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55yr old postmenopausal F presents for routine exam.she denies any use of HRT,any menopausal sym.she has no H/o of any abnormal vag bleeding,no any abnormal pap smear .married to asame partner.currentlysexually active with same partner on regular basis .Her Pap came as AGUS--ATYPICAL GLANDULARCELL OF US .Most approp next step

re-pap in 4 to6 mon

HPV testing

hystere ctomy

cone biopsy

colposcopy,end biopsy,ECC


colposcipy end biopsy ECC


I think it A?????


yup ..i think its HPV dna testing...if that comes positive then depending upon reliability of the patients u can either schedule them for follow up re-pap smear within 4-6 mon or if they r nonreliable u should go ahead with colposcopy and biopsy.


the ans is 'E' for sure

explanations..if u get an AGUS on pap smear it means it could be benign OR malignent

to rule out the malignet lesion the first step is COLPOSCOPY with ECC until unless you find atypical endometrial cells plus abnormal bleeding in over 35 year old lady (in this case you prefer endometrial biopsy).

u can get more info from the web site.


after a pap smear comes back with these results next step is always



...the presence of glandular cells in a pap smears mandates to rule out two possible adenocarcinomas (squamous is 100% of excocervical):

1. Endocervical canal (ECC)
2. Endometrium (endo bx)

Colposcopy will help, but will likely not help in defining diagnosis.

Answer is completely E.


E would be my best shot too


there was an explanation in UW that said:

ASCUS - repeat Pap in 6 m
invasive cancer - hysterectomy +/- radiation

so I'd go for A. Even if colposcopy is generally the universal ans for abnormal Paps (still US doesn't necessarily mean abnormal), biopsy is only done if there are abnormal white areas observed during the colposcopy and not routinely


plus, FA says at obgyn rapid review:

do colposcopy + curretage only if two consecutive findings of AGCUS


colposcopy, end biopsy, ECC


Blueprints obs-gyn says....with the advent of HPV DNA testing,it is now recommended that wOmen with an ASC-US should be tested immediately for HPV.



# observation is only conditioned with pts compliance as to come after 3 ms for repeating pap

# If pt is unreliable or u simply don't know, the next step is Colposcopy & ECC


HPV testing

Edited by CKreflux on Dec 20, 2010 - 9:44 PM

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