Re: Atypical complex hyperplasia / endometrial cancer
From: Larry Glazerman (l.glazerman@rcn.com)
Sat Feb 22 19:37:42 2003
PMB = postmenopausal bleeding
PCP = primary care physician (a side effect of managed care here in the US)
At 02:40 PM 2/22/2003 -0600, you wrote:
>Please,
>I would like to know what means PMB and PCP
>Regards
>Dib
>
>DIB ABDALLA CHACUR
>GYNECOLOGY-MASTOLOGY
>Teacher of Ginecology of CAMPOS FACULTY OF MEDICINE
>Campos dos Goytacazes-RJ-Brazil
>cep 28.030-360
>dibchacur@uol.com.br
>>----- Original Message -----
>From: "Dr. Ainsworth" <ainsron@sbcglobal.net>
>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
>Sent: Friday, February 21, 2003 3:02 AM
>Subject: Atypical complex hyperplasia / endometrial cancer
>
> > 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.
> >
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown
610-402-0161
l.glazerman@rcn.com
