I am 54 years old and on 18/07/10 have undergone a total laparascopic Vaginal assisted hysterectomy (TLVAH) and bilateral salpingooophrectomy further to an endometrial pipelle biopsy (for perimenopausal bleeding) " Endometrial Mucosa showing simple and complex hyperlasia with focular glandular atypia"
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I was told by my gynacologist that I had precancerous changes- CAH -although there was a risk of concurrent cancer in an area of endometrium not sampled by the pipelle. This would only be known at time of histo-pathological evaluation of uterine sample and there was a small risk I may need further surgery to remove some lymph nodes in the event that there was carcinoma and it had penetrated myometrium at more than one third depth.
Meanwhile I have received results that showed Endometrium: "partially autolytic,mostly inactive and Adenomyosis." In addition note that my surgical procedure was completed at 22.30 hours on July 18th and the evaluation was not carried out until July 20th. As far as I am aware autolysis is a process that destroys the cells of the specimen sometimes to such an extent that interpretation pathologically can be extremely hampered and even at times impossible. I understand it is advisable therefore to ensure that the specimen is treated in order to prevent this autolysis either by the surgeon or the laboratory.
I also note on my results there is an absence of any comment on the endometrium of CAH as per pipelle or even simple hyperplasia/ complex hyperplasia/ simple hyperplasia with atypia or carcinoma. The adenomyosis is presumably considered a separate concurrent condition.
I understand that the pipelle endometrial biopsy only samples a small amount (4-12%) of the endometrium and therfore feel extremely anxious that this result indicates that, due to autolysis, it was impossible for the laboratory to determine the histopathology and now it is also impossible to determine if there was concurrent cancer or worse still invasive cancer.
Firstly how it is that even though the pipelle endometrial biopsy a few weeks earlier showed COMPLEX HYPERPLASIA WITH ATYPICAL FOCI, the pathology evaluation of my uterus never reported any CAH or indeed never specified anything besides inactive and adenomyosis?
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Secondly, if different areas of the endometrium can show concurrently different stages, is there any risk at all (no matter how small) that if somewhere in the endometrium there was indeed concurrent cancer (as I was warned there could be) that the only area that it might have shown was that which had unfortunately undergone autolysis or would it be also show up in the remaining non autolysed area no matter how small or large an area of endometrium that percentage was-there is no indication just what percentage "partially" autolysed represents? Could cancer be missesd?
below is a detailed report <O😛></O😛>
Macroscopic check- <O😛></O😛>
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Uterus,cervix, two adnexa were received, 7 x 4.5 x 5 cm. In the area of the fundus, a sub serosal circumscribed mass was viewed-4cm diameter- by incisional biopsy- and was a grey white color. External cervical os covered with grey and pink mucous membrane. Thickness of myometrium 1.2-1.6 cm. Uterine cavity was not enlarged, the mucous membrane was pink. Incisions through myometrium shows grey fibrous tissue. Right adnexa: Fallopian tube 6 cm long and 0.4 cm diameter with grey serosa and ovary 3 cm diameter, a cystic cavity 0.5cm diameter with clear fluid was viewed through incision. Left adnexa: fallopian tube 5.5 cm length and 0.5cm diameter with a number of miniscule cysts on the serosa. Ovary 3.2cm diamter, 1cm diameter cystic cavity was viewed with clear fluid.<O😛></O😛>
A-cervix (1/2)<O😛></O😛>
B-E uterine membranes (4/6)<O😛></O😛>
F-Myometrium (1/2)<O😛></O😛>
G+H sub serosal mass (2/4)<O😛></O😛>
I-Right adnexa (1/2)<O😛></O😛>
J-Left adnexa (1/3)<O😛></O😛>
<O😛></O😛>
Microscopic check/diagnosis<O😛></O😛>
SPECIMEN OF ADENEXOHYSERECTOMY SHOWING:<O😛></O😛>
Cervix-mild chronic inflammation, erosions and fresh hemorrhages<O😛></O😛>
Endometrium,partially autolytic, mostly inactive.<O😛></O😛>
Adenomyosis<O😛></O😛>
Subserosal leiomyoma, partially hyalinized(4cm in diameter)<O😛></O😛>
Right adnexa-without significant changes<O😛></O😛>
Left adnexa-ovary showing follicular cyst<O😛></O😛>
Fallopian tube, is unremarkable<O😛></O😛>
<O😛></O😛>
Many thanks
Libi<O😛></O😛>
<O😛></O😛>
I was told by my gynacologist that I had precancerous changes- CAH -although there was a risk of concurrent cancer in an area of endometrium not sampled by the pipelle. This would only be known at time of histo-pathological evaluation of uterine sample and there was a small risk I may need further surgery to remove some lymph nodes in the event that there was carcinoma and it had penetrated myometrium at more than one third depth.
Meanwhile I have received results that showed Endometrium: "partially autolytic,mostly inactive and Adenomyosis." In addition note that my surgical procedure was completed at 22.30 hours on July 18th and the evaluation was not carried out until July 20th. As far as I am aware autolysis is a process that destroys the cells of the specimen sometimes to such an extent that interpretation pathologically can be extremely hampered and even at times impossible. I understand it is advisable therefore to ensure that the specimen is treated in order to prevent this autolysis either by the surgeon or the laboratory.
I also note on my results there is an absence of any comment on the endometrium of CAH as per pipelle or even simple hyperplasia/ complex hyperplasia/ simple hyperplasia with atypia or carcinoma. The adenomyosis is presumably considered a separate concurrent condition.
I understand that the pipelle endometrial biopsy only samples a small amount (4-12%) of the endometrium and therfore feel extremely anxious that this result indicates that, due to autolysis, it was impossible for the laboratory to determine the histopathology and now it is also impossible to determine if there was concurrent cancer or worse still invasive cancer.
Firstly how it is that even though the pipelle endometrial biopsy a few weeks earlier showed COMPLEX HYPERPLASIA WITH ATYPICAL FOCI, the pathology evaluation of my uterus never reported any CAH or indeed never specified anything besides inactive and adenomyosis?
<O😛></O😛>
Secondly, if different areas of the endometrium can show concurrently different stages, is there any risk at all (no matter how small) that if somewhere in the endometrium there was indeed concurrent cancer (as I was warned there could be) that the only area that it might have shown was that which had unfortunately undergone autolysis or would it be also show up in the remaining non autolysed area no matter how small or large an area of endometrium that percentage was-there is no indication just what percentage "partially" autolysed represents? Could cancer be missesd?
below is a detailed report <O😛></O😛>
Macroscopic check- <O😛></O😛>
<O😛></O😛>
Uterus,cervix, two adnexa were received, 7 x 4.5 x 5 cm. In the area of the fundus, a sub serosal circumscribed mass was viewed-4cm diameter- by incisional biopsy- and was a grey white color. External cervical os covered with grey and pink mucous membrane. Thickness of myometrium 1.2-1.6 cm. Uterine cavity was not enlarged, the mucous membrane was pink. Incisions through myometrium shows grey fibrous tissue. Right adnexa: Fallopian tube 6 cm long and 0.4 cm diameter with grey serosa and ovary 3 cm diameter, a cystic cavity 0.5cm diameter with clear fluid was viewed through incision. Left adnexa: fallopian tube 5.5 cm length and 0.5cm diameter with a number of miniscule cysts on the serosa. Ovary 3.2cm diamter, 1cm diameter cystic cavity was viewed with clear fluid.<O😛></O😛>
A-cervix (1/2)<O😛></O😛>
B-E uterine membranes (4/6)<O😛></O😛>
F-Myometrium (1/2)<O😛></O😛>
G+H sub serosal mass (2/4)<O😛></O😛>
I-Right adnexa (1/2)<O😛></O😛>
J-Left adnexa (1/3)<O😛></O😛>
<O😛></O😛>
Microscopic check/diagnosis<O😛></O😛>
SPECIMEN OF ADENEXOHYSERECTOMY SHOWING:<O😛></O😛>
Cervix-mild chronic inflammation, erosions and fresh hemorrhages<O😛></O😛>
Endometrium,partially autolytic, mostly inactive.<O😛></O😛>
Adenomyosis<O😛></O😛>
Subserosal leiomyoma, partially hyalinized(4cm in diameter)<O😛></O😛>
Right adnexa-without significant changes<O😛></O😛>
Left adnexa-ovary showing follicular cyst<O😛></O😛>
Fallopian tube, is unremarkable<O😛></O😛>
<O😛></O😛>
Many thanks
Libi<O😛></O😛>
