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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Tested Positive For HPV. Had A Leep And Cone Procedure. Biopsy Showing Dysplasia. Hysterectomy Advised. Need Advice

Hi I am a 52 year old woman who has tested positive for hpv18 for the last 5 years, having paps every six months Now my last three paps have shown abnormal cells. I have had a leep procedure and a cone procedure before. I been having bleeding after intercourse lately so I went and had a colposcopy done. The biopsy that was done has come back now with moderate dysplasia. My doctor now wants to do a hysterectomy but not until I have another cone biopsy done. With having HPV 18 and dysplasia what type of hysterectomy is preformed and why do the cone biopsy first?
Thank you for your time,
Rickee
Sat, 15 Jun 2013
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Critical Care Specialist 's  Response
Hi thanks for your question.
Since your cervical biopsy report shows moderate dysplasia. This is indication for cone biopsy .In cone biopsy the cervix is stained with lugol iodine, dysplastic cervix takes up the colour and biopsy is taken from abnormally stained portion. In cone biopsy entire squamocolumnar junction of cervix, generally agreed to be site of origin of squamous cell carcinoma of cervix is removed. Cone biopsy helps gynecologist to rule out the presence of invasive carcinoma and determine the grade and distribution of the intraepithelial lesion. Currently only HGIL (high grade intraepithelial lesion) is considered premalignant and requires aggressive treatment. Toptal hystrectomy of is procedure choice for dysplasia. In total hysterectomy uterus along with cervix is removed ,ovaries and tubes are left there if they are healthy. If on cone biopsy changes are more aggressive, panhystrectomy may be done, in which cervix, uterus, tubes, ovaries, pelivic lymph nodes and pelvic tissue is removed.
Hope this answers your question.
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Tested Positive For HPV. Had A Leep And Cone Procedure. Biopsy Showing Dysplasia. Hysterectomy Advised. Need Advice

Hi thanks for your question. Since your cervical biopsy report shows moderate dysplasia. This is indication for cone biopsy .In cone biopsy the cervix is stained with lugol iodine, dysplastic cervix takes up the colour and biopsy is taken from abnormally stained portion. In cone biopsy entire squamocolumnar junction of cervix, generally agreed to be site of origin of squamous cell carcinoma of cervix is removed. Cone biopsy helps gynecologist to rule out the presence of invasive carcinoma and determine the grade and distribution of the intraepithelial lesion. Currently only HGIL (high grade intraepithelial lesion) is considered premalignant and requires aggressive treatment. Toptal hystrectomy of is procedure choice for dysplasia. In total hysterectomy uterus along with cervix is removed ,ovaries and tubes are left there if they are healthy. If on cone biopsy changes are more aggressive, panhystrectomy may be done, in which cervix, uterus, tubes, ovaries, pelivic lymph nodes and pelvic tissue is removed. Hope this answers your question.