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Re: clinical problemFrom: Deborah Richert (tdricher@pressenter.com)Tue Jan 5 21:55:25 1999
At 09:06 PM 1/5/99 -0600, you wrote: >I would like to hear some expert opinion on the following case: >64 year old post menopausal female in good health getsreferred by her >primary care doc ( actually the nurse practitioner) for post menopausal >spotting. Pap, mammo all normal. My exam reveals a mass which >displaces the cervix way upward ( you cant visualize it at all with the >speculum--and endo biopsy is impossible. Rectal exam reveals the mass ( >and/or uterus?) above the rectum and shes guiac neg. There is no >ascities and ca125 is wnl. The radiologist wanted me to order a ct scan >but I dont feel this is necessary since this most likely uterine or >ovarian neoplasm clearly needs to come out.(Ido these cases with a >gyn-onc who can stage these tumors adequately.)I am not sure if this is >malignat or benign. r/o colon tumor ?-although this seems highly >unlikely. My one reservation about ordering these tests is that the the >hmo medical directors might delay my case ruling out distant spread when >none exists. ( such a thing happened recently to me and there was a 4 >week delay-- that woman had ovarian cancer. Any insights? My point here >is how would additional testing in this case alter management? > >-- >nsohn > Natalie - How about ordering a transvaginal pelvic ultrasound exam to see if this patient has a retropositioned uterus or possibly a uterine fibroid? I've done many transvaginal ultrasounds for a possible cul de sac mass that turned out to be a retropositioned uterus. Also, with a transvaginal ultrasound exam, sonohysterography could be performed as needed to see if there may be a polyp or fibroid within the endometrial cavity as a cause for the PMP spotting. Just a thought. Deb Richert, AAS, RDMS, RVT La Crosse, WI
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