Malignancy in Endometrial Polyps: A 12-Year Experience

Abstract

Endometrial polyps (EPs) are common uterine pathological lesions in perimenopausal women. The prevalence of symptomatic EPs in the general female population ranges from approximately 13% to 50%. Agonist estrogen activity appears to play a crucial role in their development. This is suggested by the findings of several studies showing that steroid receptors were overexpressed in the glandular epithelium of polyps, and that hormone replacement therapy or tamoxifen were often associated with the development of EPs. Although polyps are generally benign growths, malignant carcinoma has been identified in up to 4.8% of such polyps, depending on patient selection criteria and the diagnostic method. This retrospective study assessed the risk of premalignant and malignant changes in EPs, and also investigated whether histopathologic features could be identified, which were predictive for malignant transformation of the lesions. Between 1995 and 2006, the medical charts of 1242 consecutive women with clinical EPs were reviewed. Clinical data related to histopathologic results were extracted. Of the 1242 cases, histological diagnosis identified 95.2% of the polyps as benign, and the remaining 4.8% as either premalignant (1.3%) or malignant (3.5%) lesions confined to the polyp. Univariate analysis identified older age, menopausal status, presence of abnormal uterine bleeding, and hypertension as significant factors associated with premalignancy or malignancy of EPs. The investigators conclude from these findings that polyps in older menopausal bleeding patients with hypertension are at high risk for premalignant and malignant changes and should be removed.