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Richard Chudacoff, MD
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
ENDODOK@aol.com
Sent: Friday, December 31, 2004 3:05 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Appreciate your advice
Follow up on following case:
>>58 yr.old G2 P2, one year hx. menometrorrhagia. Endo Bx. simple
hyperplasia,
>>no atypia. UTZ uterus 5.7x 6.8x 10.9.cm. Cavity widened to 24 cm .Oblong
>>inhomogeneous density 11mmx36mm (polyp?fibroid?carcinoma?). Endometrial
lining
>>posterior to this density 4-8 mm. Small fibroid anteriorly 7 mm.
>> Had been treated by NP at an HMO with E/P, then Depoprovera, no
>>improvement. Hb.10/HCT 32. Pt diabetic (HbA1c 8.6 / hypertensive. Weight
240.) Also
>>has SUI.
>> Was advised she needed a hysterectomy because of a premalignant
lesion
>>of the endometrium.
>>
>>Am considering the least traumatic Rx, via endometrial resection/ablation
>>and TVT for SUI.
Discussed case with our local Gyn oncologist, concurred with
hysteroscopy with resection of the mass, as well as th entire endometrium.
At time of hysteroscopy, much old and organized clot ( ??UTZ
inhomogeneous density), but about 60% of the endometrial surface
(contiguous) had an exophytic, shaggy, friable lesion, that was grossly
carcinoma. Took two generous cuts with loop electrode for pathology.
Frozen section = most likely no carcinoma
Permanent sections = "atypical polypoid adenomyoma". No carcinoma.
(pathologist Stanford trained, much exposure to gyn path; a member of a 10
pathologist group. Will have slides reviewed by colleagues)
Plan: LAVH/BSO, TVT
PS: I knew there was another reason I was hoping to avoid a hysterectomy...
she was hospitalized for 5 days 2000 for diverticulitis. I may have to do
this one OPEN!!
Happy New Year to all
J.Glenn Bradley MD
