Re: Complex hyperplasia
From: Dr. Ainsworth (ainsron@sbcglobal.net)
Fri Aug 19 10:17:29 2005
I submitted one of the images from her hysteroscopy on the website, if
anyone wants to look at it.
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
>
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