--
----------
From: Suddoc@aol.com[SMTP:Suddoc@aol.com]
Sent: Tuesday, October 31, 1995 2:27 AM
To: philip@ICSI.Net
Subject: 20 Week Fibroid Uterus
I have a 47 yo G2 P2002 patient who has a 20 week fibroid uterus. She has
regular menses of normal flow and no pain. She is asymptomatic. When first
seen in 1993 I did an endometrial biopsy which was benign and an IVP which
was within normal limits. She was against surgery of any type.
I would be vehemently against continued conservative management.
Regarding continued GnRH analog with add-back therapy: I'm not sure that a 20-week uterus would be a classic indication for this therapy. Further, GnRH analogs, as you have discovered, cause only a temporary diminution in uterine size. Cessation of analog therapy returns the uterus to its original size and in (I think nearly 20%?) a substantial number the uterus actually INCREASES in size. My use of these analogs with fibroids is to reduce the size of the uterus to prepare for surgery and decrease complications and possibly convert an abdominal case into a laparoscopically-assisted one.
The most crucial concern is the actual diagnosis. It looks, smells, walks, and feels like simple benign uterine fibroids. But, how do you know for certain the pathologic (cellular) diagnosis. This diagnosis is impossible to obtain with endometrial biopsies, by the way. Already in my relatively short 9-year career I have, on four occasions, removed large uteruses (that I was convinced were only "fibroids") only to discover that they actually involved sarcomatous degeneration. I would wager that if these folks were adamant against surgery and would rather walk around looking like a pregnant woman, that their days of walking would have been severely restricted.
In short: be terribly concerned over the possibility of cancer. Leiomyosarcoma is not a fun disease. I think you're treading on thin (very thin) ice leaving this mass within her pelvis (actually, more exact - her abdomen...).
IMHO,
Philip--------------------------------------------------------
Philip Suarez, M.D. philip@icsi.net
Philip--------------------------------------------------------
Fellow - American College Ob/Gyn
Philip--------------------------------------------------------
Delegate - Texas Medical Association
President - Internet Connect Services, Inc.
Internet Connect Services, Inc.
http://www.icsi.net
Physicians GenRx on the World Wide Web
Medicine's most complete drug compendium
http://www.icsi.net/GenRx
------ =_NextPart_000_01BAA763.52AED3A0
Content-Type: application/ms-tnef
Content-Transfer-Encoding: base64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://www9SHGRgNh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://wwwVNFXy0E4QSQxxDbJE/1nwSe0wYATeUIRwGRROVD3WhJE8I6xaW9wCuPU/9YO
f8bQ3ELXD+TP5d/aPAqAfQHoAAAAAAMAEBAAAAAAAwAREAAAAABAAAcwQGiZ5JOnugFAAAgwQGiZ
5JOnugEeAD0AAQAAAAUAAABSRTogAAAAAJJF
------ =_NextPart_000_01BAA763.52AED3A0--
