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Kornhauser Health Sciences Library

Greer Manning: The Case

Problem Based Learning guide for 1st Year medical students.

 

The Case

 

Greer Manning is a 46-year-old female patient who is seen for a well woman exam with her new OB/Gyn Dr. Pfyfe. When completing the online registration, she lists the following family history:

  • Mother-uterine cancer, age 50, colon polyp diagnosed age 65, and basal cell carcinoma, age 70
  • Maternal aunt-colon polyp, age 58
  • Maternal cousin, leukemia, age 2 years
  • Maternal grandfather, colon cancer, age 55
  • Maternal grandmother, breast cancer, age 70
  • Paternal uncle, kidney cancer, age 70

Her personal medical history is reviewed in light of her family history, and Dr. Pfyfe confirms that Ms. Manning had an abnormal Pap smear 15 years ago treated with cryotherapy and has had normal Pap smears since.

She has had multiple miscarriages in the 6- to 8-week gestation range and attempted in-vitro fertilization twice ten years ago without carrying a pregnancy to term. She has not had any abnormal bleeding and has regular monthly periods. She took combination oral contraceptives in her twenties but stopped around the age of 30. She smokes several cigarettes a day and drinks about 7 alcoholic beverages a week.

A week after this visit, Ms. Manning is asked to return to discuss abnormal results on her Pap smear. When she meets with Dr. Pfyfe, she tells her that she had an abnormal type of cell on her Pap smear that raises concern for endometrial health. Ms. Manning asks what kind of cell and the OB shows her the report, which says “atypical glandular cells seen, evaluation for endometrial neoplasia recommended.” Dr. Pfyfe explains that the significance of the finding will not be known unless additional tests are performed and sets up an appointment for the patient to have cervical cone biopsy with dilation and endometrial curettage in the operating room. This procedure is performed a week later and the specimens are sent for pathologic analysis.

Results return in one week. The cone biopsy pathology report shows chronic cervicitis and squamous metaplasia. The endocervical curettage pathology report shows dysplastic glandular mucosa, and the endometrial curettage pathology shows moderately differentiated adenocarcinoma with positive staining for estrogen- and progesterone-receptor proteins.

Clinical Librarian

Ansley Stuart's picture
Ansley Stuart
Contact:
Health Science Campus
Kornhauser Library, Rm 204
502-852-8534

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