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Re: abnormal papFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Mon Oct 7 22:33:49 2002
At Mon, 7 Oct 2002, 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. I would do leep or cone, if leep or cone is negative then I would do a TAHBSO. If she has a very early adenocarcinoma of the cervix or lower uterus then a hyst may be her best chance of cure. The pathologist may not pick up an early adenocarcinoma unless he does multiple sections.
--
Take care, John
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