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Re: Gyn: Complex hyperplasia in a polypFrom: Andrew Folley (agfolley@hotmail.com)Sat Oct 20 14:51:14 2007
In light of breast cancer history I would think the prudent option for doctor and patient would be a vaginal hysterectomy. Alternative for any other patient could be treatment with prgestational agent for 3 to 6 months and then rebiopsy.> Date: Sat, 20 Oct 2007 14:10:30 -0500> From: garrys@mindspring.com> To: ob-gyn-l@dns.obgyn.net> Subject: Gyn: Complex hyperplasia in a polyp> > 49 YO P1001, menopausal, S/P Tamoxifen a few years ago for treatment> after breast cancer. She is having no bleeding.> > She had been seen by a now-retired gynecologist from our community, and> had a 17 mm. or so endometrium for a good while. A biopsy was> negative, and she didn't withdraw to Provera.> > When I first saw her and reviewed the records, I told her that I was> worried about her endometrium given Tamoxifen usage. A saline sonogram> showed a 3 cm. or so polyp.> > At H-scope, she had a broad-based anterior wall polyp that I had to> trip/shave with the resectoscope. The rest of the endometrium was flat.> > ECC, endo curretings negative.> > Polyp--Complex hyperplasia, mucinous change, no atypia.> > I am not 100& sure that I was able to trip the entire polyp, as it was a> long resection. My guess is that I totally excised it.> > Would you:> > 1. Do nothing?> 2. Repeat an ultrasound for thickness in a couple of months?> 3. Repeat a saline ultrasound in a couple of months?> 4. Repeat a H-scope in a couple of months?> 5. Offer hysterectomy?> 6. High-dose progestin Rx?> 7. Other?> > Garry> > --> Garry E. Siegel, M.D.> Private Practice> Roswell, GA 6971033
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