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Re: Atypical Endocervical Cells From: Joanne Bulley (jbulley@cheshire.net) Thu May 13 19:51:52 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley: "Re: Triscreen question" Previous message: Arthur W. Curtis, Jr.: "Re: Gyn: Hot Flashes" Next in thread: Diane Hibbs, DO: "Re: Atypical Endocervical Cells" Reply: Diane Hibbs, DO: "Re: Atypical Endocervical Cells" Reply: Anthony Evans: "Re: Atypical Endocervical Cells" Interesting that this comes up right now! I very recently had a patient with AGUS ?endometrial vs endo cervical by PAP, with colpo showing AdenoCa in situ of endo cervix and and endo biopsy showing normal endometrium by pipelle. Like others (from this discussion) I did the LLETZ only to have the margins charred and difficult to read... Talking with my gyn/onc folks we agreed that the better procedure would have been the traditional cold knife cone. I gave her a choice of repeat cone then or waiting the first Pap. She waited and the pap is consistent with AdenoCa in situ. For this patient the "advantage" of waiting is that she had horrendous menorrhagia before the first cone which improved markedly with the Hysteroscopy, D&C done at the time of the LLETZ (after the LLETZ). The menorrhagia returned full force in the third cycle prior to the Pap, so we are going to do a vag hyst for both problems... Any votes or recommendations for second (cold knife) cone prior to the hyst? -- Joanne Bulley, MD KEene, NH ------------------------------ Date: Wed, 12 May 1999 17:56:52 -0500 (CDT) ------------------------------ From: gekgionk@nic.mpt.com.mk (Georgi Kostadinov) ------------------------------ Subject: Re: GYN: Atypical Endocervical Cells--followup At 11-th of May, Garry E. Siegel, M.D. wrote: >The endo was negative, the ECC just clot, and the LEEP had adenoCa in situ, with a postive endocervical margin (and I went as deeply as I could)........... LLETZ is not most appropriate excisional technique in evaluation of endocervix. The literature says that you must obtain multiple fragments to evaluate entire endocervix, and endocervical specimens suffered the most thermal injury. So, standard cold knife conization or FCBE with Wide Endocervical Angle CBE electrode, that obtain cylindrical specimen (currently under investigation in my study) should be performed and not LLETZ [1], [2]. Glandular abnormalities are often treated by loop excision or cone biopsy but a recent study demonstrated that assessment of cone biopsy resection margins was not predictive of residual/recurrent disease in a subsequent hysterectomy in patients with adenocarcinoma in situ [3]. This is supported by a case report of invasive adenocarci-noma following loop excision for adenocarcinoma in situ despite clear resection margins [4]. Next message: Joanne Bulley: "Re: Triscreen question" Previous message: Arthur W. Curtis, Jr.: "Re: Gyn: Hot Flashes" Next in thread: Diane Hibbs, DO: "Re: Atypical Endocervical Cells" Reply: Diane Hibbs, DO: "Re: Atypical Endocervical Cells" Reply: Anthony Evans: "Re: Atypical Endocervical Cells"

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