Re: Complex hyperplasia
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Aug 21 17:38:13 2005
Thanks, Ron. A shortcoming of email/internet is the inability to hear
tones, inflections, and see facial expressions. No harm intened, and
thanks for the compliment.
Garry
At Sun, 21 Aug 2005, ainsron wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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