clinical pathological conference - hksccp
TRANSCRIPT
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The Hong Kong Society for Colposcopy
and Cervical Pathology
& The NTEC
Clinical Pathological
Conference
Dr. May Yu/Dr. S.F. Yim
Senior Medical Officer
Department of Obstetrics & Gynaecology
Prince of Wales Hospital
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• Coming meetings 2008:
• Refresher Course for Accredited Colposcopists in May at FPA
• Colposcopy Workshop in July at KWH
• Refresher Course for Accredited Colposcopists in September at QEH
• BGM in November/December
• http://www.hksccp.org.hk
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Case 1
• F/43
• Hx of repeated episodes of vulval & oral ulcers for 2 years, unknown diagnosis and resolved spontaneously
• Vaginal & tongue ulcers 2 months prior to presentation.
• Tongue ulcers healed, vaginal ulcers persisted
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Investigation results
• Microbiological cultures: E. Coli
• Viral cultures: negative
• Gonococcus : negative
• Chlamydia : negative
• HIV : negative
• VDRL: non-reactive
• Biopsy
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Behcet’s disease
• Clinical triad of relapsing ulcers (genital &
oral) & iritis, named after Behcet in 1937.
• Manifestation includes ulcers (genital &
oral), skin lesions, iritis, arthritis,
spondylitis, systematic vasculitis involving
pulmonary, heart and even cerebral regions.
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Epidemiology
• Prevalence related to geographic & ethnics regions
• 13-17 per 100,000 in Japan, Korea, China
• 0.5-3 per 100,000 in Europe
• Up to 300 per 100,000 in Turkey
• ? Problem of reporting as difficult recognition & diagnosis
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International study group criteria
• Recurrent oral ulcers at least 3 times in a 12 months’ period
• Plus 2 of:
• Recurrence genital ulcers
• Eye lesions
• Skin lesions
• Positive pathergy test (excessive skin response to trauma)
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Diagnosis
• International criteria
• Autoimmune markers usually negative
• Diagnosis on clinical ground
• No specific tests available
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Management
• No cure
• Treatment focuses on symptoms and
prevention of serious complications such as
blindness, stroke.
• Steriods for immunosuppression may used
to reduce inflammation
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Behcet’s disease
• Multisystemic inflammatory disease
• Postulated theories:
• Endothelium being the primary target of the
disease
• Related to the bizarre behaviour of the
immune system
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Case 2
• F/49
• CIN III, LEEP 8/07
• TAH 8/07 Path: CIN III, VAIN III margins
involved
• Scheduled assessment 4 months after surgery:
plaque at right vaginal angle, Biopsy: VAIN II
• referred PWH for further management.
• Seen 4 weeks after biopsy
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Management
• Radical vaginectomy, BSO pelvic
lymphadenectomy
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Case 3
• F/59
• Known ca corpus stage IBG3
• TAHBSO pelvic & para-aortic
lymphadenectomy 5/07
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Case 3
• Path: endometrioid adenoca G3
• Myometrial invasion 2/8 mm
• No evidence of LVSI
• Lower segment & endocervical canal not
involved
• Negative pelvic LNs (total 46)
• Negative para-aortic LNs (total 29)
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Case 3
• Decided not for adjuvant radiotherapy.
• Developed vaginal bleeding 8 months after
operation
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Management
• For interstitial brachytherapy
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Thank you