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Gyn: PMB/painFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Jun 6 18:13:02 2007
60 YO P2002, many years menopausal, old patient not seen in 4 years. When last seen then, had simple hyperplasia on HRT corrected or being corrected with increasing the relative amount of progestin. The last biopsy, 4 years ago, on HRT, was disordered proliferative endometrium. 1999 she had H-scope for a large endocervical polyp, negative curettings. A week ago she had malaise, poor appetite, N-V, and the onset of postmenopausal bleeding (it has been at least 3 years per patient) and was hospitalized for an internist for a tune up. She has vague back and lower abdominal pain, and poor appetite. The workup was mostly negative for heart, etc. problems. She is a petite women whom I remember well, and she just doesn't look well. Her Ca 125 was 9, a pelvic ultrasound showed a 1.5 cm. hypoechoic mass on one ovary, which as around 1.5 cm., and her endometrium was 9.6 mm. Today, I saw her in the office--small, posterior uterus, no adnexal tenderness or mass, heme negative, and her uterus sounded to 7 cm. and I did an endo biopsy with two Pipelle passes, and got scant tissue/blood. Of course, I'll await the biopsy, but I'm thinking that if it isn't diagnostic, then she might need any/all of the following: CT Saline Sono H-scope--and if I did that, I would likely consider lapscope. Consultants, what do you think? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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