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abnormal papFrom: Dr. Ainsworth (ainsron@sbcglobal.net)Mon Oct 7 16:05:12 2002
74 yo lady with PMB, on HRT for over two years. Sonogram showed a thickened endometrium, hysteroscopy showed benign polyps, w/squamous metaplasia and simple hyperplasia, ecc was negative. Pap done at the time of her preop exam returned two weeks later, showed abnormal cells, suspicious for adenocarcinoma. Colposcopy was negative, except for small, benign appearing polypoid growth on the cervix that was pathologically benign. The ECC was negative. When the pathologist reviewed all of the slides and paps at the same time, he felt the abnormal pathology originated in the polyp that was removed at the time of the hysteroscopy and was therefore there was no evidence of malignancy. Never one to leave "well enough alone," I repeated the pap at the time of the last colposcopy, of course it returned with the comment, abnormal cells, appear to be glandular, suspect adenocarcinoma. Now what to do? This lady is a train wreck, severe COPD on oxygen therapy 24/7, not a very good candidate for surgery, although she did well with the hysteroscopy. She is not a good candidate for office LEEP, her cervix is very difficult to visualize, even for a colpo, the upper vagina tunnels in and it does not descend well at all. I'm thinking that I should probably do a cone biopsy in the hospital, but what if that is not diagnostic either? Who would vote for going directly to TAH/BSO? Currently I'm waiting to hear back from a couple of gyn oncs.
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