A 42-year-old woman comes to the office for a routine health examination. She is sexually active with a male partner and underwent a tubal ligation for contraception. The patient has had no abnormal bleeding or recent changes in weight. Menses are regular and last 3-5 days; her last menstrual period was 3 weeks ago. Ten years ago, the patient had genital warts successfully treated by laser ablation. Pap tests have been normal to date. She has had no other serious medical illness or surgeries and takes no medications. She has a family history of hypertension but no history of cancer. Pelvic examination shows a normal cervix without any visible lesions, a small anteverted uterus, and no adnexal masses. The Pap test shows atypical glandular cells. Which of the following is the next best step in management of this patient?

Question

A 42-year-old woman comes to the office for a routine health examination.  She is sexually active with a male partner and underwent a tubal ligation for contraception.  The patient has had no abnormal bleeding or recent changes in weight.  Menses are regular and last 3-5 days; her last menstrual period was 3 weeks ago.  Ten years ago, the patient had genital warts successfully treated by laser ablation.  Pap tests have been normal to date.  She has had no other serious medical illness or surgeries and takes no medications.  She has a family history of hypertension but no history of cancer.  Pelvic examination shows a normal cervix without any visible lesions, a small anteverted uterus, and no adnexal masses.  The Pap test shows atypical glandular cells.  Which of the following is the next best step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d9ad_b6aa_bc81_5303f0df840a_MD0003_00 Atypical glandular cells (AGC) on Pap testing may be due to either cervical or endometrial adenocarcinoma. All women age >35 with AGC or women age <35 with AGC and risk factors (eg, obesity, anovulation) require evaluation for endometrial cancer in addition to cervical pathology. Therefore, AGC on Pap testing is investigated with colposcopy, endocervical curettage, and endometrial biopsy to evaluate the ectocervix, endocervix, and endometrium. As a result, a return to routine Pap screening is not indicated (Choice E). > colposcopy (Choice B) Hysterectomy is a treatment option for endometrial or early cervical adenocarcinoma; it is not performed for diagnosis. (Choice C) Hysteroscopy is a procedure that evaluates and treats endometrial or myometrial pathology (eg, endometrial polyps, submucosal leiomyoma). It is more invasive than an endometrial biopsy and is not a first-line choice for evaluation of the endometrium. (Choice D) Loop electrosurgical excision procedure (LEEP) is a type of cone biopsy that removes the cervical transformation zone. A LEEP does not evaluate the endometrium and is not used in the diagnosis of AGC on Pap test. Loop electrosurgical excision procedure (LEEP) (Choice F) Serum CA-125 is used to determine the likelihood of epithelial ovarian cancer in patients with an adnexal mass with malignant features. Ovarian cancer is not typically detected on Pap testing and is unlikely in a patient without a family history or examination findings suggestive of ovarian malignancy (eg, ascites, adnexal mass). Educational objective: Atypical glandular cells (AGC) on a Pap test may be due to either cervical or endometrial adenocarcinoma. Evaluation of AGC requires colposcopy, endocervical curettage, and endometrial biopsy. References: Biology and treatment of cervical adenocarcinoma. (http://www.ncbi.nlm.nih.gov/pubmed/27198186)

A 42-Year-Old Woman Comes to the Office for a Routine