Re: Complex hyperplasia
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Aug 19 16:27:47 2005
OK
On 8/19/05, ainsron <ainsron@sbcglobal.net> wrote:
>
> I sent it to the website. They wanted more information, which I sent. I
> don't know how long it takes to get it up. If you like, I'll send copies to
> your personal email.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> *From:* ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] *On Behalf Of *R.
> Daniel Braun
> *Sent:* Friday, August 19, 2005 12:42 PM
> *To:* Multiple recipients of list OB-GYN-L
> *Subject:* Re: Complex hyperplasia
>
> Where is the link?
>
> Dan
>
> On 8/19/05, *Dr. Ainsworth* <ainsron@sbcglobal.net> wrote:
>
> 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
> >
>
> --
> R. Daniel Braun
> Kinky for Governor
>
--
R. Daniel Braun
Kinky for Governor
