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Endometrial polyps

Endometrial polyps

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Endometrial polyps

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  1. Endometrial polyps Dr Shaun Monagle MBBS 1991

  2. Definition • Benign localised overgrowth of endometrial glands and stroma, covered by epithelium, projecting above the adjacent epithelium • Clonal lesions • chromosome 6

  3. 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

  4. 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

  5. polyp

  6. 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

  7. Benign polyp in a hysterectomy specimen • Note • Endometrial epithelium on three surfaces • Dilated glands • Fibrotic stroma • Scattered dilated thick walled blood vessels

  8. Endometrial polyp • Note: • Dilated thick-walled blood vessels • Stromal fibrosis (less than previous image) • Proliferative endometrial glands

  9. Endometrial polyp (low power)features cystically dilated glands of various sizes and shapes

  10. Endometrial polyp (high power)characteristic features of thick walled blood vessels in a fibrous core

  11. 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

  12. 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

  13. 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

  14. Adenosarcoma

  15. Adenosarcomanote the cellular stroma

  16. Adenosarcomastromal cells condensing around cytologically benign glands

  17. 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

  18. References • http://www.pathologyoutlines.com • Blaustein’s Pathology of the Female Genital Tract. 5th Edition. RJ Kurman. Springer-Verlag New York. 2002. • Differential Diagnosis in Surgical Pathology. Haber, Gattuso, Spitz and David. Saunders, 2002 • WHO Classification of Tumour. Pathology and Genetics. Tumours of the breast and female genital organs. Tavassoli and Devilee. IARC Press, 2003 • Sternberg’s Diagnostic Surgical Pathology, 4th edition. SE Mills. Lippincott, Williams and Wilkins, 2004