Benign Endometrial Polyps Research Articles

Endometrial assessment by transvaginal sonography and histological findings after D & C in women with postmenopausal bleeding

A total of 149 women with postmenopausal bleeding underwent transvaginal sonography, hysteroscopy and dilatation and curettage in order to study the diagnostic accuracy of several ultrasound parameters in assessing endometrial pathology and to determine the most sensitive cut-off value of endometrial thickness for the exclusion of endometrial lesions. In distinguishing pathological from normal endometrium, transvaginal sonography showed a sensitivity of 69.3%, specificity of 82.7%, positive predictive value of 74.1% and negative predictive value of 72.1%. In detecting premalignant and malignant endometrial pathology, transvaginal sonography showed a sensitivity, specificity, positive predictive value and negative predictive value of 55%, 96.1%, 68.7% and 93.2%, respectively. Considering endometrial thickness as a single parameter, the most sensitive cut-off for defining normality was 4 mm; nevertheless, in the group of patients that had an endometrial thickness less than 4 mm, there was one case of malignancy (sensitivity, 95.2%; specificity, 49.4%; positive predictive value, 57.3%; and negative predictive value, 93.5%). Transvaginal sonography combined evaluation (morphology, thickness and color Doppler) showed a poor diagnostic accuracy in detecting endometrial pathology and in differentiating between endometrial benign lesions, endometrial polyps and adenocarcinoma in women with postmenopausal bleeding. Endometrial thickness evaluated with transvaginal sonography was preferable but not sensitive enough to exclude endometrial pathology.

Hysteroscopic appearance of benign and malignant endometrial polyps. What are the differences?

The objective of this study is to evaluate the differences between benign and malignant endometrial polyps at hysteroscopy. In our collected experience of 1793 diagnostic hysteroscopies performed from December 1989 to December 1993, we found 3 malignant polyps in 151 cases of hysteroscopically diagnosed endometrial polyps. The differences in appearance of the malignant polyps are mainly represented by surface irregularities such as necrosis, vascular irregularities and whitish thickened areas. We conclude that when these patterns are present it is better to perform a targeted biopsy to confirm the hysteroscopic diagnosis. This approach allows selection of patients that can be treated by hysteroscopic polypectomy from those who require more radical treatment.

Sonohysterography for the diagnosis of endometrial thickening in postmenopausal bleeding—A preliminary report

Sonohysterography or sonographic uterine cavity visualization by uterine cavity distension may help in distinguishing true endometrial thickening from other intracavitary pathologic conditions assuming the same appearance on conventional sonography. We examined 15 women with thickened endometrium (range 10-25 mm) on sonography performed for postmenopausal bleeding. Subsequent sonohysterography with saline revealed a polypoid structure in seven women, a normal uterine cavity in four, and thickened endometrium in four. All patients underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 patients (93.3%). Hysteroscopic resection of the polypoid structures was performed while the remaining patients underwent diagnostic curettage. Histologic examination of the seven polypoid structures revealed benign endometrial polyp in six and one pedunculated submucous fibroid. In patients undergoing diagnostic curettage, histologic examination revealed three cases of glandular hyperplasia, one case of cystic (atrophic) hyperplasia, one case of papillary endometrial adenocarcinoma, and two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyp or fibroid is clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.

Transvaginal sonographic evaluation of endometrial polyps.

The purpose of this study was to correlate the sonographic and histologic findings of focal lesions of the endometrium as depicted by transvaginal sonography. Sixteen focal endometrial masses were encountered during an 8 month period. The transvaginal sonographic appearance was correlated with findings at surgery or hysteroscopy. All uniformly hyperechoic endometrial masses were benign endometrial polyps. Five heterogeneous lesions were complicated endometrial polyps; one of these showed a focus of endometrial carcinoma. Four small and uniformly hypoechoic lesions were all prolapsed submucosal leiomyomata. Our results showed that a well-defined, uniformly hyperechoic mass within the endometrial cavity is most suggestive of a benign endometrial polyp. Larger masses with a heterogeneous appearance are nonspecific and warrant further evaluation and biopsy.

Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.

Magnetic resonance evaluation of acquired benign uterine disorders

MRI has become an invaluable method for evaluating uterine pathology. This article reviews MRI assessment of benign uterine disorders, including leiomyoma, adenomyosis, endometrial polyp, and Nabothian cyst. The article also describes extensively the technical aspects of uterine MRI scanning, and the normal MRI features of the uterus, vagina, and the uterine ligaments. A companion article in the same issue is concerned with MRI of malignant uterine disorder.

Uterine Malignant Mixed Mullerian Tumor in a Patient on Long-Term Tamoxifen Therapy for Breast Cancer

A case of malignant mixed mullerian tumor of the uterus, heterologous type, in an 83-year-old woman on tamoxifen (TAM) therapy for 9 years for breast cancer is presented. Benign endometrial polyps were diagnosed on endometrial curettings for postmenopausal bleeding after the patient had been on TAM for 5 years. Recurrent postmenopausal bleeding developed 4 years later. Endometrial curettings and hysterectomy revealed a 10-cm polypoid malignant mixed mullerian tumor (MMMT) and endometrial polyps. There was no invasion of the myometrium or endocervix and no evidence of metastatic tumor in 13 pelvic lymph nodes, peritoneal washings, or omentum. TAM has been associated with the development of endometrial polyps, hyperplasia, and adenocarcinoma possibly mediated through its agonistic estrogenic properties. Only one other case of MMMT arising in patients on TAM therapy has been previously reported, but may also be a consequence of the estrogenic effects of TAM therapy.

The effect of tamoxifen on the endometrium

Tamoxifen is one of the most important treatments for breast cancer, especially in postmenopausal patients. It acts primarily as an anti-estrogenic agent, due to its cytoplasmic estrogen receptor binding capacity. However, it also exerts a mild estrogenic effect. Since the prolonged use of estrogen has been reported to increase the rate of benign and malignant changes in the endometrium, we evaluated whether there is a correlation between tamoxifen therapy and endometrial benign and malignant conditions. The study group comprised 95 patients with breast cancer who were treated with tamoxifen. No control group was examined. Patients underwent vaginal ultrasonography and endometrial biopsy in order to evaluate any changes in the endometrium occurring during tamoxifen therapy. Pathological changes were observed in 14 patients, 13 of whom were treated with tamoxifen for more than 12 months. Of these women, 3 were diagnosed with endometrial cancer, 3 had mild dysplasia, 3 had endometrial hyperplasia, and 4 had a benign endometrial polyp. Our findings indicate a significant correlation between long-term tamoxifen administration and endometrial proliferation. We therefore recommend that women treated with tamoxifen for more than 12 months have an annual vaginal ultrasonography and endometrial biopsy.

Uterine papillary serous carcinoma: A study on 108 cases with emphasis on the prognostic significance of associated endometrioid carcinoma, absence of invasion, and concomitant ovarian carcinoma

One hundred eight cases of uterine papillary serous carcinoma (UPSC) were analyzed to characterize its histologic features and biologic behavior. Special situations that could conceivably modify the behavior and therapeutic approaches were considered: (1) the occurrence of areas of endometrioid carcinoma in otherwise typical UPSC; (2) the confinement of UPSC to an otherwise benign endometrial polyp or the endometrial mucosa or absence of residual tumor at the time of hysterectomy; and (3) the coexistence of a superficial UPSC and a serous ovarian carcinoma. There was coexistence of endometrioid and UPSC in 22 cases, and tumor was confined to an endometrial polyp or endometrium in 19 cases. There was simultaneous pathologic stage I UPSC and papillary serous ovarian carcinoma in 10 cases. In patients with pathologic stages I and II UPSC the presence of areas of endometrioid carcinoma intermixed with the UPSC did not improve survival. Patients with stage I disease and no residual tumor or tumor confined to an endometrial polyp/endometrial mucosa and without vascular invasion had a survival not statistically different from those with stage I disease but with myometrial and/or vascular invasion. Patients with stage I UPSC with concomitant ovarian serous surface papillary carcinoma had survival not statistically different from patients with stage IV UPSC.

Endometrial histology and bleeding patterns after 8 years of continuous combined estrogen and progestogen therapy in postmenopausal women

Continuous combined estrogen and progestogen preparations enable the postmenopausal woman to enjoy the benefits of estrogen replacement without the inconvenience of regular progestogen-induced withdrawal bleeding. The endometrium appears to be adequately protected in the short term, but no published data are available on the bleeding patterns or endometrial response after more than 18 months of therapy. Therefore, we reviewed 41 patients who continued on such preparations for up to 10 years (mean duration of use 8.0 years). Six women had experienced episodes of breakthrough bleeding after achieving amenorrhea, two of whom had benign endometrial polyps and two with adenocarcinoma of the endometrium. The remaining 35 women each had prolonged amenorrhea and were found to have an atrophic inactive endometrium. It is too early to comment on the long-term endometrial effects of these preparations because the numbers are too small; however, any breakthrough bleeding occurring after a period of prolonged amenorrhea must be investigated by means of endometrial biopsy.

92016232 Endometrial histology and bleeding patterns after 8 years of continuous combined estrogen and progestogen therapy in postmenopausal women

Continuous combined estrogen and progestogen preparations enable the postmenopausal woman to enjoy the benefits of estrogen replacement without the inconvenience of regular progestogen-induced withdrawal bleeding. The endometrium appears to be adequately protected in the short term, but no published data are available on the bleeding patterns or endometrial response after more than 18 months of therapy. Therefore, we reviewed 41 patients who continued on such preparations for up to 10 years (mean duration of use 8.0 years). Six women had experienced episodes of breakthrough bleeding after achieving amenorrhea, two of whom had benign endometrial polyps and two with adenocarcinoma of the endometrium. The remaining 35 women each had prolonged amenorrhea and were found to have an atrophic inactive endometrium. It is too early to comment on the long-term endometrial effects of these preparations because the numbers are too small; however, any breakthrough bleeding occurring after a period of prolonged amenorrhea must be investigated by means of endometrial biopsy.

Inv(12)(p11.2q13) in an endometrial polyp

A benign endometrial polyp from a 50-year-old postmenopausal woman has been cytogenetically investigated. A single clonal karyotypic anomaly, inv(12)(p11.2q13), was found in about 30% of cells analyzed after short-term culture. This finding contributes further to the hypothesis that the chromosomal segment 12q13-q14, which is also involved in chromosomal rearrangements in uterine leiomyomas, pleomorphic adenomas of the salivary glands, lipomas, and myxoid liposarcomas, contains a gene or genes that are related to cellular proliferation rather than to malignant transformation.

Endometrial cytology: six years of experience.

This article deals with a 6-yr mass screening program for the early detection of endometrial cancer, which took place 1978-1983. The diagnostic accuracy of endometrial cytology and the possibility of integrating this technique with the hysteroscopy and endometrial biopsy were studied. The authors analyzed 2,504 outpatients, all over the age of 45. The results of endometrial cytology were compared with those found using hysteroscopy and endometrial biopsy. Endometrial cytology showed high sensitivity in diagnosing endometrial cancer (97.7%) and high specificity in diagnosing true negatives. However, this technique was not adequate in identifying benign endometrial pathology, e.g., endometrial hyperplasia, polyps, or submucous fibromas. Epidemiological and clinical data in our series were fundamental in establishing mass screening for the early detection of endometrial cancer using integrated techniques. These data should be taken into consideration for creating new projects. The significantly high prevalence of endometrial neoplasia even in asymptomatic women over 45 years of age (4 per 1000) and the possibility of improving the accuracy of endometrial diagnosis using hysteroscopy and endometrial biopsy were the cornerstones of this project.

CLEAR CELL CARCINOMA OF THE ENDOMETRIUM. AN ANALYSIS OF 21 CASES

Twenty-one cases of clear cell carcinoma of the endometrium are analysed in an effort to characterize the histologic features and biologic behavior of this type of neoplasm in the uterus and thereby to shed further light on the histogenesis of clear cell carcinoma in the female genital tract. The clinical profile of the patients closely paralleled that of women with the usual types of carcinoma of the endometrium. Fifteen (71%) were stage I, five were stage II, and one was stage IV at diagnosis. An assessment of the clinical stage and depth of myometrial invasion are useful in predicting the prognosis. The actuarial survival for all stages is 55.3% at 5 years, which is somewhat lower than that of adenocarcinoma of the endometrium in general. Operation alone or combined with radiation therapy is the treatment of choice for stage 1 clear cell carcinoma of the endometrium. The most cogent evidence for a mullerian rather than a mesonephric origin for clear cell carcinoma in the female genital tract is its presence in the endometrium, a Mullerian derivative. More specific points that support this concept are the findings of clear cell carcinoma confined to an otherwise benign endometrial polyp in two instances, the initimate admixture of clear cell and typical adenocarcinoma in three other instances, and the absence of mesonephric remnants in any of the 21 cases.

Clear cell carcinoma of the endometrium. An analysis of 21 cases

Twenty-one cases of clear cell carcinoma of the endometrium are analysed in an effort to characterize the histologic features and biologic behavior of this type of neoplasm in the uterus and thereby to shed further light on the histogenesis of clear cell carcinoma in the female genital tract. The clinical profile of the patients closely paralleled that of women with the usual types of carcinoma of the endometrium. Fifteen (71%) were stage I, five were stage II, and one was stage IV at diagnosis. An assessment of the clinical stage and depth of myometrial invasion are useful in predicting the prognosis. The actuarial survival for all stages is 55.3% at 5 years, which is somewhat lower than that of adenocarcinoma of the endometrium in general. Operation alone or combined with radiation therapy is the treatment of choice for stage 1 clear cell carcinoma of the endometrium. The most cogent evidence for a müllerian rather than a mesonephric origin for clear cell carcinoma in the female genital tract is its presence in the endometrium, a Müllerian derivative. More specific points that support this concept are the findings of clear cell carcinoma confined to an otherwise benign endometrial polyp in two instances, the initimate admixture of clear cell and typical adenocarcinoma in three other instances, and the absence of mesonephric remnants in any of the 21 cases.

Primary carcinoma of the Fallopian tube. Case report.

Summary: A case of primary carcinoma of the left Fallopian tube is reported. The patient presented with postmenopausal bleeding which persisted after curet‐tage and removal of a benign endometrial polyp. Total hysterectomy and bilateral salpingo‐oophorectomy was performed, and the diagnosis of tubal carcinoma was made only on histopathological examination of the specimen.

Ferris, D. O., and Dockerty, M. B.Adenocarcinoma of the Body of the Uterus Arising From a Benign Endometrial Polyp: Report of Case, Proc. Staff Meet. Mayo Clinic 19: 133, 1944.

Ferris, D. O., and Dockerty, M. B.Adenocarcinoma of the Body of the Uterus Arising From a Benign Endometrial Polyp: Report of Case, Proc. Staff Meet. Mayo Clinic 19: 133, 1944.