Re: AGUS
From: Rafael Haciski (haciski@earthlink.net)
Thu Apr 28 22:25:25 2005
I agree with Dr. Siegel (except for the OR)
... generous LEEP in office
... hysteroscopy through the now open canal, with biopsy as needed
... endocervical curettage
And if no cancer found then schedule for hysterectomy (my preference
laparoscopic, with BSO)
--
Rafael C. Haciski MD FACOG
Bradenton FL
On Apr 28, 2005, at 22:10, Garry E. Siegel, M.D. wrote:
> Hey, check out the ASCCP guidelines. http://www.asccp.org/
>
> Before you do a TVH and find an undiagnosed cancer (unlikely, but. .
> .), if you cannot access her cervix due to stenosis, why not do an OR
> visit:
>
> 1. Cold knife cone--unless you feel the cervix is "cleared" and it
> doesn't need evaulation.
> 2. ECC
> 3. Hysteroscopy/endometrial curettage
>
> Unless I'm missing something, you have an unexplained AGUS smear (CIN
> doesn't fully cover that) and you've not been able to evaluate the
> endometrium or the endocervix.
>
> Garry
>
> At Thu, 28 Apr 2005, Joanne Bulley, MD wrote:
>>
>> My thoughts run the same way as you and Efrain
>>
>> Joanne
>>
>> At Thu, 28 Apr 2005, ainsron wrote:
>>>
>>> Cone or LEEP. Consider TVH.
>>>
>>> Ronald E. Ainsworth
>>>
>>> -----Original Message-----
>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>> Joanne
>>> Bulley, MD
>>> Sent: Thursday, April 28, 2005 2:36 PM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: AGUS
>>>
>>> 48 yo G0 s/p Cryosurgery of cervix prior to 1993. (presume CIN)
>>> VIN 3 (carcinoma in situ) of vulva at posterior introitus excised
>>> 1998.
>>> Vulvar coploscopies normal since then.
>>>
>>> Pap 3/04 AGUS (possible adenocarcinoma in situ)
>>> LEEP (cervical stenosis from cryo precluded any office evaluation)
>>> path: CIN 1 - mild dysplasia with severe cervicitis, comparison with
>>> Pap
>>> confirms the same cellular characterisics were present.
>>>
>>> Pap 10/04 ASCUS negative for high risk HPV subtypes.
>>>
>>> Pap 3/05 AGUS.
>>>
>>> Colposcopy - unable to see SCJ. Endocervical curette would not pass
>>> through stenotic cervix. Endocervical specimen taken with
>>> endocervical
>>> brush.
>>>
>>> Pathology pending.
>>>
>>> Of course the next step will depend somewhat on the patology, but,
>>> what
>>> do you think you would do next?
>>>
>>> Joanne
>>>
>>> --
>>> Joanne Bulley, MD
>>> Keene, NH, USA
>>>
>> --
>> Joanne Bulley, MD
>> Keene, NH, USA
>>
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
