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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 42848
Experience:  Experienced Oncology Physician trained in New York City. I'm ready to help.
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MRI OF PELVIS WITH ABDOMEN SCREENING Technique: T1 ,T2,T2FS

Customer Question

MRI OF PELVIS WITH ABDOMEN SCREENING Technique : T1 ,T2,T2FS & IR - Axial T1 & T2 - Coronal. T2 & IR - Sagittal OBSERVATIONS: Urinary bladder is partially distended, shows normal lumen and wall thickness. No focal lesions or calculi noted. Uterus is anteverted.
Uterus measures 7.3 cm in long axis. Intermediate T2 signal, polypoidal lesion noted projecting from the endometrial lining of the uterine fundus. Lesion is infiltrating into the outer half of uterine myometrium in the region of fundus. Lesion measures 3.4
x 2.2 x 2.5 cm. No extension beyond the margins of the uterus. Uterine cervix is normal. No obvious lesions in the vagina. No evidence of parametrial extension. No significant parametrial/pelvic lymphadenopathy. Tiny, intramural and subserous myoma in the
posterior wall of uterus measuring approximately 4-5 mm. Uterine cervix is normal. No evidence of ovarian or adnexal mass seen. No evidence of pelvic collections. The iliac vessels are normal. No pelvic lymphadenopathy or ascites. The pelvic bones, sacrum
and visualized portions of femur are normal. No evidence of any focal lesions noted. No signal alteration. SCREENING OF ABDOMEN: Liver shows normal size and shape. No focal lesions. No IHBR or CBD dilatation. The portal vein and branches are normal. IVC and
hepatic veins are normal. Gall bladder is well distended, shows normal lumen and wall thickness. Calculus noted in the GB measuring approximately 5 mm. The spleen and pancreas appears normal. No focal lesions. Right kidney is not visualised in the right renal
fossa. Signal voids noted in the renal fossa and abdominal wall. Post surgical changes noted in the right posterolateral abdominal wall. Left kidney is normal in size and signals. No focal lesions/hydronephrosis. No supra renal mass lesions. Aorta and IVC
are normal. No significant paraaortic lymph adenopathy. No ascites or focal collections. (Note: All lesions cannot be identified and characterized on limited screening study) IMPRESSION: known case of endometrial carcinoma, MRI shows Intermediate T2 signal,
polypoidal lesion projecting from the endometrial lining of the uterine fundus-consistent with endometrial carcinoma. Lesion is infiltrating into the outer half of uterine myometrium in the region of fundus. Lesion measures 3.4 x 2.2 x 2.5 cm. No extension
beyond the margins of the uterus. Uterine cervix is normal. No evidence of parametrial extension. No significant parametrial/pelvic/paraaortic lymph adenopathy. Tiny, intramural and subserous myoma in the posterior wall of uterus measuring approximately 4-5
mm. Cholelithiasis. Right kidney is not visualised in the right renal fossa. Signal voids noted in the renal fossa and abdominal wall-? Post surgical changes. (Correlate with CT to rule out calcification/calculi)
Submitted: 1 year ago.
Category: Oncology
Customer: replied 1 year ago.
I have been having vaginal bleeding for over a year now. I went to a doctor and a biopsy was done and they say I have a uterine adenocarcinoma. A follow up MRI was done (The report of which is mentioned in the first part of the question) Can someone go over these reports and give me an idea about treatment options? I would like to know what stage my cancer is in? I believe a hysterectomy is needed to be done but my current financial condition has left me without an insurance. I will hopefully have coverage from Jan 1st. Is it advisable to prolong it that long?Here are the details of the case: Age: 59 - Menopause ~ 10 years ago. About a year and a half ago started having a whitish discharge. This later on became dark brown with occasional bleeding. Around 6 months ago the bleeding was more frequent. During my vacation trip overseas 2 months ago I had to be admitted because of heavy bleeding. An UltraSound revealed a thickened endometrium (19mm) A Pap smear was done which was normal. The Dr. proceeded to do a D&C and a biopsy was done.
Biopsy Results:
Nature of Specimen: Endometrial Currettings
Microscopy: Section shows tubular and papillary glands lined by columnar cells with eosinophillic ctyoplasm and vesicular nucleus with anisonucleosis and pseudostratification. Some of the glands are focally replaced by squamous epithelium with minimal anisonucleosis and mucin secreting cells. Bit of squamous epithelium is also seen with endocervical tissue focally replaced by squamous epithelium.
Diagnosis: Atypical hyperplasia endometrium, possibly well differenctiated adenocarcinoma and endocervical polyp with squamous epithelium.
Following this the doctor ordered an MRI and got the report that is written in the initial question.
All these tests were conducted overseas. The doctors suggest I go in for an immediate hyseterectomy. I would be more comfortable doing the procedures in the US. At least some of these tests would need to be repeated Im thinking. This would mean that I am looking at a possible hysterectomy somewhere mid or end of January 2016. Is that safe for me?
Please let me know if any further information is required.
NB: 1)Just prior to my bleeding episode overseas, I had started getting a smelly yellowish discharge which was identified as an infection and treated successfully. I also had a viral fever episode last month following which I had a quick weight loss of about 10lbs
2) I also have a CD version of the MRI imaging if you would like to look at it.
Expert:  Dr. David replied 1 year ago.

This is Dr. David

you need to see a gyn oncologist to have a TAH/BSO total abdominal histerectomy and bilateral salpingo oophorectomy to remove your uterus and ovaries and fallopian tubes.

you should apply for emergency medicaid in your state.

because you have a cancer diagnosis, you are eligible.

some university hospitals will get you on the OR schedule if you have medicaid.

you need to talk to a social worker at a hospital or cancer center to work with you on getting insurance right away.

the MRI scan shows that the uterine cancer hasn't spread yet, but you still need surgery to remove lymph nodes in your pelvis to check for cancer spread outside of the lymph nodes

you may still need additional chemotherapy and or radiation therapy after the surgery depending on the findings of the surgery.

let me know if you have questions.

Customer: replied 12 months ago.
My apologies for not responding earlier. I was on my way back to the US and have been busy travelling. I have purchased insurance which goes active as of Jan 1st 2016. I spoke to a gynae-oncologist near my house and they have asked me to send them the MRI and Biopsy results. Do I have to worry about this being considered as a pre-existing condition? Can I be denied insurance for some reason?
Expert:  Dr. David replied 12 months ago.

This is Dr. David

Obama-care law which was passed said that insurance companies now can not deny you because of pre-existing conditions.

so you should be able to get insurance

I am glad you are going to see a gyn oncologist.

let me know if you have other questions.

if done for now, please leave positive rating above the chat box so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

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