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Dr. Pfeiffer
Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5986
Experience:  Ob/Gyn Doctor
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My mother (aged 68) did an MRI for the pelvis on Sunday. The

Resolved Question:

My mother (aged 68) did an MRI for the pelvis on Sunday. The reason was to investigate a left Adnexal Cyst that was discovered in the pelvis through a CT Scan that was done in October.

MRI result came that the cyst is simple and with the same size as it was in October.

However, the report conclusion says: thickened and enlarged cervix with disruption of zonal anatomy and widening of the endocervical canal which needs further evaluation with histopathology i.e. pap smear to exclude malignancy.

this is just the conclusion but there are more details in the body of the report. I wish that there is a way to attach the report so that the picture is complete.

My question is: we will do the pap smear but I just want to know the materiality of this observation, please note that my mother had only one birth (C-Section) and 1 miscarriage.
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. Pfeiffer replied 1 year ago.

Dr. Pfeiffer :

hello

Dr. Pfeiffer :

has you mother experienced any abnormal bleeding?

Dr. Pfeiffer :

when was her last pap test?

Dr. Pfeiffer :

has she ever had an abnormal pap test?

Customer:

hi

Customer:

no abnormal bleeding

Customer:

last pap test was like 20 years ago

Dr. Pfeiffer :

ok..

Customer:

i was pushing her to make one but she was resisting ...

Customer:

but we'll do it now

Dr. Pfeiffer :

to you knowledge did she every have an abnormal?

Customer:

no

Dr. Pfeiffer :

ok

Customer:

no abnormalities

Dr. Pfeiffer :

does the MRI note any fluid in the abdomen?

Dr. Pfeiffer :

any inflammation of lymph nodes in the pelvis?

Customer:

is there a way to attach the report to this chat ?

Customer:

i have it as an image file

Dr. Pfeiffer :

see if you can cut and paste

Dr. Pfeiffer :

I'm not sure how though

Customer:

Full Size Image

Customer:

i attached it

Dr. Pfeiffer :

got it...thanks

Dr. Pfeiffer :

so it shows some type of inflammation, but no definite mass

Customer:

so , what does this might indicate ?

Dr. Pfeiffer :

it also doesn't comment on other things such as fluid in the abdomen or inflammed lymph nodes...

Dr. Pfeiffer :

those are things we commonly see with cancer.

Dr. Pfeiffer :

so..you have to have cancer excluded, but these findings may be a polyp or fibroid

Dr. Pfeiffer :

I'm gonna read it one more time...

Customer:

ok ,,,,

Dr. Pfeiffer :

ok...

Dr. Pfeiffer :

so reading it again.

Dr. Pfeiffer :

it does mention the masses on the uterus to be consistent with fibroids.

Customer:

yes

Customer:

which is a benign thing ? right ?

Dr. Pfeiffer :

the 'cystic' lesion being called a simple cyst is a bit concerning for me in a 68 year old woman

Dr. Pfeiffer :

yes

Dr. Pfeiffer :

the dilation of the endocervical canal can still be from a polyp or fibroid..

Dr. Pfeiffer :

but it too may be caused by cervical cancer

Dr. Pfeiffer :

if you mother were my patient I would be a bit more aggressive than simply doing a pap test.

Customer:

ok , what would be the additional tests to do ?

Dr. Pfeiffer :

in my opinion...

Dr. Pfeiffer :

she needs a diagnostic laparoscopy with removal of the 'cystic lesion' and ovary....sent for frozen section to pathology to ensure it isn't a cancer.

Dr. Pfeiffer :

at the same time she needs a hysteroscopy with fractional D&C....and possibly biospy of the cervix for any suspicious looking lesions.

Dr. Pfeiffer :

that's how I would personally handle this with one of my patients so we knew exactly what all the abnormal findings actually suggest.

Dr. Pfeiffer :

until that examination is done I would not feel comfortable with simply a normal or abnormal pap test..

Dr. Pfeiffer :

the reality is, if the pap test comes back abnormal the above still needs to be done

Dr. Pfeiffer :

perhaps referral to a gyn/oncologist for a consult would be best.

Customer:

clear

Customer:

so the recommendation is go for additional tests as mentioned above

Customer:

and pap test is not sufficient

Dr. Pfeiffer :

absolutely

Customer:

this to be handled by OBGYN ?

Dr. Pfeiffer :

I don't think I (personally) would be reasurred by a pap test

Dr. Pfeiffer :

The basics I listed above can be done by an ob/gyn.

Dr. Pfeiffer :

The benefit of having an evaluation by a gyn/oncologist is....

Dr. Pfeiffer :

if the pathology evaluated during surgery happened to return as a cancer, the appropriate staging surgery can be done immediately.

Dr. Pfeiffer :

So, for example, if I were to do those procedures..it would be to determine if there are benign finding accounting for the MRI results.

Dr. Pfeiffer :

and, if it turned out to be cancer she would be referred to the gyn/oncologist for the staging/debulking procedures.

Customer:

ok , i get your point

Customer:

anything else i should know ?

Dr. Pfeiffer :

so her ob/gyn would be trying to determine not cancer vs cancer...

Dr. Pfeiffer :

and the gyn/oncologist would be debulking and staging a cancer...which could be done at the same time.

Dr. Pfeiffer :

I think a lot depends on her health and how well she would tolerate surgery.

Dr. Pfeiffer :

If she is in questionable health I would recommend the gyn/oncologist who are typically at larger medical institutions and have the surgical expertise and support staff to operate on those types of patients.

Dr. Pfeiffer :

If she is in really good health...discuss with her regular ob/gyn.

Customer:

if it were - God forbid - cancer , what stage would it be in ? i know it is difficult to tell

Dr. Pfeiffer :

we get that question all the time, but unfortunately these cancers need to be staged surgically.

Dr. Pfeiffer :

hopefully it isn't

Customer:

i pray so too

Customer:

thank you for the info dr.

Dr. Pfeiffer :

sure'

Dr. Pfeiffer :

you're welcome

Dr. Pfeiffer :

and I wish the best for your mother..(and you too)

Customer:

thank you

Dr. Pfeiffer :

please come back at some point and let me know what the results are...

Customer:

thanks , will sure do

Dr. Pfeiffer :

ok

Dr. Pfeiffer :

thanks

Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5986
Experience: Ob/Gyn Doctor
Dr. Pfeiffer and other OB GYN Specialists are ready to help you
Customer: replied 1 year ago.

Dear Dr. Pfeiffer


 


The Pap smear result came out (attached).


 


The Gyne/Oncologist recommended course of action is as follows:


 



  1. removal of both ovaries and the cyst with it to be sent to the lab for analysis.

  2. cone biopsy from the cervix also to be sent to the lab.


 


I would like to seek your opinion on the above, and ask the following: can the procedure done using regional anesthesia ? or full one is required ? my mother normally has low BP around 90/60 , and this is a cause of concern for me. I still did not discuss it with the anesthesia doctor as the operation is to be scheduled for the 28th but i need to have your opinion on that.


 


Thank you

Customer: replied 1 year ago.

A follow up on the question I asked few hours ago:


 


My mother did a CT Scan in October, MRI on 02/02 and Mammogram on 17/02 and now as part of pre-operative procedure she needs to do Chest X-Ray either tomorrow or Saturday, is all this exposure to Radiation safe ? will it induce any dormant cancer cells ?

Expert:  Dr. Pfeiffer replied 1 year ago.

Hello,

sorry for the delay.

So, the pap test is negative. However, it's nice to see that they aren't relying upon that to fully evaluate your mother.

Now, in my opinion, there doesn't seem to be much benefit in leaving the uterus. I'd remove the uterus, cervix and both ovaries. Send for frozen pathology and then perform a staging procedure if anything came back positive. Again, this is in line with what I see our gyn/oncologists do in the US.

The addition of a chest X-Ray is little more (if any) radiation exposure of that on a cross country airplane flight. So, I don't think it's something to be concerned about and is very normal to do in a woman her age.

These procedures are normally done under general anesthesia. They might be done under a spinal or epidural, but given the length of time some of these surgeries can take, most use general anesthesia.

Feel free to ask anything you thing needs to be clarified.

Dr. Pfeiffer

Customer: replied 1 year ago.

Hello Dr. Pfeiffer


 


As far as I know hysterectomy is a major surgery whose side effects are not yet fully known unlike Oophorectomy, which is why maybe the doctor wants to wait and see the result?


 


Another question, maybe I should discuss with the Doctor doing a D&C procedure? to get a tissue sample from the upper part of the uterus as opposed only a cone biopsy which to my limited understanding will be from the inner edge of the cervix.


 


 

Expert:  Dr. Pfeiffer replied 1 year ago.

that's an option.

the cone biopsy isn't very useful in my opinion because the pap test is normal.

my concern would be ovarian cancer, which can spread to the uterus usually from the outside.

Dr. Pfeiffer

Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5986
Experience: Ob/Gyn Doctor
Dr. Pfeiffer and other OB GYN Specialists are ready to help you
Customer: replied 1 year ago.

Wouldn't the ovarian cancer be checked by the removal of both ovaries and sending them to the lab? I mean while doing the surgery will it be clear if something is effecting the uterus from the outside ?


 


 

Expert:  Dr. Pfeiffer replied 1 year ago.

yes...

I know this isn't making a lot of sense..

but, if the diagnosis of ovarian cancer is made, the next step is to see if it spread.

To the uterus and other nearby structures.

There is always cancer cells we can see and others we cannot. So, simply looking won't make it clear.

Dr. Pfeiffer

Customer: replied 1 year ago.

Hello Dr. Pfeiffer ,,,


 


Attached is the Pathology Report of the Cone Biopsy and of the Bilateral Oophorectomy.


 


I would like to get your advice on the result and what's next.


 


Thank you.


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Expert:  Dr. Pfeiffer replied 1 year ago.

That's great news.

Cystadenomas are benign...so no cancer.

Removing the ovaries is all that needs to be done there.

Part of the cervical sample contained CIN1, which is a precancerous lesion usually due to HPV...a common virus.

Given they opted to leave the uterus she will need to have pap tests every 6 months until they are normal again. CIN1 carries only about a 1% chance of progressing to cancer...so you can see, it's not likely that it causes any big problems. Just needs to be followed up on.

It is also very likely they removed all the affected tissue with the cone biopsy, but it doesn't comment the margins of the specimen.

So, I would ask to clarify if the margins were negative - meaning, were the abnormal cells still continuing to be seen at the area where the sample was removed. If so, that means some abnormal cells are still there. If not, that means they were likely all removed.

So...good news on the ovary - not cancer.

And just a couple more visits to make sure the cervical dysplasia resolved.

Dr. Pfeiffer

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