Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Obstetrics & Gynecology


Answer 4
  1. Colposcopy with endocervical assessment and endometrial biopsy. A review of 1869 patients with AGC of undetermined significance found that 33.7% of these patients had a squamous intraepithelial lesion of the cervix, 2.5% had adenocarcinoma in situ, and 1% had invasive adenocarcinoma.9 Thus, an evaluation of the entire cervix is indicated, including a colposcopic examination with cervical biopsy and endocervical assessment. Women over age 35 years with chronic anovulation and irregular bleeding are at risk for developing endometrial hyperplasia, the precursor for endometrial cancer. Therefore, endometrial sampling is indicated in all women over age 35 years with AGC of undetermined significance as well as in women younger than age 35 years with abnormal bleeding, morbid obesity, oligomenorrhea, or a clinical evaluation suggesting endometrial cancer.10 If these evaluations do not provide a definitive diagnosis, careful examination of the uterine cavity and upper genital tract (eg, ovaries, tubes) is warranted. Cryotherapy is an option for management of cervical dysplasia without endocervical involvement and thus would not be indicated in this case. Pelvic ultrasound helps to assess the endometrial thickness, structural abnormalities of the uterus, and adnexal structures but does not replace histologic evaluation. Diagnosis should be confirmed before hysterectomy is considered.

    REFERENCES
    9. Eddy GL, Strumpf KB, Wojtowycz MA, et al. Biopsy findings in five hundred thirty-one patients with atypical glandular cells of uncertain significance as defined by the Bethesda system. Am J Obstet Gynecol 1997;177:1188–95.

    10. Chhieng DC, Elgert P, Cohen JM, Cangiarella JF. Clinical significance of atypical glandular cells of undetermined significance in postmenopausal women. Cancer 2001;93:1–7.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 10/24/08 • nvf