WOMENS-HEALTH Messages for March, 2000: Re: AGUS

Re: AGUS - Negative Workup?

From: R. Daniel Braun, MD (anonymous@obgyn.net)
Thu, 30 Mar 2000 20:55:00 -0600 (CST)

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In reply to: Ruth: "AGUS - Negative Workup?"

At Thu, 30 Mar 2000, Ruth wrote: >
>Thank you Dr. Wang and Dr. Braun for answering my question if my plan
>of followup is reasonable. And for all of you doctors being so nice and
>answering my questions in general about AGUS.
>
>Dr. Braun: You wrote:
>It sounds to me as though you have had as complete a workup as is
>possible. In a patient with an AGCUS (Atypical Glandular Cells of
>Undetermined Significance), Colposcopy, endocervical curettage and
>sampling of the endometrium is the workup of choice. If all those are
>negative, I would repeat the pap smear every 3 months until I had 2
>normals in a row and then go to every year again. If there were any
>abnormals again, the workup would need to be repeated. After 3 negative
>workups, a hysterectomy might be indicated.
>
>If you were exposed to DES in utero, there is a different scenario that
>should be evaluated. I don't know what you mean by "DES Background".
>DES exposure in utero can lead to little pockets of glandular cells
>scattered throughout the vagina. If a patient with this has an AGCUS
>smear, I would want to do a very thorough evaluation of the vagina to
>find all of these pockets and check out each one to see if it is the
>source of the cells.
>
>RDB
>
>What do you mean by 3 negative workups? Are you saying if all the biopsy
>tests come out normal and the pap still says AGUS then I should consider
>a hysterectomy even if the tissue from the endocervix and endometrium
>are benign?

Exactly, the abnormal cells are coming from somewhere if they persist and just because we can't find it, doen't mean ther isn't a problem. It means we can't find it. Then we have to go further.

RDB

>
>I did have DES exposure in utero so I will ask that my doctor look for
>pockets of glandular cells to see if perhaps that is where they are
>coming from. If they are coming from the vagina what is usually done
>about that? Thanks.

--
R. Daniel Braun, MD FACOG  FOG

This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional.  Due to time constraints, private e-mails cannot be answered.

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