Abstract
To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.
Highlights
Patients with endometrial cancer (EC) present with polyps at the time of diagnosis between 10 and 30% of the cases.[1,2] If the tumor originates from a typical polyp, it is described as a neoplastic polyp, but if the cancer acquires a polypoid configuration, it is classified as a polypoid cancer.[2]
Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease
The risk factors for endometrial neoplasms are the same for polyps and normal endometrium,[1,5] the histological findings of the polyp might not reflect the condition of the adjacent endometrium.[5]
Summary
Patients with endometrial cancer (EC) present with polyps at the time of diagnosis between 10 and 30% of the cases.[1,2] If the tumor originates from a typical polyp, it is described as a neoplastic polyp, but if the cancer acquires a polypoid configuration, it is classified as a polypoid cancer.[2] Patients with concomitant endometrial polyps and cancer usually present in earlier stages than those with tumors that are not associated with a polyp.[1]. Few studies have described the aggressiveness of a tumor that is associated with polyps.[1,6] In the case of EC in a polyp, the thickness of the parenchyma of the polyp can be a protective factor against myometrial invasion, based on reports of the absence of residual disease after polypectomy in patients with EC.[1,2]
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