Abstract
Background and objectives: Endometrial polyps in asymptomatic postmenopausal women are often incidentally found, yet only 1.51% of them are malignant. Their potential for malignant transformation has not been adequately addressed. The aim of this study was to investigate the proliferation within endometrial polyps as one of the indicators of their malignization potential in asymptomatic postmenopausal women. Materials and Methods: Immunohistochemical studies of Ki-67 were performed. Cases included 52 benign postmenopausal polyps, 19 endometrioid carcinoma with coexisting benign polyps, 12 polyps with foci of carcinoma and 4 cases of polyps, which later developed carcinoma. The control group included 31 atrophic endometria and 32 benign premenopausal polyps. Ki-67 was scored in either 10 or 20 “hot spot” fields, as percentage of positively stained cells. Results: The median epithelial Ki-67 score in postmenopausal benign polyps (4.7%) was significantly higher than in atrophic endometria (2.41%, p < 0.0001) and significantly lower than in premenopausal benign polyps (11.4%, p = 0.003) and endometrial cancer (8.3%, p < 0.0001). Where endometrial polyps were found in association with endometrial carcinoma, Ki-67 was significantly higher in cancer (p < 0.0001). No significant difference was found between Ki-67 scores of cancer focus and of the polyps tissue itself, respectively 2.8% and 4.55%, p = 0.37. Ki-67 expression, where polyps were resected and women later developed cancer, was not significantly different (p = 0.199). Conclusion: Polyps from asymptomatic postmenopausal women showed significantly more proliferation in both epithelial and stromal components than inactive atrophic endometria but less than premenopausal benign polyps and/or endometrial cancer. Benign postmenopausal endometrial polyps exhibit low proliferative activity, suggesting low malignant potential and may not require resection in asymptomatic women.
Highlights
Endometrial polyps (EPs) are outgrowths of endometrial tissue and are composed of varying amounts of glands and fibrotic stroma containing thick-walled blood vessels covered by epithelium [1].The prevalence of EPs in the general population is approximately 8%, affecting up to 20% of Medicina 2019, 55, 543; doi:10.3390/medicina55090543 www.mdpi.com/journal/medicinaMedicina 2019, 55, 543 postmenopausal women [2,3,4]
Where endometrial polyps were found in association with endometrial carcinoma, Ki-67 was significantly higher in cancer (p < 0.0001)
The median age of the patients diagnosed with malignant polyps was 63.5 years, for the atrophic endometrium patients, it was 67.8 (54–88); for the benign premenopausal polyps patients, it was 41.2 (27–51); and for the benign postmenopausal polyps patients, it was 66.9 (53–89)
Summary
Endometrial polyps (EPs) are outgrowths of endometrial tissue and are composed of varying amounts of glands and fibrotic stroma containing thick-walled blood vessels covered by epithelium [1].The prevalence of EPs in the general population is approximately 8%, affecting up to 20% of Medicina 2019, 55, 543; doi:10.3390/medicina55090543 www.mdpi.com/journal/medicinaMedicina 2019, 55, 543 postmenopausal women [2,3,4]. Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic EPs to be detected [6]. Most of these polyps are removed surgically, as a precautionary measure in order to avoid missing a case of endometrial cancer (EC) [6]. Endometrial polyps in asymptomatic postmenopausal women are often incidentally found, yet only 1.51% of them are malignant. Their potential for malignant transformation has not been adequately addressed. The aim of this study was to investigate the proliferation within endometrial polyps as one of the indicators of their malignization potential in asymptomatic postmenopausal women. The control group included atrophic endometria and benign premenopausal polyps
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