Re: Atypical complex hyperplasia / endometrial cancer
From: Joe Cutchin (forcep@intercom.net)
Fri Feb 21 14:29:03 2003
1.Megace 40 mgm qd and rebiopsy 2-3 mos. 2. "a"
"Dr. Ainsworth" wrote:
> Two patients this week with similar problems with PMB, different
> outcomes:
> 1). I hysteroscoped a patient this week for postmenopausal bleeding and
> the final pathology showed Complex hyperplasia with focal atypia. Her
> history is that her PCP had been giving her unopposed estrogen
> injections for a number of years and he biopsied her last year and found
> complex hyperplasia w/o atypia. He referred her to me this month
> because she had 3-4 episodes of bleeding over the last year. He had
> ignored his previous biopsy findings, at least he failed to act on them.
> When I saw her, the lining was thickened on TVUS and my biopsy also
> showed complex hyperplasia w/o atypia. My recommendation to her is to
> discontinue estrogen, I feel that I completely resected the lining and
> did not miss any underlying cancer. Does anyone feel strongly that she
> should have a hysterectomy? I will probably monitor with TVUS yearly for
> a couple of years.
>
> 2) The pathology on another patient I hysteroscoped this week because of
> AGUS showed extensive complex hyperplasia w/focal atypia and focal areas
> of well differentiated adenocarcinoma, adenomyosis with hyperplasia and
> no evidence of stromal invasion. I was sure at the time of the
> hysteroscopy that I was dealing with a cancer, polypoid tissue
> extensively throughout the cavity with atypical vessesl, very friable.
> Obviously she needs a hysterectomy. Would your choice be a)
> TAH/BSO/cell washings/limited node sampling, b) LAVH/BSO with cell
> washings, c)TVH/BSO, or d)refer for Gyn oncology (which means referral
> to a center 2 hours away). She is 71 and in good health. She has been
> on continuous Premarin 0.625 with Prometrium, 100 mg. An endometrial
> biopsy prior to the hysteroscopy showed proliferative endometrium with
> focal metaplasia, TVUS showed 1.1cm thick endometrium.
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