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Re: Atypical complex hyperplasia / endometrial cancer From: Larry Glazerman (l.glazerman@rcn.com) Fri Feb 21 20:20:11 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ND84MD@aol.com: "Re: Hep C-sexuality" Previous message: Joe Cutchin: "Re: From The AMA" In reply to: Dr. Ainsworth: "Atypical complex hyperplasia / endometrial cancer" Next in thread: Dib Abdalla Chacur: "Re: Atypical complex hyperplasia / endometrial cancer" At 12:02 AM 2/21/2003 -0600, you 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. I'd probably also treat her with cyclic progestin until she stops withdrawing. If, OTOH, she prefers hysterectomy, that would be reasonable. >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. Hysterectomy with BSO, either laparoscopic or abdominal. -- Larry R. Glazerman, MD Ob-Gyn at Trexlertown 610-402-0161 l.glazerman@rcn.com Next message: ND84MD@aol.com: "Re: Hep C-sexuality" Previous message: Joe Cutchin: "Re: From The AMA" In reply to: Dr. Ainsworth: "Atypical complex hyperplasia / endometrial cancer" Next in thread: Dib Abdalla Chacur: "Re: Atypical complex hyperplasia / endometrial cancer"

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