Re: Gyn: Positive margins on a LEEP
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Oct 31 05:38:48 2007
Cold cone biopsy
Ef
At Tue, 30 Oct 2007, Garry E. Siegel, M.D. wrote:
>
>Dear all:
>
>For some reason (the chart is not with me today), I had told the patient
>that I wanted to do another LEEP, probably because I seem to remember
>that the original biopsy said invasion could not be ruled out--which is
>different than what I posted below. I also discussed this with the gyn
>onc.
>
>So. . .if I posted wrong, I'm sorry, but this has generated good
>discussion.
>
>She is scheduled for a LEEP this week, and likely a hyst later.
>
>How to hyst?
>
>Since she is having pain, I feel that a laparoscope must be involved, so
>I'll likely do an LAVH since I'll need to go vaginally to look at the
>cervix and remove it fully.
>
>Thanks to all,
>
>Garry
>
>At Tue, 30 Oct 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
>wrote:
>>
>>At Mon, 29 Oct 2007, Garry E. Siegel, M.D. wrote:
>>>
>>>33 YO P2002 S/P TL, originally came in for dysmenorrhea and dyspareunia.
>>>
>>>Her intial exam was normal, but her pap was HGSIL. Directed biopsies at
>>>satisfactory colposcopy showed moderate dysplasia.
>>>
>>>LEEP in the OR--CIS with positive endo and ectocervical margins, and
>>>extensive glandular involvement.
>>>
>>>What's next?
>>>
>>>Garry
>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>>>
>>- repeat pap in 3-6 months, new wet prep brushs are just as good as ECC.
>>- Hyst, sure if that's what pt. wants, usually if pt. has other
>>pathology,adenomyosis, endometriosis , they don't need much convincing.
>>
>>Very common problem, have had over a dozen in the last ten years, only
>>had one actual reccurence or incomplete excision show up on follow up
>>PaP, just repeated leep and patient has been -ve for five years, some
>>women just don't want a hyst.
>>Quite a few had low grade lesion on follow up PAP's which eventually
>>turned normal.
>>
>>--
>> Take care, John
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
