BACKGROUND PATIENT is a 42-year-old female Asian having 4 children. 

Patient : BACKGROUND PATIENT is a 42-year-old female Asian having 4 children - the youngest of which is 14 years of age - with no history of health issues. In SEPTEMBER 2015, a routine PAP smear lead to a diagnosis of CIN II (from sample biopsy) with excision via LEEP recommended. In MAY 2016, the LEEP was performed and sample Cervix and Endocervix tissues were dent for biopsy. POST-LEEP BIOPSY REPORT Microinvasive Squamous Cell Carcinoma / Negative for Lymphatic and Vascular Invasion; Microscopic examination shows foci of malignant squamous cells outpouching from the surface epithelim and some invading the endocervical glands. Marked atypia of the lining epidermis is noted in several areas. Stromal invasion is approximately 2mm with horizontal spread of 7mm. Higher magnification shows malignant cells displaying loss of polarity, having eosinophilic cytoplams, coarse chromatin patter and prominent nucleoli. Mitotic figures are brisk. The GYN / Oncologist is recommending that a RADICAL HYSTORECTOMY be performed ASAP. LAYMAN’S QUESTIONS 1. How likely is it that a biopsy result of CIN II in September, subsequently results in a post-LEEP biopsy of Malignant Carcinoma just 8 months later? 2. If the LEEP removes the subject lesion PLUS some portion of the surrounding tissue, how does the post-op biopsy of the removed tissue correlate to carcinoma in tissue that was NOT removed? 3. If all of the information is correct, would a Radical Hysterectomy be the appropriate treatment? SPECIAL NOTE The patient and physicians are ALL Filipino living and working in a semi-rural area of the Southern Philippines. The Philippines does NOT have a reputation for competency at anything….including medical practices. The opportunity for error is considered significantly higher than the United States and other Western countries.
Symptoms:  See question
Doctor :   Hi, Thanks for the query at ATD. I have gone through your history and understand your concerns. 1)The chances of malignant transformation is quite less in 8 months after LEEP procedure. 2)LEEP procedure is usually performed to removed CIN 1 and 2 so malignant transformation rapidly is not possible. So in my opinion if your reports are correct of malignancy then most likely it is initially there rather it developed after 8 months. 3)If all your reports are normal radical hysterectomy is the best treatment for you at this stage. Have you done your hpv testing and what is the report. Hope found useful, feel free to ask more information. Good luck. Regards

Comments / Follow Ups

Patient: Response #1 : 8 months from PAP/biopsy until the LEEP.

BACKGROUND
PATIENT is a 42-year-old female Asian having 4 children - the youngest of which is 14 years of age - with no history of health
issues.
In SEPTEMBER 2015, a routine PAP smear lead to a diagnosis of CIN II (from sample biopsy) with excision via LEEP
recommended.
In MAY 2016, the LEEP was performed and sample Cervix and Endocervix tissues were dent for biopsy.
POST-LEEP BIOPSY REPORT
Microinvasive Squamous Cell Carcinoma / Negative for Lymphatic and Vascular Invasion;
Microscopic examination shows foci of malignant squamous cells outpouching from the surface
epithelim and some invading the endocervical glands. Marked atypia of the lining epidermis is noted in
several areas. Stromal invasion is approximately 2mm with horizontal spread of 7mm. Higher
magnification shows malignant cells displaying loss of polarity, having eosinophilic cytoplams, coarse
chromatin patter and prominent nucleoli. Mitotic figures are brisk.
The GYN / Oncologist is recommending that a RADICAL HYSTORECTOMY be performed ASAP.
LAYMAN’S QUESTIONS
1. How likely is it that a biopsy result of CIN II in September, subsequently results in a post-LEEP biopsy of Malignant Carcinoma
just 8 months later?
2. If the LEEP removes the subject lesion PLUS some portion of the surrounding tissue, how does the post-op biopsy of the
removed tissue correlate to carcinoma in tissue that was NOT removed?
3. If all of the information is correct, would a Radical Hysterectomy be the appropriate treatment?
SPECIAL NOTE
The patient and physicians are ALL Filipino living and working in a semi-rural area of the Southern Philippines. The Philippines
does NOT have a reputation for competency at anything….including medical practices. The opportunity for error is considered
significantly higher than the United States and other Western countries.
Michael Minieri
mminieri@yahoo.com
Doctor: Hi,

There are two possibilities -

1) It was diagnosed wrong means in September biopsy it maybe cancer not CIN.

2)Yes,it is a possibility that if you left CIN untreated than it may turn into invasive carcinoma in 8 months( because after CIN diagnosis you get LEEP procedure after 8 month).

So maybe initially it is CIN but after 8 months it turned invasive carcinoma.

Hope now it is helpful.
Good luck
Regards

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