Re: Gyn: Positive margins on a LEEP
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Oct 30 18:34:18 2007
In a previous institution, we called our two pathologists Dr. Waffle & Dr.
Hedge. We saw that on every cx bx.
Dan
On 10/30/07, Richard Chudacoff <rchudacoff@mylinuxisp.com> wrote:
>
> Okay, but if invasion cannot be ruled out, then I would do a cold knife
> cone
> rather than a LEEP. I would not want to burn the margins
>
> Richard Chudacoff, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
> Siegel, M.D.
> Sent: Tuesday, October 30, 2007 10:43 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Gyn: Positive margins on a LEEP
>
> Dear all:
>
> For some reason (the chart is not with me today), I had told the patient
> that I wanted to do another LEEP, probably because I seem to remember
> that the original biopsy said invasion could not be ruled out--which is
> different than what I posted below. I also discussed this with the gyn
> onc.
>
> So. . .if I posted wrong, I'm sorry, but this has generated good
> discussion.
>
> She is scheduled for a LEEP this week, and likely a hyst later.
>
> How to hyst?
>
> Since she is having pain, I feel that a laparoscope must be involved, so
> I'll likely do an LAVH since I'll need to go vaginally to look at the
> cervix and remove it fully.
>
> Thanks to all,
>
> Garry
>
> At Tue, 30 Oct 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
> wrote:
> >
> >At Mon, 29 Oct 2007, Garry E. Siegel, M.D. wrote:
> >>
> >>33 YO P2002 S/P TL, originally came in for dysmenorrhea and dyspareunia.
> >>
> >>Her intial exam was normal, but her pap was HGSIL. Directed biopsies at
> >>satisfactory colposcopy showed moderate dysplasia.
> >>
> >>LEEP in the OR--CIS with positive endo and ectocervical margins, and
> >>extensive glandular involvement.
> >>
> >>What's next?
> >>
> >>Garry
> >>
> >>--
> >>Garry E. Siegel, M.D.
> >>Private Practice
> >>Roswell, GA
> >>
> >- repeat pap in 3-6 months, new wet prep brushs are just as good as ECC.
> >- Hyst, sure if that's what pt. wants, usually if pt. has other
> >pathology,adenomyosis, endometriosis , they don't need much convincing.
> >
> >Very common problem, have had over a dozen in the last ten years, only
> >had one actual reccurence or incomplete excision show up on follow up
> >PaP, just repeated leep and patient has been -ve for five years, some
> >women just don't want a hyst.
> >Quite a few had low grade lesion on follow up PAP's which eventually
> >turned normal.
> >
> >--
> > Take care, John
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
