with
> >>> Pap
> >>> confirms the same cellular characterisics were present.
> >>>
> >>> Pap 10/04 ASCUS negative for high risk HPV subtypes.
> >>>
> >>> Pap 3/05 AGUS.
> >>>
> >>> Colposcopy - unable to see SCJ. Endocervical curette would not pass
> >>> through stenotic cervix. Endocervical specimen taken with
> >>> endocervical
> >>> brush.
> >>>
> >>> Pathology pending.
> >>>
> >>> Of course the next step will depend somewhat on the patology, but,
> >>> what
> >>> do you think you would do next?
> >>>
> >>> Joanne
> >>>
> >>> --
> >>> Joanne Bulley, MD
> >>> Keene, NH, USA
> >>>
> >> --
> >> Joanne Bulley, MD
> >> Keene, NH, USA
> >>
> >
> > --
> > Garry E. Siegel, M.D.
> > Private Practice
> > Roswell, GA
> >
>
--
R. Daniel Braun
Kinky for Governor
