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Background
This is a very common disease affecting the endometrial lining of the uterus. It may present with abnormal bleeding necessitating an endometrial biopsy.
OUTLINE
EPIDEMIOLOGY CHARACTERIZATION INCIDENCE Common
DISEASE ASSOCIATIONS CHARACTERIZATION TAMOXIFEN
Endometrial polyps in postmenopausal patients receiving tamoxifen.Nuovo MA, Nuovo GJ, McCaffrey RM, Levine RU, Barron B, Winkler B.
Department of Pathology, Montefiore Hospital Medical Center, Bronx, New York.
Int J Gynecol Pathol 1989;8(2):125-31 Abstract quote The histologic features of an endometrial polyp include irregular, often dilated glands, thick-walled blood vessels, and a fibrotic stroma. Such polyps may be responsive to some chemotherapeutic drugs that can exert hormonal effects.
We report on endometrial polyps detected in three postmenopausal patients who were receiving tamoxifen for treatment of metastatic breast carcinoma. The clinical presentation in all cases was vaginal bleeding and all had documented uterine enlargement suggestive of an intrauterine malignancy. The polyps were large, measuring up to 9 cm in largest diameter. On histologic examination each polyp had extensive cystic glandular hyperplasia. In one case foci of atypical epithelial proliferation and predecidualization were noted. The atypical proliferation suggested a borderline neoplastic process and was strongly positive for carcinoembryonic antigen.
These findings underscore the marked proliferative changes that can be induced in endometrial polyps in postmenopausal women receiving hormonally active chemotherapeutic agents.
Tamoxifen-induced endometrial polyp. A case report and review of the literature.Nomikos IN, Elemenoglou J, Papatheophanis J.
Department of Surgery, Tzanion General Hospital, Piraeus, Greece.
Eur J Gynaecol Oncol 1998;19(5):476-8 Abstract quote A case of an endometrial polyp which developed in a 74-year-old woman treated with tamoxifen for 15 years after breast cancer surgery was the stimulus for this brief and concise review of the endometrial changes caused by anti-estrogen treatment in post-menopausal women with breast cancer.
Tamoxifen therapy has been associated with the development of endometrial polyps, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogenic properties.
Hysteroscopy follow-up should be performed in this group of patients and hysteroscopy should be done before the beginning of therapy and repeated once a year during the treatment.
PATHOGENESIS CHARACTERIZATION CHROMOSOMAL ABNROMALITIES
Is t(6;20)(p21;q13) a characteristic chromosome change in endometrial polyps?Speleman F, Cin PD, Van Roy N, Van Marck E, Buytaert P, Van den Berghe H, Leroy JG.
Department of Medical Genetics, University Hospital, Ghent, Belgium.
Abstract quoteCytogenetic analysis of an endometrial polyp showed the presence of a t(6;20)(p21;q13) together with an ins(16;1)(q22;q32q42).
Since a 6;20-translocation has been previously found in another endometrial polyp, we think that t(6;20)(p21;q13) may be a characteristic chromosomal change in endometrial polyps.
Endometrial polyp: another benign tumor characterized by 12q13-q15 changes.Vanni R, Dal Cin P, Marras S, Moerman P, Andria M, Valdes E, Deprest J, Van den Berghe H.
Istituto di Biologia Generale, University of Cagliari, Italy.
Cancer Genet Cytogenet 1993 Jul 1;68(1):32-3 Abstract quote Clustering of aberrations to specific chromosome regions of benign tumors may indicate the location of genes related to the proliferative process. Although few endometrial polyps have been cytogenetically investigated, 6p21 band appears to be involved consistently in the chromosome changes.
We report two cases of this type of benign tumor with chromosome rearrangements in 12q14-15, allowing identification of a second cytogenetic subgroup in endometrial polyps.
An endometrial polyp with a rearrangement of HMGI-C underlying a complex cytogenetic rearrangement involving chromosomes 2 and 12.Bol S, Wanschura S, Thode B, Deichert U, Van de Ven WJ, Bartnitzke S, Bullerdiek J.
Center of Human Genetics and Genetic Counselling, University of Bremen, Germany.
Cancer Genet Cytogenet 1996 Aug;90(1):88-90 Abstract quote Cytogenetic studies of an endometrial polyp of an 82-year-old patient revealed a karyotype 46,XX,der(2)inv(2)(p25q21)ins(2;12)(p25;q13q14)t(2;12)(q21; q15),der(12)del(12)(q13q14)del(12)(q15).
By fluorescence in situ hybridization (FISH) we found the chromosome 12 translocation breakpoint to be mapping within the third intron of the HMGI-C gene also harboring the breakpoints of translocations involving 12q15 seen in uterine leiomyomas, lipomas, pleomorphic adenomas, and pulmonary chondroid hamartomas.
LABORATORY/
RADIOLOGIC/
OTHER TESTSCHARACTERIZATION RADIOLOGIC DOPPLER
Predicting atypia inside endometrial polyps.Perez-Medina T, Bajo J, Huertas MA, Rubio A.
Department of Obstetrics and Gynecology, Santa Cristina University Hospital, Madrid, Spain.
J Ultrasound Med 2002 Feb;21(2):125-8 Abstract quote OBJECTIVE: To evaluate the efficacy of color Doppler exploration for assessing atypia inside endometrial polyps.
METHODS: A prospective study was conducted in a tertiary university hospital. Eight hundred six patients with endometrial polyps were studied with color Doppler sonography, and the resistive index inside the polyp stalk was obtained. The patients were then referred for hysteroscopic resection, and pathologic analysis was performed.
RESULTS: Thirty-five polyps with sonographic indications of atypia were pathologically confirmed. Sonographic indications of atypia inside 16 polyps were not confirmed. Three nonquestionable endometrial polyps had atypia inside them.
CONCLUSIONS: Low Doppler resistance is highly predictive of atypia inside endometrial polyps.
MRI
Endometrial polyps: MR imaging features and distinction from endometrial carcinoma.Grasel RP, Outwater EK, Siegelman ES, Capuzzi D, Parker L, Hussain SM.
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa, USA.
Radiology 2000 Jan;214(1):47-52 Abstract quote PURPOSE: To determine the magnetic resonance (MR) imaging characteristics of endometrial polyps and the accuracy of MR imaging in distinguishing endometrial polyps from endometrial carcinomas in a case-control study.
MATERIALS AND METHODS: Cross-referencing pathology records with MR studies from two institutions disclosed 35 patients with surgically proved endometrial polyp or carcinoma after controlling for tumor size. All MR examinations were performed at 1.5 T with T2-weighted fast spin-echo sequences in multiple planes. Three independent readers blinded to histologic diagnoses and clinical data scored each image for the presence of several defined findings.
RESULTS: A central fibrous core (low signal intensity on T2-weighted images) and intratumoral cysts (high signal intensity on T2-weighted images) were seen more frequently in endometrial polyps than in carcinomas; myometrial invasion and necrosis showed high predictive value for carcinomas. The readers' responses showed a mean sensitivity of 79%, specificity of 89%, accuracy of 86%, positive predictive value of 82%, and negative predictive value of 88% for diagnosis of carcinoma. The mean area under the receiver operating characteristic curve for the three readers was 0.87 for the diagnosis of carcinoma.
CONCLUSION: MR images can help to distinguish most polyps from endometrial carcinomas on the basis of morphologic features. Accuracy does not appear to be sufficient to obviate biopsy, partly because carcinomas and polyps frequently coexist.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION GENERAL
Hysteroscopic Appearance of Benign and Malignant Endometrial Polyps. What are the Differences?Marcone E, Zupi E, Valli E, Di Felice M, Solima E, Romanini C.
Department of Obstetrics and Gynecology, University of "Tor Vergata", Policlinico S. Eugenio, Viale Umanesimo 10, 0144 Rome, Italy,
J Am Assoc Gynecol Laparosc 1994 Aug;1(4, Part 2):S21 Abstract quote The objective of this study is to evaluate the differences between benign and malignant endometrial polyps at hysteroscopy.
In our collected experience of 1793 diagnostic hysteroscopies performed from December 1989 to December 1993, we found 3 malignant polyps in 151 cases of hysteroscopically diagnosed endometrial polyps. The differences in appearance of the malignant polyps are mainly represented by surface irregularities such as necrosis, vascular irregularities and whitish thickened areas.
We conclude that when these patterns are present it is better to perform a targeted biopsy to confirm the hysteroscopic diagnosis. This approach allows selection of patients that can be treated by hysteroscopic polypectomy from those who require more radical treatment.
VARIANTS
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL
- A Diagnostically Useful Histopathologic Feature of Endometrial Polyp: The Long Axis of Endometrial Glands Arranged Parallel to Surface Epithelium.
Kim KR, Peng R, Ro JY, Robboy SJ.
*Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and daggerDepartment of Pathology, Duke University Medical Center, Durham, NC.
Am J Surg Pathol. 2004 Aug;28(8):1057-1062. Abstract quote
We describe a histologic feature useful in the diagnosis of endometrial polyps, namely, the parallel arrangement of the endometrial glands' long axis to the surface epithelium (PGE). Polyps that are removed intact are usually easy to diagnose because of the polypoid appearance plus surface epithelium on all sides. In addition, there are thick-walled blood vessels and irregularly shaped glands. Rarely are all or even some of the characteristic features easy to identify in biopsies and curettage specimens.
We evaluated 76 cases of grossly identifiable polyps from hysterectomy or polypectomy (working group) for various histologic features and tested the validity of those findings with another 75 specimens (test group), which had been diagnosed as polyps in another institute by separate investigators. |
The frequency of the various histologic features in the polyps varied depending on the menstrual state, shape, and histologic types of the polyps. PGE was found in 80% (40 of 50 polyps) of premenopausal women as the most common histologic feature, but it was less common in postmenopausal women (42%, 11 of 26) (P = 0.001). All functional polyps (100%, 19 of 19), many of hyperplastic polyp (65%, 20 of 31), and some fibrous polyps (38%, 8 of 21) showed the change. In premenopausal women, incidence of PGE was significantly different by the polyp's shape or histologic types (P < 0.05), but not in postmenopausal women. PGE was not identified in any of the 56 normal background endometria, even though the surface was often undulated. Almost identical findings were observed in the series from the test group, confirming the validity of this new finding.
In summary, PGE, if present, is a useful histologic finding in facilitating the diagnosis of endometrial polyp in curettage specimens.
The stromal component of large endometrial polyps.Hattab EM, Allam-Nandyala P, Rhatigan RM.
Department of Pathology, University of Florida Health Science Center, Jacksonville 32209, USA.
Int J Gynecol Pathol 1999 Oct;18(4):332-7 Abstract quote Benign endometrial polyps belong in the differential diagnosis of adenofibroma and adenosarcoma. There is, however, little information about the range of stromal mitotic activity, stromal cellularity, and stromal atypia in benign endometrial polyps, rendering the differential diagnosis with the aforementioned tumors problematic.
In this study, the stroma of 66 polyps 1 cm or more in greatest dimension from 56 patients was analyzed for stromal mitotic activity, cellularity, and atypia. Sixteen (24%) had an almost completely fibrotic stroma that had rare mitoses, little cellularity, and no atypia. However, 50 polyps (76%) had stroma that was predominantly endometrial or was a mixture of endometrial-type stroma and fibrous stroma. In these polyps stromal mitoses were relatively common, averaging 1.2/10 MFs/HPFs (range, 0-5.8 MFs/10 HPFs). Stromal cellularity was frequently equal to or mildly increased over adjacent nonpolypoid endometrial stroma and mild nuclear atypia (enlarged stromal nuclei) was also common. Twelve polyps (24%) from the group of 50 had two or more MFs/10 HPFs, a mitotic rate present in some adenosarcomas. None of these polyps had other features necessary for the diagnosis of adenofibroma or adenosarcoma and follow-up in all patients was uneventful (average follow-up, 96 months).
It is concluded that benign polyps that retain areas of endometrial-type stroma often have mitotic activity and that significant stromal mitotic activity (> or = 2 MFs/HPFs) is relatively common. These polyps do not have significant stromal atypia nor do they have a marked increase in stromal cellularity. Thus, in the absence of other supportive features, stromal mitotic activity alone should not be regarded as a worrisome finding.
VARIANTS ATYPICAL STROMAL CELLS
Endometrial polyps with atypical (bizarre) stromal cells.Tai LH, Tavassoli FA.
Department of Gynecologic & Breast Pathology, Armed Forces Institute of Pathology, Washington, DC, U.S.A.
Am J Surg Pathol 2002 Apr;26(4):505-9 Abstract quote Atypical stromal cells of the lower female gynecologic tract have been specifically described in the vagina, vulva, and cervix, predominantly in the context of polyps. Rare cases of atypical stromal cells have been documented in the endometrium.
We report a series of 15 examples of atypical stromal cells in the endometrium: 13 in endometrial polyps and two within endometrial stroma in curettage/biopsy specimens unassociated with polyps. The patients ranged in age from 45 to 82 years. Immunohistochemical studies were performed to aid in the identification of the origin of these atypical cells. The differential diagnoses included adenosarcoma, endometrial stromal sarcoma, and, less likely, malignant mesodermal mixed tumor (MMMT/carcinosarcoma). Similar to atypical stromal cells reported in other gynecologic sites, such cells discovered in the endometrium also appear to have a benign clinical course after complete excision or polypectomy (follow-up ranging from 1 month to 44 months).
Accurate recognition of this lesion is essential to avoid unnecessary surgical overtreatment. Because of their rarity, limited available data, and lack of significant long-term follow-up, continued clinical monitoring of these patients would be prudent.
METASTATIC CARCINOMA
Metastatic breast lobular carcinoma involving tamoxifen-associated endometrial polyps: report of two cases and review of tamoxifen-associated polypoid uterine lesions.Houghton JP, Ioffe OB, Silverberg SG, McGrady B, McCluggage WG.
Department of Pathology, Royal Group of Hospitals Trust (JPH, WGMcC), Belfast, Northern Ireland.
Mod Pathol 2003 Apr;16(4):395-8 Abstract quote Two cases of lobular breast carcinoma metastatic to an endometrial polyp are described. Both patients had been treated with tamoxifen and presented with abnormal uterine bleeding.
Histology of endometrial biopsy in both cases showed typical tamoxifen-associated endometrial polyps with focal subtle stromal infiltration by metastatic lobular breast carcinoma. This was confirmed by positive immunohistochemical staining with cytokeratin epithelial markers. Metastatic breast carcinoma may rarely involve tamoxifen-associated endometrial polyps. Because primary endometrial carcinomas may also arise within tamoxifen polyps, these should be extensively sampled.
We briefly review polypoid uterine lesions that may occur secondary to tamoxifen therapy.
SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHERCHARACTERIZATION SPECIAL STAINS IMMUNOPEROXIDASE HORMONE RECEPTORS
Estrogen and progesterone receptor expression in endometrial polyps.Mittal K, Schwartz L, Goswami S, Demopoulos R.
Department of Pathology, New York University Medical Center, New York, USA.
Int J Gynecol Pathol 1996 Oct;15(4):345-8 Abstract quote Endometrial polyps are a frequent cause of abnormal uterine bleeding, but their pathogenesis is poorly understood.
This study was undertaken to investigate if endometrial polyps result from localized overexpression of estrogen receptors (ERs) or reduced expression of progesterone receptors (PRs). Fourteen cases of endometrial polyps, in which normal cycling endometrium was also present on the same slide, were immunostained for ERs and PRs. Percentages of positive cells in glands and stroma for each receptor were subjectively assessed to the nearest 5%. The intensity of staining was recorded on a scale from 1+ to 4+. The level and intensity of staining in polyps were compared with the staining in normal endometrium. Fewer stromal cells in polyps expressed ERs and PRs compared with cycling endometrium (% ER = 55.9 +/- 25.8 vs. 74.3 +/- 25.8, p = 0.03; % PR = 56.1 +/- 28.2 vs. 87.5 +/- 10.1, p = 0.002). Stroma in polyps also had significantly reduced intensity of staining for PRs, but not for ERs (intensity PR = 2.7 +/- 1.4 vs. 3.5 +/- 0.7, p = 0.015; intensity ER = 2.1 +/- 0.7 vs. 2.4 +/- 0.8, p = 0.45). There were no significant differences in expression of ERs and PRs in the endometrial glands in endometrial polyps compared with normal endometrium (% ER = 75.4 +/- 32.5 vs. 70.7 +/- 39.2. p = 0.25; % PR = 79.6 +/- 32.8 vs. 80.4 +/- 34.4, p = 0.8; intensity ER = 2.7 +/- 0.9 vs. 2.4 +/- 1, p = 0.15; intensity PR = 2.9 +/- 1.4 vs. 3.4 +/- 0.7, p = 0.15).
We conclude that endometrial polyps may result from a decrease in ER and PR expression in stromal cells. Because of these receptor-negative stromal cells, endometrial polyps may be relatively insensitive to cyclic hormonal changes.
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES ADENOSARCOMA CELLULAR PSEUDO-SARCOMATOUS FIBROEPITEHLIAL STROMAL POLYPS
Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma.Nucci MR, Young RH, Fletcher CD.
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Am J Surg Pathol 2000 Feb;24(2):231-40 Abstract quote Fibroepithelial stromal polyps of the vulvovaginal region are benign lesions that, when bland or hypocellular, are readily recognized. However those that exhibit bizarre cytomorphology, atypical mitoses, or hypercellularity, raising the possibility of malignancy, continue to be underrecognized.
The authors reviewed a series of fibroepithelial stromal polyps to characterize further the morphologic features that can lead to a misdiagnosis of sarcoma. A total of 33 of 65 consecutive cases of fibroepithelial stromal polyps retrieved from the authors' consultation files were remarkable for marked hypercellularity (33 of 33), marked cytologic pleomorphism (21 of 33), mitotic counts of more than 10 mitoses per 10 high-power fields (12 of 33), and the presence of atypical mitoses (14 of 33). A total of 16 of 33 lesions had three or more of these features.
Important morphologic clues to the diagnosis (shared with usual polyps at this site) were lack of an identifiable lesional margin, extension of abnormal stromal tissue up to the mucosal-submucosal interface, and the frequent presence of individually scattered multinucleate stromal cells, most often located close to the surface epithelium. Immunohistochemically, seven of 12 cases were desmin positive and one of 11 cases were smooth muscle actin positive. The age range of patients was 16 to 75 years (median, 32 years), and 21 patients (64%) were premenopausal. Sites included the vagina (18 of 33), cervix (seven of 33), and vulva (eight of 33). A total of 14 of 33 patients were pregnant, three patients were taking Tamoxifen, and one patient was on oral progesterone. Eight of 33 patients had multiple lesions at the time of presentation, of whom five were pregnant.
Clinical follow-up was available in 21 of 33 patients. Three of 21 patients with follow-up had local, nondestructive recurrence. Two of these patients had multiple recurrences. None of the patients followed developed metastases. Cytologic atypia has been a previously recognized feature in these lesions; however, the occurrence of marked stromal cellularity and a mitotic rate of more than 10 mitoses per 10 high-power fields have not been emphasized previously. Moreover, the combination of these features has only rarely been documented. Awareness of the spectrum of histologic features that these lesions can exhibit is crucial in their accurate recognition, thus avoiding potential overtreatment.
PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSTIC FACTORS MALIGNANCY RISK
- Serous papillary carcinoma of the endometrium arising from endometrial polyps: a clinical, histological, and immunohistochemical study of 13 cases.
Trahan S, Tetu B, Raymond PE.
Department of Pathology, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada G1R 2J6.
Hum Pathol. 2005 Dec;36(12):1316-21. Abstract quote
Serous papillary carcinoma is an aggressive tumor. Point mutations in the p53 suppressor gene might explain in part the rapid growth of this malignant tumor and its unfavorable outcome.
The aims of this study were to evaluate the behavior of serous papillary carcinoma developing in endometrial polyps and to assess the p53 protein overexpression. Patients included in this study were treated in our institution between 1982 and 2003. All clinical and pathological materials were examined. A p53 protein immunohistochemical analysis was performed on paraffin-embedded tissues.
Thirteen serous papillary carcinomas arising from benign polyps of the endometrium were identified. The patients' age averaged 73 years. All patients were treated surgically. After an average follow-up of 22 months, 54% of the patients were dead or alive with disease. Of 10 serous papillary carcinomas, 8 (80%) for which paraffin blocks were available overexpressed the p53 protein. A serous papillary carcinoma arising from benign polyps of the endometrium remains a malignant neoplasia with an unfavorable outcome even if the primary tumor is limited to the polyp.
The high rate of protein p53 overexpression suggests that a p53 gene mutation occurs early in the disease and might explain the rapid growth of the tumor.
Endometrial polyps and hyperplasia as risk factors for endometrial carcinoma. A case-control study of curettage specimens.Pettersson B, Adami HO, Lindgren A, Hesselius I.
Acta Obstet Gynecol Scand 1985;64(8):653-9 Abstract quote As part of a comprehensive case-control study, the impact of previous endometrial pathology on the risk of developing endometrial carcinoma was investigated.
The study comprised 254 consecutive women with histopathologically confirmed cancer of the uterine body in a well-defined population, and their age-matched controls. Ninety-eight (39%) of the patients and 81 (32%) of the controls had previously undergone endometrial curettage. More than one previous curettage was positively associated with endometrial carcinoma (odds ratio = 2.5; 95% CL = 1.4-4.5).
Endometrial abnormalities in previous curettage specimens occurred significantly more often among carcinoma patients (57%) than among controls (25%) (odds ratio = 4.0; 95% CL = 2.0-8.0). Twelve patients, but no controls, had adenomatous hyperplasia and this hyperplasia antedated the cancer diagnosis by a mean of 4.6 years. Endometrial polyps were present significantly more often in patients (20%) than in controls (10%) (odds ratio = 3.4; 95% CL = 1.3-9.3). The present results suggest that both of these conditions are risk factors for endometrial carcinoma. Among women who had undergone endometrial curettage more than 4 years after the menopause, 19 out of 30 patients, but none out of 7 controls, showed abnormality in the curettage specimens.
Postmenopausal women with endometrial abnormality should thus be regarded as being at risk of developing endometrial carcinoma.
Endometrial polyps during menopause: characterization and significance.
Orvieto R, Bar-Hava I, Dicker D, Bar J, Ben-Rafael Z, Neri A.
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel.
Acta Obstet Gynecol Scand 1999 Nov;78(10):883-6 Abstract quote BACKGROUND: To characterize postmenopausal women with endometrial polyps and to evaluate their significance.
METHODS: The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings.
RESULTS: Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories.
CONCLUSIONS: Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.
Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA.
Department of Obstetrics and Gynecology, General Hospital of Alexandroupolis, Democritus University of Thrace, Greece.
Eur J Gynaecol Oncol 2000;21(2):180-3 Abstract quote PURPOSE OF INVESTIGATION: To report our evaluation of the prevalence and malignant potentiality of endometrial polyps in women with abnormal uterine bleeding, as well as the efficacy of transvaginal ultrasonography and sonohysterography as diagnostic techniques.
METHODS: Fractional dilatation and curettage (D&C) was performed in 1,415 patients aged 23-85 years treated in our clinic for abnormal uterine bleeding from 1986 to 1998. Transvaginal ultrasonography was performed prior to D&C on all patients. Sonohysterography was performed only on 157 patients. Diagnostic efficacy for both techniques was evaluated for the detection of endometrial polyps combined with hyperplasia due to sonographic and histologic difficulties in distinguishing them.
RESULTS: The prevalence of endometrial polyps was 8.9% (126/1,415). From all 126 endometrial polyps found, 94 were benign, 30 (23.8%) were found with premalignant changes (complex and atypical hyperplasias) and two (1.5%) had undergone malignant degeneration. Transvaginal ultrasonography was of limited diagnostic value for polyps and hyperplasia in premenopausal women, while in postmenopausal women the method provided a greater yield. Sonohysterography was found to be a more effective diagnostic tool.
CONCLUSION: Endometrial polyp prevalence rises by age and/or menopause. Malignant degeneration of endometrial polyps was observed only in postmenopausal women. Sonohysterography represents an improvement over conventional ultrasonography and both methods could be used for screening purposes especially when hysteroscopy can not be performed.
TREATMENT
A randomized, prospective study of endometrial resection to prevent recurrent endometrial polyps in women with breast cancer receiving tamoxifen.Goldenberg M, Nezhat C, Mashiach S, Seidman DS.
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 52621 Tel-Hashomer, Israel.
J Am Assoc Gynecol Laparosc 1999 Aug;6(3):285-8 Abstract quote STUDY OBJECTIVE: To assess the role of endometrial resection in preventing recurrence of tamoxifen-associated endometrial polyps in women with breast cancer.
DESIGN: Randomized, prospective study (Canadian Task Force classification I).
SETTING: Tertiary university-affiliated medical center.
PATIENTS: Twenty consecutive women (age range 43-61 yrs).
INTERVENTIONS: Hysteroscopic removal of tamoxifen-associated endometrial polyps with or without simultaneous resection of the endometrium.
MEASUREMENTS AND MAIN RESULTS: Patients were randomized to undergo (10 women) or not undergo (10) concomitant endometrial resection. They were followed for at least 18 months (range 18-24 mo), including transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps; occurrence of uterine bleeding was also noted. In women who underwent endometrial resection, only one had a 1 x 1-cm endometrial polyp diagnosed and removed during follow-up. Seven women remained amenorrheic, and three experienced spotting for a few days every month. In the control group, six women had recurrent endometrial polyps requiring hysteroscopic removal (two-tail Fisher's exact test p <0.06).
CONCLUSION: Recurrence of endometrial polyps, one of the most common problems in patients with breast cancer receiving long-term treatment with tamoxifen, may be reduced by performing endometrial resection at the time of hysteroscopic removal of polyps. The possible risk of occult endometrial cancer is yet to be determined.
Treatment of endometrial polyps.Tjarks M, Van Voorhis BJ.
Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
Obstet Gynecol 2000 Dec;96(6):886-9 Abstract quote OBJECTIVE: To determine the effectiveness of different treatments for abnormal uterine bleeding in women with known endometrial polyps.
METHODS: We retrospectively assessed the effectiveness of polypectomy and other treatments of women with abnormal uterine bleeding who had benign polyps detected by sonohysterography. Women with endometrial polyps diagnosed by sonohysterography between January 1997 and July 1998 were sent questionnaires on pretreatment and posttreatment uterine bleeding and satisfaction with their treatments. Charts were reviewed to validate questionnaire responses and determine treatments administered.
RESULTS: Seventy-eight women had endometrial polyps by sonohysterography, and 60 of them (77%) responded to the questionnaire. Two with endometrial adenocarcinoma were excluded. The average age of the remaining 58 was 49 years; 37 (64%) were premenopausal and 21 (36%) postmenopausal. The average time from treatment to follow-up was 13 months (range 5-24 months). Participants were grouped according to the following treatments: polypectomy, polypectomy plus endometrial ablation, polypectomy plus hysteroscopic myomectomy, hysterectomy, D&C, and nonsurgical treatment. The most frequent treatment was polypectomy (n = 26). Polypectomy, polypectomy plus endometrial ablation, polypectomy plus myomectomy, and hysterectomy each resulted in at least a twofold decrease in the number of bleeding days per month and led to high satisfaction rates.
CONCLUSION: Our results showed that simple polypectomy and more invasive surgical procedures led to subjective improvement in symptoms of menorrhagia and metrorrhagia and a high satisfaction rate in women with endometrial polyps.
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