Re: Complex hyperplasia
From: ainsron (ainsron@sbcglobal.net)
Sun Aug 21 09:42:18 2005
I understood your questions and I really was simply trying to explain.
Takes more than that to get me "hot." You always ask good questions Garry.
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: Friday, August 19, 2005 8:13 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Complex hyperplasia
Simmer down, Ron :). I was asking a question, and obviously my concern
about doing an ablation after menopause may be an incorrect one.
The resection for pathology is what I was thinking, and I also always do
a hysteroscopy, too. I cannot remember the last time I did a fractional
D and C and didn't do a h-scope.
Garry
At Fri, 19 Aug 2005, ainsron wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
