Abstract
BackgroundEndometrial polyps (EMPs) are commonly encountered in routine surgical pathology practice, but opinions differ on whether they are intrinsically a marker for concurrent or subsequent malignancy. The objectives of the present study are 1) to investigate the age-group in which EMP are most commonly encountered 2) to document the age-group in which EMP are most commonly associated with malignancies 3) To investigate whether the age of diagnosis of the various carcinoma subtypes in EMPs is congruent with published data on similar malignancies arising in non-polypoid endometrium and 4) To investigate whether the histologic subtype distribution of malignancies associated with EMPs are similar or different from the distribution of malignancies arising from non-polypoid endometrium based on published data.Patients and methodsAll cases of EMPs were retrieved from the files of Yale-New Haven Hospital for the period 1986–1995. The patients were divided into 5 age groups: Each group was further subclassified based on an association (or lack thereof) of EMPs with endometrial carcinoma. Chi-square test was used to compare the proportion of malignancy associated EMPs between the age groups.ResultsWe identified 513 EMPs, of which 209 (41%) were from biopsy specimens and 304 (59%) from hysterectomy specimens. Sixty six (13%) of all EMPs were malignant. The 66 malignant EMPs included 58 endometrioid, 6 serous, 1 carcinosarcoma, and 1 clear cell carcinoma. In age group >35, only 1(2.5%) of 40 EMPs was associated with endometrial malignancy. In contrast, 37(32%) of 115 EMPs were associated with malignancy in the age group > 65. The frequency of malignant EMPs increased with age and reached statistical significance in the age group >65 (p < 0.001). The most common histologic type of malignancy was endometrioid adenocarcinoma.ConclusionsEMPs show statistically significant age dependent association with malignant tumor involvement. Careful search for malignancy, particularly in women with multiple risk factors is advised in daily practice. Additional studies are needed to address the histological features and immunohistochemical profiles in the context of association between endometrioid and high-grade endometrial carcinoma and endometrial polyps.
Highlights
Endometrial polyps (EMPs) are commonly encountered in routine surgical pathology practice, but opinions differ on whether they are intrinsically a marker for concurrent or subsequent malignancy
The objectives of the study are 1) to investigate the age-group in which EMP are most commonly encountered in routine surgical pathology practice 2) to document the age-group in which EMPs are most commonly associated with malignancies 3) To investigate whether the age of incidence of the various carcinoma subtypes in EMPs at the time of diagnosis is congruent with published data on similar malignancies arising in non-polypoid endometrim and 4) To investigate whether the histologic subtype distribution of malignancies associated with EMPs is similar or significantly different from the distribution of malignancies arising from non-polypoid endometrium
The incidence of EMP peaked at age group 46–55 years, which was similar to previous reports
Summary
Endometrial polyps (EMPs) are commonly encountered in routine surgical pathology practice, but opinions differ on whether they are intrinsically a marker for concurrent or subsequent malignancy. Serous endometrial intraepithelial carcinoma (EIC), the presumptive early form of uterine papillary serous carcinomas, may be identified as very minute foci in EMPs [5,6] This finding may be interpreted as the EMP homologue of similar changes that are occasionally identified in non-polypoid atrophic endometrium. The study showed that in abnormal uterine bleeding, hyperplasia presented more frequently in women with EMPs compared to those without polyps, but cancer involvement regardless of the histological pattern was not significantly different [9]. Similar results and failure to establish any association of endometrial polyps and carcinoma were demonstrated in another recent study dealing with endometrial polyp characteristics in menopausal women on hormonal replacement therapy [10]
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