Drs, Renuka, Malini, Sandeep, Kishore, Gangane and others

[Guest guest]

Thanks so much to respond so quickly.

Ok the patient is me.

Pathologist here in St 's NL Canada, took a second opinion from senior

most and very learned Consultant Pathologist in another province because

here they could not reach a consensus in intradepartmental meeting on the

diagnosis. I am giving the report exactly in their wordings. The first part

is from first pathologist and second from second pathologist.

*

First pathologist:*

Diagnosis: Atypical Mucinous Proliferation; Low grade adenocarcinoma cannot

be ruled out. Definitive diagnosis will require the examination of

hysterectomy specimen.

" Sections show microglandular and papillary mucinous proliferation, areas of

eosinophilic metaplasia and cytologic atypia. Acute inflammatory cells are

noted. The close differential diagnosis with this morphology is

microglandular hyperplasia of cervix, which is relatively an uncommon cause

of postmenopausal bleeding. IHC was performed. These cells are positive for

vimentin and Ki 67 shows mild to moderate proliferative activity; which

support a proliferative endometrial lesion. This case was discussed

intradepartmentally and there was no consensus opinion. It was worrisome to

me and I conveyed the message to the clinician. Therefore I sent this case

out for a consult opinion. "

*

Second Pathologist:*

" Final Diagnosis: Endometrial biopsy showing atypical mucinous proliferation

of the endometrium; low grade adenocarcinoma of the endometrium cannot be

ruled out.

Comment: This biopsy shows a mucinous proliferation of the endometrium with

cytological atypia. The mitotic rate is relatively low, although there is

Ki67 positivity, as you have noted. The differential diagnosis does include

microglandular hyperplasia of the cervix, however, your immunostains support

this being an endometrial lesion. We continue to struggle with biopsy and

curetting specimens. The cytological and architectureal features that we use

to distinguish between atypical hyperplasia and low grade adenocarcinoma of

endometriod type do not work for mucinous lesions. Accordingly, I routinely

diagnose them as atypical/ cannot exclude carcinoma a diagnosis equivalent

to what I would use for complex atypical hyperplasia of endometrium with

severe atypia that borders on outright carcinoma. Definitie diagnosis will

ultimately require examination of the hysterectomy specimen. Thank-you for

allowing me to review this interesting case. "

Meanwhile, I have decided to under TAH with BSO instead of D & C and

hysteroscopy, and have given them consent to decide about the Lymph nodes

depending upon what they find at the time of operation.

Thanks everyone who responded.

Parvin Ansari '71