Re: AGUS
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Apr 29 10:33:28 2005
Interesting???????????
According to the other literature that I have seen, there should be a
10% incidence of adenocarcinoma-in-situ of the endocervix with AGUS
smears. They don't even report one!!!!
Dan
On 4/29/05, art fougner, md <evsono@pipeline.com> wrote:
> Of interest:
>
> Acta Cytol. 2000 Jan-Feb;44(1):41-5.
>
> Cytohistologic correlation between AGUS and biopsy-detected lesions in
> postmenopausal women.
>
> Obenson K, Abreo F, Grafton WD.
>
> Department of Pathology, Louisiana State University Medical Center,
> Shreveport 71130, USA.
>
> OBJECTIVE: To evaluate histologic findings in patients aged 50 and older
> whose cervical smears revealed atypical glandular cells of undetermined
> significance (AGUS). STUDY DESIGN: Computerized records spanning a
> four-year period were retrospectively analyzed. Thirty patients over
> age 50 had cervical smears interpreted as AGUS and had follow-up
> biopsies within 12 months following the abnormal smear. The most
> important histologic diagnosis from the biopsy specimens was correlated
> with the subcategory of the cervical smear. RESULTS: Five smears
> interpreted as AGUS, favor reactive, revealed abnormal histology in four
> cases: three endometrial polyps and one squamous carcinoma. Two smears
> interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial
> lesions on biopsy in both cases. Seventeen smears interpreted as AGUS,
> favor endometrial cells, revealed abnormal histology in 13 cases: 1
> endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and
> 3 adenomyosis. Six patients with smears interpreted as AGUS,
> unclassifiable, revealed abnormal histology in five cases: two
> endocervical polyps, one endometrial polyp, one endometrial carcinoma
> and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical
> smears from women over 50 was highly predictive of abnormal lesions
> detected by histologic examination. Although three cancers were
> detected on histologic follow-up, the most common lesions detected were
> endometrial polyps.
>
> art
>
> At Thu, 28 Apr 2005, Joanne Bulley, MD wrote:
> >
> >Garry
> >
> >You are right and - yes - before hyst - I would do a cold knife cone,
> >ECC of upper endocervix and Endometrial assessment.
> >
> >With this case it is noteworthy that she had the prior LEEP in March 04
> >with negative ECC. (I always do an ECC above my LEEP or cold knife cone
> >... but the results from the ECC with the LEEP are at the office and I
> >am home.)
> >
> >What do you make of her previous VIN 3 (1998) of the posterior introitus
> >... prior cryo (?1993) for CIN ... the CIN on this cone and the
> >"negative" for high Risk HPV?
> >
> >Obviously - she carries a different strain of HPV that is high risk ...
> >or does she have an immune system problem (and should it be worked up)
> >that allows genital tract carcinomas to get started?
> >
> >Joanne
> >
> >At Thu, 28 Apr 2005, 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
> >>
> >--
> >Joanne Bulley, MD
> >Keene, NH, USA
> >
>
> --
> art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
> Lawrence Peter Berra
>
--
R. Daniel Braun
Kinky for Governor
