Re: Atypical complex hyperplasia / endometrial cancer

From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Feb 21 14:46:28 2003

#1--Hyst, any route.

#2--I would do a TAH/BSO along with local gyn onc; if that isn't easy, and if you have someone who can do nodes (if you don't yourself), then TAH/BSO, get frozen for depth of invasion/grade, and decide whether or not to do pelvic nodes. Also, washings. I could live with LAVH/BSO, or TVH/BSO, but I would want a bit of support (literature, gyn onc consult/letter) to justify the "lesser" procedure. I assume you propose LAVH/BSO to get washings and to visualize the pelvis, and if you chose this "lesser" route, I would favor the LAVH/BSO for visualization (it will be normal) and washings, the latter of which you probably actually DON'T want to know about.

Garry

At Thu, 20 Feb 2003, 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.

--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA



use when must restrict search to only the ob-gyn-l forum...
Enter search keywords:
Returns per screen: Require all keywords:

Return to OB-GYN-L Mail a New Message to the Forum: ob-gyn-l@obgyn.net
Forum Administrator: geffrey.klein@obgyn.net
Report Technical Problems: webmaster@obgyn.net
Last Updated: Mon Nov 2 04:53:10 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.

Women's Insurance Checklist from Auto Insurance Quote

home | medical professionals | women | industry | forums | international
e-mail | about us | advertising | our sponsors | contact us | disclaimer |

This information is provided for educational purposes only.
Please read the disclaimer. ©1996-2008, all rights reserved.
Do not reproduce without permission of MediSpecialty.com