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Re: Complex hyperplasia From: ainsron (ainsron@sbcglobal.net) Fri Aug 19 09:55:54 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ainsron: "Re: Complex hyperplasia" Previous message: art fougner, md: "Re: OB: A Cautionary Tale" In reply to: Garry E. Siegel, M.D.: "Re: Complex hyperplasia" Next in thread: ainsron: "Re: Complex hyperplasia" 1. The resection was done for pathologic diagnosis. 2. When I do a resection, I always cauterize with the rollerball afterwards, hence an ablation. 3. I did an endocervical curettage before dilating, that was negative. 4. I don't do D&C's for postmenopausal bleeders, hysteroscopy is more complete. If I find a polyp that can be resected, I usually stop there. In this case, the endometrium was not the typical atrophic endometrium and in fact, sampling alone would probably have missed the pathology. 5. Why wouldn't a resection/ablation be appropriate after the menopause?? Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Thursday, August 18, 2005 8:09 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Complex hyperplasia Why was an ablation done? Was the resection for pathologic diagnosis? Was a fractional D and C done first? In the spirit of learning only, I am less experienced in ablation and resection but have the impression--perhaps a mistaken one--that you don't resect and ablate after menopause. Garry At Thu, 18 Aug 2005, D. Ashley Hill wrote: > >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 > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: ainsron: "Re: Complex hyperplasia" Previous message: art fougner, md: "Re: OB: A Cautionary Tale" In reply to: Garry E. Siegel, M.D.: "Re: Complex hyperplasia" Next in thread: ainsron: "Re: Complex hyperplasia"

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