Page 1 of 1: endometrial curettage +ve-- What next?

Moose · Credits: 1318 My Scrapbook

A 30 yr old lady is found to have a pap smear +ve cervical biopsy -ve
and endometrial curettage +ve. Next thing to do is?
a- conisation
b- hysterectomy
c- Wertheim's hysterectomy
d- repeat pap smear
logic sez that it is most likely ca endometrium---- therefore
[b] should be the answer but a is given-- any idea?

pl · Credits: 78264 My Scrapbook My Reading List 262569 Books

hi,
i ll also go for b,which covers all layers of endometrium to confirm the diagnosis in CA endometrium,we v here smear n curretage +ve but biopsy -ve,so the result is doubtful as in the presence of -ve biopsy(which is specific) the rest of +ve result came under doubt ...
after that u can plan for weirthham's hysterectomy
comments welcome

Moose · Credits: 1318 My Scrapbook

But the neg biopsy only rules out ca cervix!
pap smear is +ve even in ca endom in 50-67% of cases.
No role for wertheim's in ca endom as far as i can rmember.

suneet · Credits: 6830 My Scrapbook

IT IS TOTAL ABDOMINAL HYSTERECTOMY WITH B/L SALPINGOOPHORECTOMY
IN STAGE II WERTHIEM HYSTERECTOMY IS DONE

DrIyiola · Credits: 1137 My Scrapbook

total hysterectomy in a 30yr old with neg biopsy???

ophtha · Credits: 10492 My Scrapbook

The Qs asks what is NEXT step.
women screening sequnce is: pap-smer->colposcopy (icluding endocervical biposy and endocervical curetaj-ECC)->cone biopsy.
Indications for cone Bx:
1. +ve ECC
2. inadequate/unsatisfactory colposcopy (cannot see)
3. discrepancy between cytology and histology (our case)
4. Dx of microinvasive Ca (<3mm past BM)

Need to rule out Cerv Ca.

Cervical Ca -> radial hysterectomy + regional lymphadenectomy +/- BSO depending on age
Endom Ca -> simple hysterectomy

So, the answer is: next step (a) - cone biopsy

dr_nidhi · Credits: 12986 My Scrapbook My Reading List 5 Books

well pap smear is also a modality of investigation for carcinoma endometrium , how ever it is only positive in 50% cases. In this case endometrial currettage positive...... diagnosis becomes endometrial carcinoma......treatment as per the options becomes hysterectomy.

nailo · Credits: 122 My Scrapbook

answer is cone biopsy as cervical biopsy may have missed cancerous area cone biopsy of whole transitional zone is required

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