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Re: clinical problem From: Joe Cutchin (forcep@shore.intercom.net) Wed Jan 6 08:25:43 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Ann Polin: "Re: clinical problem" Previous message: ahmad abdelhafeez: "emove name from listserve" Maybe in reply to: Natalie Sohn: "clinical problem" Next in thread: Ann Polin: "Re: clinical problem" Natalie Sohn 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 Forget the HMO.Do what is correct for the patient. Get MRI or Cat scan. Joe -- Joseph H. Cutchin MD FACOG 4105463125 314 West Carroll Street 4105463128 Fax Salisbury,Maryland 21801 http://www.penobgyn.com Next message: Ann Polin: "Re: clinical problem" Previous message: ahmad abdelhafeez: "emove name from listserve" Maybe in reply to: Natalie Sohn: "clinical problem" Next in thread: Ann Polin: "Re: clinical problem"

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