Analysis of estrogen- and progesterone-receptor expression in endometrial polyps

Lopes, Reginaldo Guedes Coelho; Baracat, Edmund Chada; Neto, Luiz Cavalcanti de Albuquerque; Ramos, José Francisco Dória; Yatabe, Salete; Depesr, Daniela Baptista; Lippi, Umberto Gazi

doi:10.1016/j.jmig.2006.10.022

Cited by 68 publications

(48 citation statements)

References 3 publications

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“…Some investigators suggested that the endometrial polyp is formed as a consequence of abnormal expression of estrogen and progesterone receptors [1][2][3]. The prevalence of endometrial polyps depends on the population being studied and the uterine imaging technique.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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Objective This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. Methods One hundred and fifty women aged 29-52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. Results Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p \ 0.001; OR 4.61; CI 1.9-27), polyp volume [10 ml (p \ 0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume [10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. Conclusion Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant 123 transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

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Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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“…The underlying cause of uterine polyp formation remains unclear but is believed to be multifactorial. 3 They are thought to originate as focal areas of stromal and glandular overgrowth. This hyperplasia of the endometrium may occur within an area of mucosa that contains more hormonal receptors, thus making it more sensitive to oestrogenic stimulation.…”

Section: Aetiology Of Uterine Polypsmentioning

confidence: 99%

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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“…Endometrial polyps are believed to develop as a consequence of focal stromal and glandular overgrowth caused by prolonged oestrogen exposure (Schlaen et al 1988 ;Lopes et al 2007 ;Ryan et al 2005 ; Sant'Ana de Almeida et al 2004 ). The balance between mitotic activity and apoptosis is considered to regulate normal endometrial development during the menstrual cycle, and disturbances of these physiological processes have been proposed to occur in endometrial polyps (Stewart et al 1999 ).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Oestrogen and progesterone act, via their receptors, as modulators of proliferation and differentiation in the normal endometrium (Inceboz et al 2006 ). Both oestrogen and progesterone receptors have been identifi ed in the glandular epithelium of endometrial polyps in both post-and premenopausal women, but the receptor expression appears to be disorderly compared with normal endometrium (Lopes et al 2007 ;Ryan et al 2005 ;Mittal et al 1996 ;McGurgan et al 2006a ). Furthermore, demonstrations of increased levels of Ki61, a marker of cell proliferation, and Bcl-2, an inhibitor of apoptosis, indicate that loss of usual control mechanisms for growth may be of importance in development of endometrial polyps (Inceboz et al 2006 ;McGurgan et al 2006a ;Maia et al 2004a ;Mertens et al 2002 ;Taylor et al 2003 ).…”

Section: Pathophysiologymentioning

confidence: 99%

Endometrial Polyps

Lieng

2014

Minimally Invasive Gynecological Surgery

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Analysis of estrogen- and progesterone-receptor expression in endometrial polyps

Cited by 68 publications

References 3 publications

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Endometrial Polyps

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