Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy

Abstract

Objective:To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy.Methods:The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm.Results:Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal.Conclusion:Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.

Risk Factors for Endometrial Hyperplasia Concomitant Endometrial Polyps in Pre- and Post-menopausal Women

“…Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. In 0.5% of the patients endometrial cancer was found in EP (Lenci et al, 2014). In our study, 13/203 (6.4%) cases with polyps, (twelve with no atypia and 1 with atypia), had premalignant lesions.…”

Comparison of the distinctive pathological features of and p16 and c-Kitexpression levels in benign and malignant endometrial polyps

“…The mean ages of patients with malignant and benign polyps were 60 and 58 years, respectively, compatible with literature data. Previously reported mean ages were 63.6 and 64.4 years for those with malignant polyps, and 56.5 and 61.7 years for those for benign polyps (11,23). However, Hui et al reported that the mean age of patients with malignant polyps was 67 years.…”

Pólipos endometriales: Actualización en diagnóstico y tratamiento

“…La correlación visual histeroscopica con benignidad o malignidad de la lesión, es baja e imprecisa (50). Los determinantes de esta serán la experiencia del examinador, forma del pólipo y vascularización de superficie (50,51).…”

“…Los determinantes de esta serán la experiencia del examinador, forma del pólipo y vascularización de superficie (50,51). Por otra parte, lesiones uterinas pequeñas y/o cambios funcionales del endometrio limitarán el rendimiento de la histeroscopia en el diagnóstico de lesiones focales.…”