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________________________________
Haciski
Sent: Thursday, 29 March 2007 1:52 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Atypical
I do not find endometrial biopsies useful, as the necessary assumption
is that the changes are uniform and throughout the endometrium, which
may not be the case. With simple EBx (EMB) you stand a very high chance
of missing a solitary lesion. And they are not benign by any means
(when was the last time you had one?).
If the bleeding is related to hormonal manipulation, recent changes,
etc, then sono is the first line and if good picture is obtained with
thin lining throughout (2-3 mm, even) then I would observe. If I am
uncomfortable with the endometrium (poor picture, thicker endometrium,
irregular) then I go to hysteroscopy at which time a directed biopsy of
any suspicious lesion is accomplished, followed with extensive
curettage.
This way I sleep better knowing I had not missed any lesions.
Rafael Haciski MD FACOG
Palmetto, FL.
On Mar 28, 2007, at 8:57 PM, Raymond Stephen wrote:
A pipelle sampling is a benign procedure, and so is an ultrasonically
generated measurement of endometrial thickness.
Steve
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod,
Darryl G Maj 48 MDOS/SGOBO
Sent: Thursday, 29 March 2007 12:54 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Atypical
That's why I've asked my esteemed colleagues. I have read about
hyperplasia and atypical hyperplasia but not atypical without
hyperplasia.
She really doesn't want another tissue sampling if at all possible.
I don't want to put her in for a) more risk and b) a worse prognosis if
she does have an undiagnosed cancer.
Glen
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
Cutchin
Sent: Wednesday, March 28, 2007 3:28 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Atypical
For me this is an unusual reading in that the term "atypical" is used
but not hyperplasia. I am uncomfortable with this and would get more
tissue. Joe C
Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
69 yo G2P2 with postmenopausal bleeding, not entirely known
where the
source was at first. Had a colonoscopy and cystoscopy prior to
getting to me.
EMB shows atypical glandular proliferation, no hyperplasia seen.
Suggestions for treatment? The patient is not keen on
medication or
further biopsies and wants definitive treatment.
Thanks,
Glen
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