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Re: abnormal pap From: Dr. Ainsworth (ainsron@sbcglobal.net) Mon Oct 7 19:37:58 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "Re: Puzzling case" Previous message: Larry Glazerman: "Re: Puzzling case" In reply to: Gail Waldby: "Re: abnormal pap" Next in thread: RModugno@aol.com: "Re: abnormal pap" She did have a sonogram and that was negative, except for the thickened endometrium prior to hysteroscopy, which turned out to be polyps. No adnexal pathology was noted. I will probably do a cone biopsy in the hospital, tubal carcinoma is an obvious potential source, since the ECC was negative and I've considered doing a cone w/frozen section, w/Diagnostic Lap if the path is negative, but I am concerned how her pulmonary status would decompensate with a pneumoperitoneum. The Gyn onc I spoke to made another good point. He wants me to have the pathologists correlate all of the slides on this patient to see just exactly how high their index of suspicion is. After the hysteroscopic resection, they felt the previous abnormal cytology could be explained by the polyps. They didn't comment or compare the second pap to the previous pap or other specimens and that may be helpful. He also suggested having them reviewed at Stanford if the local pathologist appear to be hedging their bets. We don't have a gyn onc closer than 90 miles away and if anything radical is necessary she will have to be shipped out, which she is hoping to avoid. It would be a shame to have to send her for a cone biopsy with RFS, possible laparoscopy, possible TAH/BSO, etc., but that may become inevitable. >Cone or LEEP at hospital with at least IV sedation >Sonography if not done already to look at Fallopian tubes >Gail Waldby, MD >Huron Clinic SD > >10/7/2002 4:06:03 PM, ainsron@sbcglobal.net (Dr. Ainsworth) wrote: > >>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. >> Next message: Braun, R. Daniel: "Re: Puzzling case" Previous message: Larry Glazerman: "Re: Puzzling case" In reply to: Gail Waldby: "Re: abnormal pap" Next in thread: RModugno@aol.com: "Re: abnormal pap"

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