severe dysplasia without lesions?

Hi! I went to see a gyn/onc to give me a advice on whether i should get a hysterectomy of cervix and uterus yesterday. I wrote in another thread that I had CIN III in 98 followed by a LEEP and CINIII in May of this year followed by another LEEP. The gyn/onc said she believe a hysterectomy was not necessary and is not sure why the obgyn perfomed a LEEP. I had CIN III in the biopsy but the colposcopy showed no lesions. I thought severe dysplasia meant lesions of the cervix. I still feel unsure about having had severe dysplasia but I guess I feel much better knowing there were no lesions. She said that is a very good thing to have zero lesions. But she is going to have the original biopsy read later this month to be on the safe side. So I am just wondering has anyone else ever had severe dysplasia with no lesions?

Ranzo31: I don't know if this exactly answers your question, but here is what I know. During my colposcopy, I was told I had mild to moderate dysplasia and a LEEP was performed. My Dr. actually told me at the time that it did not look that bad so the LEEP should take care of the problem. Well, the pathology report came back and I had invasive cervical cancer stage 1a2. I asked my gyn/onc how that could be. He explained that sometimes the lesions start further up in the cervix and grow from there. He said it was rare, but he has seen it happen. He assumes that is what happened to me. The lesion started higher up and grew in both directions so that by the time it showed up in a pap and on the colposcopy it had already progressed into invasive cancer.

I hope this is not the case for you and the LEEP will be your last step. If you are unsure, get another opinion from another gyn/onc. This is your body and you should do what is right for you. I wish you the best and send your way!!!!

Thank you for the information. Quick question: when you say the pathology report, are you talking about your post LEEP report? My post-Leep pathology report was clean with clear margins so I am hoping everything is fine. So I wasn't sure did you find out you had cancer from the LEEP pathology report?

Yes, the LEEP pathology was the one that showed the cancer. If your LEEP pathology showed clear with clear margins, I would be hesitant to have the hysterectomy. Remember that a hysterectomy is a major surgery and that if you do not have to subject your body to it then I wouldn't. Just my opinion of course and you need to do what is best for you. Ask a lot of questions and come here as often as you need. The women on this site are wonderful and I don't know how I would have mae it through without them.

Hi, Ranzo 31. I am no expert on this (had a bad pap in March, bad colposcopy in April and bad LEEP in May).....CIN3/CIS and my doctor said 'hysterectomy.' The pathology report for me was the paper my doc handed me after I got my LEEP results. He said the 'good news' was the surface cut was 'benign' and the good news further was that the 'deep cut' showed no malignancy but the 'bad news' was that my margins weren't clear. And when I looked more closely at the paper I got, it said 'operative findings would show the true margins' (more or less)... and I thought what are 'operative findings'? I called my sister, who has a ton of medical experience, and asked if that meant 'operation' as in 'hysterectomy' and she said, 'yep.' I hunted for a lot of info/answers as fast as I could and decided to go w/the hysterectomy. For me I'm 55 and no more kids, so it made sense. I am anxiously awaiting my 7/25 appointment to see how the biopsy of everything taken out during my TVH goes........... maybe none of this info will help but I, too, send you a hug and encouragement to seek as many opinions as it takes to help you understand your situation, your options, and to help you make a decision. If your report says 'clear margins' and makes no mention of 'operative findings' that to me is a good sign. Keep asking questions, though!! E.

Dear Elefante64, Thankyou and I hope your appointment on the 25th brings you lots of good news! I agree with you about the "clear margins" being a good sign and the fact that it was CINIII but no lesions is also a good sign. Much luck to you!

Thankyou Scared03 for responding so quickly! I am very relieved about the clear margins part and I do appreciate this site and for the information I have gained. Searching the Internet can be confusing and sometimes scary with some of the information out there. But I am realizing that dysplasia is no so uncommon. In fact, I finally told a friend of mine about the dysplasia (only my husband knows) and she told me she had a LEEP ten years ago. While that is not good for her, I actually felt relieved that I wasn't the only one out there. While I am done having kids (I have two beautiful ones), I am leaning more against a hysterectomy at this point in my life. We have so much going on right now and I think I jumped the gun on that one. But I jumped the gun out of fear and anxiety. I also fear about the scar tissue from two LEEPS making pap smears less reliable. But I do understand that a hysterectomy is a big decision and one that I hopefully don't need now or ever. Thanks again!
LOL to you and I will be praying for you.

(((Ranzo)))

I'm a little confused reading your post so I hope you don't mind if I ask for some clarification.

First, a lesion is just an area of abnormal tissue. So if you have dysplasia, you have a lesion or lesions because dysplasia is also an area of abnormal tissue.

OK, so in 1998 you had an abnormal PAP, an abnormal coloposcopy/biopsy and then a LEEP. Is that correct? Then in May, I assume you had an abnormal PAP which led to additional testing.

	Quote:
I had CIN III in the biopsy but the colposcopy showed no lesions.

That's the part I'd like clarified, please. Are you saying that on visual exam there were no lesions, but that the biopsy that was taken at that time showed CIN III? The way you've described it, it almost sounds like this occurred at two separate times. The colposcopy is only able to visualize the exterior of the surface. Depending on what's seen on the exterior, the doc may biopsy the outside of the cervix, or may biopsy the inside of the cervix (or both), but there isn't much visibility for the interior of the cervix. So, was it the biopsy taken at that time that showed CIN III, or was that the report from your PAP?

It can be really difficult to figure out what to do sometimes. I had several treatments over several years (I did have 10 years of normal PAP's mixed in there early on), but I did eventually end up having a TAH. The scarring that formed as a result of the procedures just made it extremely difficulty to get any accurate PAP readings. But my gyn and my gyn/onc were both in agreement that that was what was in my best interest. Clearly, you are still working through the process.

Good luck with your decision making!

hi Jeannine, I was confused also when the GYN/ONC said I could have CINIII without lesions. Here is my history:
1998: bad pap with severe dysplasia, colposcopy biopsy showing CINIII, LEEP showed clear margins
1999-2004: normal paps
2005: pap came back abnormal, colposcopy looked fine, I was five months pregant so OBGYN decided to just monitor it.
2006: normal pap
2007: March-pap showed mild dysplasia
May-Colposcopy visual showed nothing questionable and my GYN sounded like the biopsy would find nothing more than mild dysplasia. But Colposcopy biopsy showed severe dysplasia (I questioned how it could be CINI
in March and CINIII in May and was told it could have been missed on the the pap, which is kind of scary!)
June-LEEP performed, pathology report showed clear margins and everything looked good.
July-seeked opinion of GYN/ONC whehter I should get hysterectomy of cervix and uterus, she said she would absolutely not do a hysterectomy and probably would not have done another LEEP in my case. She said colposcopy showed no questional lesions and would probably have monitored me over the course of several months instead. She said the fact that the LEEP pathology showed clear margins is an excellent sign. She is going to reexamine the slides from the Colposcopy biopsy and make sure she doesn't see anything else but seems to think followups including paps and colps are my best option right now.

Do you think I will have a problem with scar tissue from two leeps?

That helps. Thanks.

Your pathology from your LEEP in June showed clear margins. What else did it say? CIN III? Or did it show something milder than that?