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Re: Complex hyperplasia From: ainsron (ainsron@sbcglobal.net) Fri Aug 19 09:59:02 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: benjamin sharp: "Re: GBS" Previous message: ainsron: "Re: Complex hyperplasia" In reply to: D. Ashley Hill: "Re: Complex hyperplasia" Next in thread: Dr. Ainsworth: "Re: Complex hyperplasia" She really does not have other risk factors - she is not diabetic, not obese and has been on combined estrogen/progesterone. I have requested a referral of the path slides to a gyn pathologist and I'll let you know what I hear. What concerns me about the potential for recurrence and possible lack of complete resection is the co diagnosis of Adenomyosis - i.e., how deep are the glands in the myometrium? Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley Hill Sent: Thursday, August 18, 2005 6:12 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Complex hyperplasia 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 Next message: benjamin sharp: "Re: GBS" Previous message: ainsron: "Re: Complex hyperplasia" In reply to: D. Ashley Hill: "Re: Complex hyperplasia" Next in thread: Dr. Ainsworth: "Re: Complex hyperplasia"

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