A 26-year-old nulligravid woman comes to the office to discuss treatment of cervical intraepithelial neoplasia 3, which was revealed on a Pap test 4 weeks ago and confirmed by colposcopic biopsies. The patient has one dose remaining of catch-up human papillomavirus vaccination. She has smoked a pack of cigarettes daily for 10 years and does not use alcohol or illicit drugs. The patient recently married and is planning to have children in the next few years. She currently receives progesterone injections for contraception and takes no other medications. Her father is currently undergoing chemotherapy for pancreatic cancer. Risks and benefits of treatment options are discussed. Which of the following is the most likely complication of treatment for this patient?

Question

A 26-year-old nulligravid woman comes to the office to discuss treatment of cervical intraepithelial neoplasia 3, which was revealed on a Pap test 4 weeks ago and confirmed by colposcopic biopsies.  The patient has one dose remaining of catch-up human papillomavirus vaccination.  She has smoked a pack of cigarettes daily for 10 years and does not use alcohol or illicit drugs.  The patient recently married and is planning to have children in the next few years.  She currently receives progesterone injections for contraception and takes no other medications.  Her father is currently undergoing chemotherapy for pancreatic cancer.  Risks and benefits of treatment options are discussed.  Which of the following is the most likely complication of treatment for this patient?

Quizplus · Accepted Answer

11ec25c8_d9ad_4179_bc81_4b70721dc157_MD0003_00 Human papillomavirus infection and tobacco use are important risk factors for cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). Colposcopy is the gold standard method of diagnosing CIN. CIN 3 is a premalignant cervical lesion at high risk of progressing to SCC, and cervical conization, excision of the intact transformation zone, is the recommended treatment. Cervical conization may be performed with a scalpel (cold knife conization) or via electrocautery, also known as a loop electrosurgical excision procedure (LEEP). Colposcopy (cold knife conization) (LEEP) Cervical stenosis, an abnormal stricture of the cervical canal, is a potential complication of cervical conization due to scar tissue. Cervical stenosis may impede menstrual flow and cause secondary dysmenorrhea or amenorrhea. The obstruction of the cervical outlet may prevent sperm entry, resulting in impaired fertility. Cervical conization carries additional risks, including cervical incompetence and preterm delivery due to weakened cervical stroma. These risks are related directly to the amount of cervical tissue removed. (Choice A) Asherman syndrome refers to the formation of intrauterine adhesions from infection (eg, severe endometritis) or intrauterine surgical interventions (eg, dilation and curettage, endometrial ablation, endometrial resection). It is not a complication of cervical conization as the procedure does not involve the endometrium. (Choice C) Cervical surgery is not associated with sexual dysfunction. However, episiotomy and/or obstetric vaginal lacerations may result in temporary entry dyspareunia. (Choice D) Thromboembolism may result from immobility from major surgical interventions. However, brief ambulatory procedures, such as cervical conization, do not limit mobility. (Choice E) Urinary tract injury (eg, ureteral ligation/transection, cystotomy) may result from pelvic (hysterectomy) or vaginal surgery but not a LEEP. (Choice F) Urogenital fistula may result from obstetric trauma, urogenital malignancy, pelvic irradiation, or pelvic surgery (eg, hysterectomy), not from local cervical procedures. Urogenital fistula Educational objective: Cervical conization is used to treat high-grade cervical intraepithelial neoplasia. Potential complications include cervical stenosis, cervical incompetence, and preterm delivery. References: Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. (http://www.ncbi.nlm.nih.gov/pubmed/26643302) LEEP verses cryotherapy in CIN. (http://www.ncbi.nlm.nih.gov/pubmed/22851827)

A 26-Year-Old Nulligravid Woman Comes to the Office to Discuss