Re: AGUS pap
From: Joe (forcep@intercom.net)
Sat Apr 8 23:15:42 2006
Garry: don't be surprised when you do VH (if you go that route) to find
no atypical glandular tissue. There is something missing in this
equation with AGUS on Pap with both negative and positive biopsies.
Maybe its the HR HPV effect on glandular tissue I don't understand. Joe C
Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote:
> At Sat, 8 Apr 2006, Garry E. Siegel, M.D. wrote:
>
>>38 YO P2002, 2 prior C/S, very petite--5 feet, 95 pounds.
>>
>>LEEP 11/05, mild dysplasia with clear margins.
>>
>>First pap 3/06 AGUS, HR HPV +
>>
>>colpo negative, easy to do an ECC and endo biopsy, both benign.
>>
>>I don't think that she is a good vag hyst in my hands--I would do a TAH.
>>
>>However, I really think that this negative evaluation and the proximity
>>of the pap to the LEEP may well mean that the pap isn't all it is
>>cracked up to be. That said, an AGUS pap is nothing to fool around
>>with. . .
>>
>>I think the choices are to do freqeunt paps--every 4 months--and
>>reassess if any aren't negative, versus a LEEP (long and narrow) and a
>>hysteroscopy. If the LEEP and H-scope are negative, then why not do
>>nothing and follow paps.
>>
>>Now, if one wants to do a hyst, would you LEEP first?
>>
>>Garry
>>
>>At Sat, 8 Apr 2006, Joanne Bulley, MD wrote:
>>
>>>As the HR HPV folks are saying that AGUS is also due to the HRHPV ...
>>>
>>>One option is to test for HRHPV and if (+) to be more aggresive (as in
>>>VH).
>>>
>>>Narrow deep cone is fine for diagnosis (and maybe cure)-- but then there
>>>is cervical stenosis if the canal seals off from the narrow deep cone...
>>>then there is the possibility of retained menstruation (I forget the age
>>>of the patient from the original post) and need to go back and open up
>>>the closed off cervix ... I had that a couple of times since doing
>>>LEEPs (instead of old fashioned cones)
>>>
>>>If you can't find the disease otherwise ... the the VH is a nice
>>>procedure.
>>>
>>>Don't need no 'scopes for the vast majority of them.
>>>
>>>Joanne
>>>
>>>At Sat, 8 Apr 2006, RModugno@aol.com wrote:
>>>
>>>>In a message dated 4/6/2006 7:11:14 A.M. Eastern Standard Time,
>>>>eramirezt@coqui.net writes:
>>>>
>>>>Then LEEP with the narrow deep one - if she pushes for TAH I'll go along
>>>>if she is aware of risks, etc..
>>>>
>>>>Ef
>>>>
>>>>Why not ye olde vag hyst?
>>>>
>>>>Robert Modugno MD MBA FACOG
>>>>Marietta, GA
>>>
>>>--
>>>Joanne Bulley, MD
>>>Keene, NH, USA
>>>
>>>"Love is indescribable and unconditional.
>>>I could tell you a thousand things that it is not, but not one that it is."
>>>— Duke Ellington, American jazz artist (1899-1974).
>>>
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>
> I have had two cases of AGUS which had cancer not related to the cervix,
> one was an endometrial, the other was an adenosquamos of the lower
> uterine segment. Nothing wrong with a TAH its not the end of the world,
> this patient keeps generating abnormal cytology its hard to ignore that.
> The fact she generated AGUS after the leep and the leep only showed mild
> dysplasia should make you very wery that the mild dysplasia was not the
> source of the abnormal cells to start of with, mild dysplasia, HGSIL and
> adenosquamous lesions can all coexist. And offcourse its always
> possible she will genrate abnormal cells after the TAH. Fortunetly she
> seems to be very good for followup, followup has become one of my
> greatest fears, seeing about 6 cases of invasive desease after poor
> follow up will do that to you.
>
> --
> Take care, John
>
|
|
