Postmenopausal Bleeding
From: ainsron@msn.com
Tue Sep 12 09:05:12 2000
I recently saw a patient for the first time who has been bleeding
irregularly for the past 9 months. She was evaluated by a gynecologist
in another state, or I more correctly, I should say she has been
"extensively" evaluated. She has had three endometrial biopsies, all
benign, a hysteroscopy which showed atrophic changes, no adenomyosis,
fibroids, etc, a saline infusion sonohysterogram - which was negative,
an MRI and a CT scan. The rub is that the MRI and CT showed an area in
the uterus "suspicious of adenoca of the endometrium," one was done
before the hysteroscopy, the other was done afterwards, still showing
the same changes. She stopped bleeding for a couple of months,
restarted 10 days before she was seen by me. What would you do? I know
what I am going to do! My feeling is that she has been worked up to the
nth degree, and we are no closer to a diagnosis than she was at the
beginning. I suspect that the MRI/CT findings will simply be an area of
adenomyosis or a fibroid in the fundus, but it could represent a mixed
mesodermal tumor, therefore I plan to do a TVH/BSO. If cancer is
present, she may need additional w/u - laparoscopic lymphadenectomy for
staging, but that can safely wait for the final pathology.
--
Ronald E. Ainsworth, MD
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