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Re: Complex hyperplasiaFrom: D. Ashley Hill (dahmd@cfl.rr.com)Thu Aug 18 20:11:45 2005
At Thu, 18 Aug 2005, Dr. Ainsworth wrote: > >62 yo patient with 2 month of cyclic bleeding q2wks. On Prempro >0.625/2.5 for six years and amenorrheic until two months ago. Sonogram >showed a 4mm endometrial stripe, endometrial biopsy was negative. >Hysteroscopic endometrial resection and ablation performed. The >endometrium had patches of erythema - suggestive of chronic endometritis >but not found on the pathology, no polyps, small cavity - 8cm uterus. >Pathology showed features "suggestive of adenomyosis and a focus of >complex hyperplasia w/o atypia." She is planning to stop the HRT. > >Any other F/U suggested? If she bleeds again, I would recommend a >hysterectomy. I feel she has been adequately treated with the resection >and ablation, does anyone feel differently. Interesting case. Normal endometrial stripe, negative biopsy, but features "suggestive" of complex hyperplasia. I would get a second opinion on the path report. If the re-read returns as hyperplasia without atypia, and you resected the endometrium (versus straight ablation) I would assume she's cured. However, one could argue that if she is obese or has other risk factors for endometrial carcinoma then it would not be unreasonable to perform a hysterectomy. My concern is that if a focus of hyperplasia because malignant, it might not show for a long time due to cervical stenosis from the ablation. Ninety-five percent or so of patients with endometrial cancer bleed, but I bet that number is much lower after a resection/ablation :) Thanks for the interesting case. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida
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