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Gynecology (Expert Forum)
Cold Knife Cone Labs - 3rd Post
Answered by
Elaine Brown, MD - Pregnancy, Gynecology
Elaine Brown, MD - BLOG
Billings - MT
Cold Knife Cone Labs - 3rd Post
by tracievh, Nov 04, 2009 05:07PM
This is my third post to you and I wanted to thank you for your time and expertise. It’s very assuring to have another perspective.
Reference to my second post with pathology report:
http://www.medhelp.org/posts/Gynecology/LEEP-Results/show/1080232
Pathology report from cold knife cone:
Uterine Cervix, Cone Biopsy:
Small foci of cervical intraepithelial neoplasia, grade I-II, present in metaplastic squamous epithelium.
Margins: Negative for dysplasia
Healing scar with acute and chronic inflammation and marked reactive changes.
No evidence of invasive carcinoma.
Endocervix Curettings:
Small fragments of benign endocervical glands.
Fragments of benging lower uterine segment endometrium and benign endometrial polps.
No evidence of dysplasia or carcinoma.
Comment:
The cervical cone shows a healing scar with inflammation and marked reactive changes. There are small areas of cervical intraepithelial neoplasia I and II present in metaplastic squamous epithelium. There is no evidence of invasive carcinoma.
Mesonephric remnants ate also identified in the cervix.
Previous biopsy or papsmear not available for review and correlation.
On another note, the endometrial biopsy I had prior to my LEEP and cold knife cone was negative but said:
Fragments of benign weakly secretory endomertium with tubal metaplasia.
My questions:
What does mesonephric remnants mean?
Can the discovery of endometerial polpys suggest any other issues that may be going up in my uterus?
Should this be ignored or is there some other testing that I should be done?
I just feel like every time I have procedure, something else shows up or is wrong. PLUS, I just learned today that my Dr. ( who is an oncologist gynecologist ) was ousted from the practice and is working temporarily out of another office with no staff. So this kind of skews my faith in her now. Plus she was an hour late for my ckc with no explanation.
thank you in advance.
Reference to my second post with pathology report:
http://www.medhelp.org/posts/Gynecology/LEEP-Results/show/1080232
Pathology report from cold knife cone:
Uterine Cervix, Cone Biopsy:
Small foci of cervical intraepithelial neoplasia, grade I-II, present in metaplastic squamous epithelium.
Margins: Negative for dysplasia
Healing scar with acute and chronic inflammation and marked reactive changes.
No evidence of invasive carcinoma.
Endocervix Curettings:
Small fragments of benign endocervical glands.
Fragments of benging lower uterine segment endometrium and benign endometrial polps.
No evidence of dysplasia or carcinoma.
Comment:
The cervical cone shows a healing scar with inflammation and marked reactive changes. There are small areas of cervical intraepithelial neoplasia I and II present in metaplastic squamous epithelium. There is no evidence of invasive carcinoma.
Mesonephric remnants ate also identified in the cervix.
Previous biopsy or papsmear not available for review and correlation.
On another note, the endometrial biopsy I had prior to my LEEP and cold knife cone was negative but said:
Fragments of benign weakly secretory endomertium with tubal metaplasia.
My questions:
What does mesonephric remnants mean?
Can the discovery of endometerial polpys suggest any other issues that may be going up in my uterus?
Should this be ignored or is there some other testing that I should be done?
I just feel like every time I have procedure, something else shows up or is wrong. PLUS, I just learned today that my Dr. ( who is an oncologist gynecologist ) was ousted from the practice and is working temporarily out of another office with no staff. So this kind of skews my faith in her now. Plus she was an hour late for my ckc with no explanation.
thank you in advance.
Doctor's Answer
by Elaine Brown, MD, Nov 10, 2009 11:21PM
, Nov 10, 2009 11:21PMTo: tracievh
Hi!
First of all, one of your doctor's partners should be willing to take your case--at least I hope so. I'm not sure that I would follow her unless she has a good explanation.
Mesonephric remnants are remnants of tissue that formed as you were a developing embryo--a birth mark--more or less. This is nothing to worry about--a normal finding.
The polyps on the specimen DO need to be taken care of. If you were my patient, I would go back to the O.R. (sorry!!!!) for a D&C/ hysteroscopy.
The cone specimen is reassuring and suggests that all of the cervical dysplasia has been removed.
I think it was probably the polyps that caused the original abnormal PAP smear.They can shed atypical cells that can be picked up with the PAP brush. It is possible ( and fairly easy ) to miss polyps with an endometrial biopsy. That is why I suggest d&c/hysteroscopy--with this procedure it is possible to see inside the uterus and to biopsy and/or remove polyps or other suspicious tissue areas
.
An alternative to the O.R. would be a saline ultrasound-guided endometrial biopsy--but I would worry about not being able to remove the entire polyp(s). The VAST majority of polyps are benign, but a rare few contain foci of precancerous cells. They can be cured by removal.. After that, I HOPE you will be done!
Good luck!
Dr B
First of all, one of your doctor's partners should be willing to take your case--at least I hope so. I'm not sure that I would follow her unless she has a good explanation.
Mesonephric remnants are remnants of tissue that formed as you were a developing embryo--a birth mark--more or less. This is nothing to worry about--a normal finding.
The polyps on the specimen DO need to be taken care of. If you were my patient, I would go back to the O.R. (sorry!!!!) for a D&C/ hysteroscopy.
The cone specimen is reassuring and suggests that all of the cervical dysplasia has been removed.
I think it was probably the polyps that caused the original abnormal PAP smear.They can shed atypical cells that can be picked up with the PAP brush. It is possible ( and fairly easy ) to miss polyps with an endometrial biopsy. That is why I suggest d&c/hysteroscopy--with this procedure it is possible to see inside the uterus and to biopsy and/or remove polyps or other suspicious tissue areas
.
An alternative to the O.R. would be a saline ultrasound-guided endometrial biopsy--but I would worry about not being able to remove the entire polyp(s). The VAST majority of polyps are benign, but a rare few contain foci of precancerous cells. They can be cured by removal.. After that, I HOPE you will be done!
Good luck!
Dr B
Post Comment
i just learned that i will be losing my health insurance at the end of the year. so now i am more anxious to know if i need any further tests or treatments as i worry later down the road it maybe seen as a pre-existing condition and not covered.
thank you again