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Had Red Post Coital Bleeding. Biopsy Showed Atypical Immature Squamous Metaplasia. Treatment?

Posted on Wed, 30 Jan 2013

Question: Can someone help my dilemma? I am 37 year old with 2 children 7 and 3. I was treated 14 years ago for CIN 2 14 years ago with LEEP. I have gone for annual paps since them and never missed. All subsequent paps were hpv neg and normal pap. In the past six months I had two episodes of bright red post coital bleeding. Went back to my ob gyn who noticed a small ectropion. He did another pap, swabs for infection, cultures, urine sample, EMB, ecc, and abdominal US. All negative. Most recently he did another ecc and colposcopy- results were ecc benign, two punch biopsies benign and one other punch biopsy says "Atypical immature squamous metaplasia" which stained p16 negative. I see this p16 negative is a good thing but what could be causing this bleeding and what would cause these immature cells to be atypical? I did have a complete thyroidectomy for papillary thyroid cancer last year and since they keep me very hyperthyroid. Wondering if this has anything to do with hormones now. Thank you for your time.

Answered by Dr. Minoo Bhagia (36 minutes later)

Hello

Welcome and thanks for the query

AIM or atypical immature metaplasia is difficult to differentiate from high grade lesions till p16 ( marker for human papilloma virus ) and CK17 ( marker for cervical reserve cells ) are done.It is good that your p16 is negative.AIM is a loose term indicating the full thickness basal cell proliferation of the uterine cervix but not significant till combined with the adjuvant tests mentioned above.
The contact bleeding can be due to hypertrophy and vasculitis of the cervix due to hyperthyroidism.
You require regular follow ups
Best wishes
Good luck
Any further query is most welcome

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minoo Bhagia (37 minutes later)

Wow! This was helpful. If you don't mind I have other questions.

Should the ck 17 have been done too or was the p 16 enough to rule out CIN 3?

I'm trying to understand I guess since there are multiple things going on here with me. an ectropion show up as atypical immature squamous cells? An what would cause this Atypical results then?

I never knew hyperthyroidism could do so much. My current TSH is 0.02

My doctor is wanting to do a LEEP to stop the bleeding. As you can tell I'm worried of them finding invasive cancer after the LEEP.

Answered by Dr. Minoo Bhagia (3 hours later)

Hello
Dear ,
Welcome once again,

AIM term can be revised as chronic cervicitis with immature metaplasia.HPV 58 is always seen in CIN 3 and HPV 35 in CIN1.An Expression of cytokeratin 17 and 8 is a useful marker for CIN 3.
LEEP is a very good OPD procedure for therapeutic as well as diagnostic purpose.The tissue can be taken for further biopsy so there is no harm getting it done.Slight spotting will occur for few weeks after the procedure.Do not forget to take good antibiotics.Repeat the ultrasound again to reconfirm the enometrial thickness as you are taking thyroxine which can cause hyperplasia of the endometrium and bleeding.
Best wishes once again
Take care

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar