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Dr. Andrew Rynne

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Had hysteroscopy. Having postmenopausal bleeding. What does scanty biopsy mean?

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Dr. Asra Ishtiaq Ahmed

OBGYN

Practicing since :2008

Answered : 689 Questions

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Posted on Thu, 20 Dec 2012 in Women's Health
Question: I have just had a hysteroscopy with endometrial biopsy after utransvaginal scan showed 4.33mm linning and 4cms mass in adenexal region, mri showed mass seemed smaller but still have postmenopausal bleeding. Paper work from d oc said visably linning seemed fine and scanty biopsy sent off what does scanty biopsy mean and how accurate is it?.
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Answered by Dr. Asra Ishtiaq Ahmed 17 minutes later
Hello there.

Thanks for writing.

Scanty biopsy refers to minimal tissue obtained on biopsy of uterine lining (endometrial tissue).
Biospy is the most accurate (98%) to know the cause of abnormal bleeding.

If your report shows no tissue could be studied due to scanty amount obtained then you can go for endometrial aspiration cytology which is less specific but useful when there is scant tissue or very thin lining.

The reason for your postmenopausal bleeding could be atrophy of genital tissues including the lining of uterus which becomes fragile due to lack of hormones after menopause. This can result in unexpected bleeding.

However it is always better to evaluate any postmenopausal bleeding with biopsy to rule out possibility of cancer.

The 4 cm mass in adenxal region in your case is a bit worrisome.
Any ovarian (adnexal) mass after menopause should be surgically removed and sent for histopathology (tissue study) to rule out cancer. This is because after menopause it is very rare for any adnexal mass to e\resolve on its own with subsequent cycles.

A blood test for CA125 levels may be useful in assessing the nature of the adnexal mass though it is not diagnostic.


I hope I have answered your query.

Kindly revert back if any doubts remain.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Asra Ishtiaq Ahmed 4 hours later
The CA125 test showed normal levels is it safe to leave mass insitu?, the doc seems to have lost interest in it. Also what treatment would help fragile linning of womb as I am unable to take pill etc as I have susceptibility to clots
doctor
Answered by Dr. Asra Ishtiaq Ahmed 2 hours later
Hello there.

Thanks for writing.

No it is not safe to leave any mass over 4 cm after menopause. Moreover you have postmenopausal bleeding which can also be related to this mass.
I also mentioned that CA125 is not diagnostic of cancer. So even if it is normal, it does not mean that your mass cannot be malignant. The definite treatment of the mass in your age is surgical removal followed by histopathology of the mass.
The other option is you follow up with repeat ultrasound to know if the mass is not increasing in size.


The second possibility of your bleeding which I kept as atrophy and thinned out uterine lining. You have history of clots so using any hormonal supplement is not safe as estrogen use with intact uterus requires protective progesterone to prevent hyperplasia. Progesterone is not safe with history of clots (deep vein thrombosis). Considering the above facts, it would be prudent to take a surgical opinion in this regard too.


Take care.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Asra Ishtiaq Ahmed 38 hours later
Thanks for the above info, one last question, if my symptoms were to be hyperplasia would this be visible to doctor during the hysteroscopy or only on the biopsy
doctor
Answered by Dr. Asra Ishtiaq Ahmed 13 hours later
Hello there.

Thanks for writing back.

Yes had there been hyperplasia of the lining it would have been visible on hysteroscopy as fluffy, thickened lining or endometrium. Also on biopsy scanty amount would not have been obtained.

However confirmation of hyperplasia or atrophic lining is done only after biopsy report. The visualization on hyysteroscopy is just preesumptive diagnosis.

Take care..
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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