Endometrial polyps www.freelivedoctor.com
Definition <ul><li>Benign localised overgrowth of endometrial glands and stroma, covered by epithelium, projecting above t...
Clinical features <ul><li>Prevalence ~ 24% </li></ul><ul><li>More common in women > 40 </li></ul><ul><li>Present with  </l...
Pathological findings <ul><li>Sessile or pedunculated </li></ul><ul><li>Size: 1mm and beyond – may fill the endometrial ca...
polyp www.freelivedoctor.com
Histopathology  <ul><li>Irregularly outlined glands that may be out of phase with endometrium </li></ul><ul><li>Fibrovascu...
<ul><li>Benign polyp in a hysterectomy specimen </li></ul><ul><ul><li>Note </li></ul></ul><ul><ul><ul><li>Endometrial epit...
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....
Classification <ul><li>Morphologically diverse lesions that are difficult to subclassify. </li></ul><ul><li>Most are eithe...
Tamoxifen related polyps <ul><li>Larger, sessile with a honeycomb appearance </li></ul><ul><li>bizarre stellate shape of g...
Differential Diagnosis <ul><li>Endometrial hyperplasia </li></ul><ul><ul><li>diffuse process, majority of fragments in cur...
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 <ul><li>At most 5% of polyps contain carcinoma </li></ul><ul><li>polyps may represent a ma...
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Endometrial polyps

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Endometrial polyps

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

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