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Clinical History: A 52-year-old
nulliparous, morbidly obese woman presents to her Gynecologist complaining of
vaginal spotting. She states that she began menstruating at age 11 and for at
least the past 5-6 years has had irregular periods. Her periods finally stopped
last year. She had seen another physician 5 years ago and was placed on estrogen
(Premarin), but not progesterone. The current gynecologist obtained an
endometrial biopsy.
Questions:
1.
Figure 1a
represents a section of the
endometrial biopsy. What is your diagnosis? How would you manage the patient?
What would you suggest?
The patient persisted in taking the drug despite the fact that she was
advised to discontinue it. She was lost to follow-up for approximately seven
years. When she returned to the gynecologist she gave a history of vaginal
spotting over a period of months which had become now become profuse. On
physical examination the uterus was enlarged.
2.
Figure 1b and
Figure 1c show tissue obtained by curetting during hospitalization. What is
your diagnosis? How would you manage the patient now?
3.
Figure 1d is a gross photograph of the
surgically removed uterus. How would you stage this disease? Is the prognosis
for this type of tumors that develop following estrogen replacement better than
that of spontaneously occurring tumors?
4. In Figure 1e and
Figure 1f: What type of endometrial carcinomas
are these? How do they behave?
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