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Endometrial polyps
 

Endometrial polyps

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    Endometrial polyps Endometrial polyps Presentation Transcript

    • Endometrial polyps www.freelivedoctor.com
    • Definition
      • Benign localised overgrowth of endometrial glands and stroma, covered by epithelium, projecting above the adjacent epithelium
      • Clonal lesions
        • chromosome 6
      www.freelivedoctor.com
    • Clinical features
      • Prevalence ~ 24%
      • More common in women > 40
      • Present with
        • intermenstrual or post-menopausal bleeding
        • Infertility
        • Persistent bleeding following curettage
      • Common association with Tamoxifen use
      www.freelivedoctor.com
    • Pathological findings
      • Sessile or pedunculated
      • Size: 1mm and beyond – may fill the endometrial cavity and project through the cervical os
      • May be multiple
      • May originate anywhere, but most commonly fundus
      www.freelivedoctor.com
    • polyp www.freelivedoctor.com
    • Histopathology
      • Irregularly outlined glands that may be out of phase with endometrium
      • Fibrovascular stalk or fibrous stroma with numerous thick walled vessels
      • Metaplastic epithelium particularly squamous may be present
      • Those in the lower uterine segment may contain endocervical glands
      • Mesenchymal component contains endometrial stroma, fibrous tissue or smooth muscle.
      • Absence of cytological atypia
      • hyperplasia, carcinoma (any type) and carcinosarcoma may involve or be entirely confined to a polyp
      • endometrial intraepithelial carcinoma may be identified in an atrophic polyp
      www.freelivedoctor.com
      • Benign polyp in a hysterectomy specimen
        • Note
          • Endometrial epithelium on three surfaces
          • Dilated glands
          • Fibrotic stroma
          • Scattered dilated thick walled blood vessels
      www.freelivedoctor.com
    • Endometrial polyp (low power) features cystically dilated glands of various sizes and shapes www.freelivedoctor.com
    • Endometrial polyp (high power) characteristic features of thick walled blood vessels in a fibrous core www.freelivedoctor.com
    • Classification
      • Morphologically diverse lesions that are difficult to subclassify.
      • Most are either hyperplastic, atrophic or functional.
        • Hyperplastic
          • resemble diffuse non polypoid endometrial hyperplasia
          • no evidence that these have the same significance as diffuse hyperplasia, so best to avoid the term hyperplastic in the diagnosis
        • Atrophic
          • low columnar or cuboidal cells lining cystically dilated glands
          • typically in post-menopausal patients
        • Functional
          • resemble normal cycling endometrium
          • relatively uncommon
      www.freelivedoctor.com
    • Tamoxifen related polyps
      • Larger, sessile with a honeycomb appearance
      • bizarre stellate shape of glands and frequent epithelial and stromal metaplasias
      • often periglandular stromal condensation
      • malignant transformation in up to 3%
      • interestingly the cytogenetic profile is similar to non-iatrogenic lesions
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    • Differential Diagnosis
      • Endometrial hyperplasia
        • diffuse process, majority of fragments in curettage, absence of thick walled vessels
      • polypoid endometrial carcinoma
        • malignant epithelial cells
      • adenofibroma
      • adenosarcoma
        • stromal cells cytologically atypical and mitotically active
        • stromal cells packed tightly around non malignant glands
        • leaf like pattern
      www.freelivedoctor.com
    • Adenosarcoma www.freelivedoctor.com
    • Adenosarcoma note the cellular stroma www.freelivedoctor.com
    • Adenosarcoma stromal cells condensing around cytologically benign glands www.freelivedoctor.com
    • Clinical behavior and treatment
      • At most 5% of polyps contain carcinoma
      • polyps may represent a marker of increased cancer risk, but no evidence suggests they are more likely to become cancer than the adjacent endometium
      • those containing atypical hyperplasia or carcinoma should be treated as per similar flat lesions
      www.freelivedoctor.com