D&C material - Large Biopsy 3-6 cm

Biopsy

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Tissue after curettage/evacuation.

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D&C Material - Large Biopsy 3-6 cm

Why is it done?
- Diagnostic evaluation of abnormal uterine bleeding, abnormal Pap smear results, or suspicion of endometrial pathology
- Detection and diagnosis of endometrial cancer, polyps, fibroids, or hyperplasia
- Investigation of postmenopausal bleeding or persistent abnormal vaginal bleeding
- Assessment of endometrial thickness or suspicious lesions identified on imaging studies
- Evaluation of infertility or recurrent pregnancy loss when endometrial pathology is suspected
- Performed under direct visualization during dilation and curettage (D&C) procedure, allowing collection of larger tissue samples for comprehensive histological analysis
Normal Range
- Normal Findings: Benign endometrial tissue consistent with normal menstrual cycle phase; simple endometrial polyp without atypia or malignancy; benign fibroids (leiomyoma) without concerning features; secretory or proliferative endometrium appropriate to cycle phase
- Abnormal Findings: Endometrial cancer (adenocarcinoma), endometrial hyperplasia (simple, complex, or atypical), malignant lesions, atypical endometrial cells, significant inflammation or infection, endometrial carcinoma in situ
- Specimen Size: Large biopsy specimens measuring 3-6 cm allow for comprehensive histological evaluation and accurate diagnosis; larger samples provide better representation of pathology compared to smaller biopsies
- Units: Histological diagnosis reported as tissue type and grade; grading systems (Nottingham score, FIGO grade) used for malignancies; specimen dimensions measured in centimeters
Interpretation
- Benign Findings: Indicate normal endometrial tissue or non-malignant pathology; endometrial polyps are common and typically benign unless showing atypical features; leiomyomas are benign smooth muscle tumors
- Simple Hyperplasia: Increased endometrial glands without atypia; relatively low risk of progression to malignancy (~1%); typically managed with progestin therapy
- Complex Hyperplasia: Complex endometrial glandular proliferation without cytologic atypia; increased risk of malignancy (~3%); requires close monitoring and treatment with progestin therapy
- Atypical Endometrial Hyperplasia (AEH): Precancerous condition with high risk of progression (~30-40%); requires aggressive treatment; may warrant hysterectomy in postmenopausal women; rigorous endometrial surveillance in younger women wanting fertility
- Endometrial Cancer: Malignant diagnosis requiring staging and comprehensive management; grade 1-3 classification indicates aggressiveness; histologic type (adenocarcinoma, serous, clear cell) determines prognosis and treatment approach
- Specimen Adequacy: Large 3-6 cm biopsies obtained during D&C provide superior diagnostic accuracy; larger specimens reduce sampling error and allow assessment of lesion extent; inadequate specimens may require repeat procedure
- Factors Affecting Results: Hormone replacement therapy, tamoxifen use, timing of biopsy in menstrual cycle, presence of inflammation or infection, specimen fixation and handling, pathologist expertise
Associated Organs
- Primary Organ System: Uterus (endometrium); female reproductive system
- Endometrial Cancer: Most common gynecologic malignancy; may metastasize to lymph nodes, pelvis, abdomen, lungs, and liver if advanced
- Associated Conditions: Endometrial polyps, uterine fibroids (leiomyomas), adenomyosis, endometrial hyperplasia, Asherman syndrome, chronic endometritis, endometrial infarction
- Risk Factors for Abnormal Results: Obesity, diabetes, hypertension, estrogen exposure (unopposed or prolonged), tamoxifen therapy, history of breast cancer, family history of endometrial or colorectal cancer, Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Potential Complications of Malignancy: Metastatic disease, hematologic spread, lymphatic involvement, peritoneal carcinomatosis, bowel or urinary tract obstruction from advanced tumors
Follow-up Tests
- For Benign Findings: Reassurance and routine gynecologic care; pelvic ultrasound if symptoms persist; repeat D&C only if abnormal bleeding recurs after intervention
- For Hyperplasia (Simple/Complex): Progestin therapy (oral, intrauterine device, or injected); transvaginal ultrasound in 3-6 months to assess endometrial response; repeat endometrial biopsy in 3-6 months if symptoms persist or if atypia present
- For Atypical Endometrial Hyperplasia: High-dose progestin therapy or hysterectomy (particularly in postmenopausal women); if preserving uterus, close endometrial surveillance every 3-6 months; consider repeat D&C to exclude occult malignancy; imaging (CT or MRI) if malignancy suspected
- For Endometrial Cancer: Tumor staging with CT chest/abdomen/pelvis or MRI pelvis; gynecologic oncology consultation; staging laparotomy or laparoscopy; possible chemotherapy, radiation, or hormone therapy depending on grade, stage, and histotype
- Immunohistochemistry (IHC): Mismatch repair (MMR) testing if Lynch syndrome suspected; estrogen and progesterone receptor status; HER2 analysis in serous or clear cell cancers
- Molecular Testing: DNA sequencing (POLE mutations, MMR gene mutations); microsatellite instability (MSI) testing; tumor molecular profiling in advanced or recurrent cases
- Complementary Imaging: Pelvic ultrasound; CT or MRI for staging; PET scan if metastatic disease suspected
Fasting Required?
- Fasting: NOT REQUIRED - This is a tissue biopsy procedure, not a blood test
- Anesthesia: If general anesthesia planned, fasting for 6-8 hours prior to procedure is required; typically NPO (nothing by mouth) after midnight if procedure scheduled for morning
- Medications to Avoid: Anticoagulants (warfarin, novel oral anticoagulants) should be held 3-5 days prior or as directed; aspirin and NSAIDs should be discontinued 3-7 days before procedure; discuss all medications with physician
- Pre-Procedure Preparation: Avoid sexual intercourse 48 hours prior; avoid douching or vaginal products 48 hours before; empty bladder and bowel before procedure; wear comfortable, easily removable clothing
- Scheduling: Procedure best performed during follicular phase (first half of menstrual cycle) to avoid disrupting potential pregnancy; schedule for non-menstrual days when possible to optimize visualization and comfort
- Post-Procedure: Light bleeding or cramping may occur; most patients resume normal diet and activities immediately; avoid tampons for 24 hours; avoid sexual intercourse for 3-5 days; contact physician if excessive bleeding, fever, or severe pain develops

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