DIAGNOSIS

• By flowershoplady
• Reply 2161
• March 10, 2008 at 9:03 pm
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hello, lilmiss. i'm sorry to hear you've been experiencing gyn problems for 4 years. it's frustrating and scary, but it sounds like you've been getting followed up, and that's a good thing to be sure things stay as much under control as possible. have you had biopsies and procedures such as leeps before now?

now it sounds like you've probably had an abnormal pap, and as a result, the doctor recommended a colposcopy and then took biopsies. i'll try to help decipher the pathology report you've got, and i would also encourage you to discuss this and any other reports with your medical team so that you always feel well informed. this pathology report is from biopsies taken, presumably during the colposcopy, and it's separate from the pap test results which are more like a 'screening' and indicate whether further testing is needed.

ok, so the part A represents the first biopsy which was an ECC (endocervical curettage) which refers to the way the biopsy was taken, using an instrument that scrapes off a portion of the cervix for testing and one portion showed CIN2/3. the CIN ('cervical intraepithelial neoplasia) is also called dysplasia and is abnormal tissue and the number which can vary from 1 to 3 indicates how much/how deep the abnormal tissue is in the cervix lining. part B is another biopsy that was taken at a position of 3 o'clock when the doctor is looking at the cervix as if a clock, and that is showing CIN1. i'm guessing that 'rem 02-09/2008' means that the biopsies were removed on february 9, 2008. and the icd and cpt codes are diagnostic codes that the insurance companies so that they can just have a code rather than all the pathology report words.

your gynecologist is sending you to a gynecologic oncologist because he feels like your situation is beyond his expertise. it's always a good thing to be seeing the specialist who sees this all the time, rather than your gyn who handles all sorts of varied situations and doesn't specialize on gyn cancers/dysplasia.

i hope this info is helpful. i'm not a doctor but can certainly be here to help you better understand what's happening. i would encourage you to take paper and pen with you so you can write down what the doctor says. and, maybe if you've got someone you trust to go with you, it would be helpful to have that person go with you to see the doctor. you may want to have a list of questions. those questions might include what treatment he/she recommends and its side effects, why he's recommending that particular treatment option and whether there were other options considered, the impact of the treatment on future pregnancies, how he will monitor you after treatment. and, you'll want to discuss what treatments you've had in the last 4 years, if any. other questions might include if they've been testing you for hpv each time you've been to the doctor, and what the test results have been.

if you've got more questions prior to you doctor's visit, please let me know. i'll be thinking of you!

• By corellin
• Reply 2162 · In reply to 2161 by flowershoplady
• March 10, 2008 at 10:28 pm
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Hi lilmiss -- I looked up the ICD-9 diagnosis codes and 622.12 means CINI (mild dysplasia) and 622.11 means CINII (moderate dysplasia). 883051 (site 1) & 883052 (site 2) are procedure codes which tell what the pathologist did and they mean that he (or she) looked at two different samples.

flowershoplady -- do you think that maybe the CINII/CINIII was just from the pap or ECC and couldn't tell the depth of the lesion until the pathologist report came back CINI/CINII? Do they do a biopsy with ECC, or is that just like a pap from inside the cervix? I do know it sure hurts!

lilmiss -- you'll need to confirm with your physician what these mean, but I wouldn't worry too much about being referred to an oncologist. It's good to work with an expert on dysplasia.

I'm curious what you mean you've been dealing with this for four years. Have you had prior lesions and this is a recurrence? Were you treated in the past?

It's also hard to know whether something is a recurrence or a new infection. I had a few abnormal paps in my early 30's and then CINI/CINII last year. I've always wondered if this was a recurrence of something I had earlier or a new infection.

I read a research study that showed women can start with one HPV infection, and after 6 months have an entirely different strain. Yikes!! If this is a recurrence, it's a little more concerning than a new infection. A recurrence means something is really hanging on, but a new infection means that your body may not have had time to try to clear the lesions. Often CINI clears on its own though CINII is usually treated.

I'm also wondering if the doctors have given you any tips on improving the health of your cervical/vaginal area -- such as clearing up infections down there, improving diet, etc. The women on this website have done a lot of research and have good ideas on that.

I wish you all the best!

• By flowershoplady
• Reply 2163 · In reply to 2162 by corellin
• March 10, 2008 at 10:38 pm
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hi, corellin....i'm not sure if i understand your question...sorry....here's my understanding of an ecc....an ecc results in a sampling of tissue that is reviewed by the pathologist. it's a scraping to get the tissue sample. does that make sense?

• By corellin
• Reply 2164 · In reply to 2163 by flowershoplady
• March 11, 2008 at 1:07 am
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I know with a pap smear, you can get a diagnosis of low grade or high grade, but they can't tell whether high grade is CINII or CINIII (moderate or severe). A biopsy can be more specific and tell you whether the high grade dysplasia is moderate (CINII) or severe (CINIII).

I was wondering if an ECC is more like a pap smear, where it can tell you low or high grade, but also can't give you the specificity of whether high grade is moderate or severe. Maybe the only way they can truly biopsy up inside the cervix is with a cone. Just wondering. I don't really know.

It sounded to me that the endocervical fragments (from an ECC) were negative (normal), but that squamous cells of CINII or CINIII were found - probably from the outside of the cervix (via the pap smear). Those were probably the lesions that were later identified through colposcopy and biopsy as CINI & CINII. If there's no CINIII, then that's really great, and I wonder why lilmiss would be referred to an oncologist. Maybe just because of having a prior history of dysplasia?

(sorry lilmiss -- we non-doctors are consulting on your case....) :)

• By corellin
• Reply 2165 · In reply to 2164 by corellin
• March 11, 2008 at 1:43 am
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PS -- I re-read lilmiss's original post and I see that Part A is just cells from the endocervix (probably ECC) and Part B is the cells from the cervix. I was confused because I didn't think the endocervix had squamous cells, but I guess it must.

lilmiss -- please let us know what the oncologist says. This will be a great opportunity for you to find out a lot of good information from an expert. Can you please ask him where the "squamous" cells came from in the Part A diagnosis?

I think it's great that you were actually able to obtain the pathology results. I've never actually looked at any of my pathology reports, and I know I should really get my chart and read through it (probably pretty fat by now). Good luck and please don't worry!

• By flowershoplady
• Reply 2166 · In reply to 2164 by corellin
• March 11, 2008 at 9:55 am
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my understanding is that the ecc results are viewed the same way as a cervical biopsy, and just the manner in which the tissue sample is obtained is different. they both are read by the pathologist and get specific diagnostic results. (that's this non-doctor's understanding! i never had an ecc, so it's from my reading. :) )

• By lilmiss
• Reply 2167 · In reply to 2161 by flowershoplady
• March 11, 2008 at 9:11 pm
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I thank you so very much for your response. I have two surgeries already and like three or four copo's. I am almost certain that my cervix basically does not exist. At least not strong enough to carry children. I have always wanted children but now that i am 25 gone thru all this crazziness not sure that I could handle this if she was to ever go thru this. Okay sorry about the ramble anyways movin on

Like i said I have been dealing with this for a very long time and I am thinkin he is sending me to this doctor cause he is prepairing me to find out that i have finally gotten the cancer fully.

my doctor is a specialist by the way.

thanks again
god bless you
lilmiss

• By flowershoplady
• Reply 2168 · In reply to 2167 by lilmiss
• March 11, 2008 at 9:38 pm
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hello, lilmiss. i'm sorry to hear that you think you're being sent to the gyn/oncologist because your original doctor thinks you have cancer. the test results you shared don't indicate cancer, and i certainly hope that they don't discover anything other than the dysplasia. i've been under the care of a gyn/oncologist because of recurring dysplasia. when a woman has dysplasia just once, then it's in the gynecologist's normal scope, but recurring or not going away is when the gyn/oncologists step in.

you are already seeing a specialist? what is his specialty?

i know it doesn't make it any better....but maybe it will help to know you're not alone in dealing with dysplasia and cervical/vaginal surgeries and treatments over a long period of time. unfortunately, there are some of us who have this as a chronic issue.

wishing you the best with your next appointment. i hope you were able to get answers to your questions. take care....and let us know how you're doing.