Difference between revisions of "Benign endometrial polyp"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Nucleated red blood cells - endometrial polyp - low mag.jpg
| Image      = Benign endometrial polyp -- low mag.jpg
| Width      =
| Width      =
| Caption    = Endometrial polyp. [[H&E stain]].
| Caption    = Endometrial polyp (right - fibrotic stroma). [[H&E stain]].
| Micro      = large blood vessels (muscular), fibrotic stroma, polypoid shape (epithelium on three sides), +/-gland dilation
| Micro      = large blood vessels (muscular), fibrotic stroma, polypoid shape (epithelium on three sides), +/-gland dilation
| Subtypes  =
| Subtypes  =
| LMDDx      = [[adenofibroma]], [[cervical polyp]] - have endocervical mucosa, lower uterine segment, [[endometrial carcinoma]]  
| LMDDx      = [[adenofibroma]], [[cervical polyp]] - have endocervical mucosa, lower uterine segment, [[endometrial carcinoma]], [[simple endometrial hyperplasia]], [[disordered proliferative endometrium]]  
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Gross      = polypoid mass in the endometrial cavity
| Gross      = polypoid mass in the endometrial cavity
| Grossing  =
| Grossing  =
| Site      =
| Site      = [[endometrium]]
| Assdx      = [[invasive breast cancer]] - specifically assoc. with tamoxifen
| Assdx      = [[invasive breast cancer]] - specifically assoc. with [[tamoxifen]]
| Syndromes  =
| Syndromes  =
| Clinicalhx = bleeding
| Clinicalhx = bleeding ([[menorrhagia]])
| Signs      =  
| Signs      =  
| Symptoms  =
| Symptoms  =
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| Endoscopy  =
| Endoscopy  =
| Prognosis  = benign
| Prognosis  = benign
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = [[uterine leiomyoma|leiomyoma]], other polypoid masses
}}
}}
:''Uterine polyp'' redirects here.
:''Uterine polyp'' and ''endometrial polyp'' redirect here.
'''Benign endometrial polyp''', abbreviated '''BEP''', is a common diagnosis is [[endometrium|endometrial]] specimens.
'''Benign endometrial polyp''', abbreviated '''BEP''', is a common diagnosis in [[endometrium|endometrial]] specimens.


It is also simply known as '''endometrial polyp''' which is a somewhat ambiguous descriptor as not all endometrial polyps are benign.
It is also simply known as '''endometrial polyp''' which is a somewhat ambiguous descriptor as not all endometrial polyps are benign.
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*Very common.
*Very common.
*May be a cause of [[menorrhagia]] (heavy & long menses).
*May be a cause of [[menorrhagia]] (heavy & long menses).
*Malignant endometrial polyps are uncommon: <2% in one series of 965 cases.<ref name=pmid24820306>{{Cite journal  | last1 = Tang | first1 = Z. | last2 = Zhou | first2 = R. | last3 = Bao | first3 = D. | last4 = Liu | first4 = C. | last5 = Wei | first5 = L. | title = [Clinical characteristics of 42 cases of malignant endometrial polyps]. | journal = Zhonghua Fu Chan Ke Za Zhi | volume = 49 | issue = 3 | pages = 204-7 | month = Mar | year = 2014 | doi =  | PMID = 24820306 }}</ref>


==Gross==
==Gross==
*Polypoid mass in the endometrial cavity.
*Polypoid mass in the endometrial cavity.
Notes:
*May be large - 10 cm.<ref name=pmid25093134>{{Cite journal  | last1 = Unal | first1 = B. | last2 = Doğan | first2 = S. | last3 = Karaveli | first3 = FŞ. | last4 = Simşek | first4 = T. | last5 = Erdoğan | first5 = G. | last6 = Candaner | first6 = I. | title = Giant Endometrial Polyp in a Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding. | journal = Case Rep Obstet Gynecol | volume = 2014 | issue =  | pages = 518398 | month =  | year = 2014 | doi = 10.1155/2014/518398 | PMID = 25093134 }}</ref>


Gross DDx:
Gross DDx:
*[[Secretory phase endometrium]].<ref name=pmid16873562/>
*[[Secretory phase endometrium]].<ref name=pmid16873562/>
*Pedunculated [[uterine leiomyoma|leiomyoma]].
*Pedunculated [[uterine leiomyoma|leiomyoma]].
==Microscopic==
==Microscopic==
Features - diagnostic criteria:<ref name=pmid16873562>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
Features - diagnostic criteria:<ref name=pmid16873562>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
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*Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.<ref name=pmid16873562/>
*Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.<ref name=pmid16873562/>
*[[Endometrial carcinoma]] - esp. [[serous carcinoma of the endometrium]].
*[[Endometrial carcinoma]] - esp. [[serous carcinoma of the endometrium]].
*[[Simple endometrial hyperplasia]].
*[[Disordered proliferative endometrium]].
===Images===
<gallery>
Image: Benign endometrial polyp -- low mag.jpg | Endometrial polyp - low mag. (WC)
Image: Benign endometrial polyp -- intermed mag.jpg | Endometrial polyp - intermed. mag. (WC)
Image: Benign endometrial polyp - alt -- intermed mag.jpg | Endometrial polyp - intermed. mag. (WC)
Image: Nucleated red blood cells - endometrial polyp - low mag.jpg | Endometrial polyp - low mag. (WC)
</gallery>
==IHC==
*p16 stroma usually +ve.<ref name=pmid>{{Cite journal  | last1 = Moritani | first1 = S. | last2 = Ichihara | first2 = S. | last3 = Hasegawa | first3 = M. | last4 = Iwakoshi | first4 = A. | last5 = Murakami | first5 = S. | last6 = Sato | first6 = T. | last7 = Okamoto | first7 = T. | last8 = Mori | first8 = Y. | last9 = Kuhara | first9 = H. | title = Stromal p16 expression differentiates endometrial polyp from endometrial hyperplasia. | journal = Virchows Arch | volume = 461 | issue = 2 | pages = 141-8 | month = Aug | year = 2012 | doi = 10.1007/s00428-012-1276-1 | PMID = 22772724 }}</ref>


==Sign out==
==Sign out==
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ENDOMETRIUM ("POLYPS"), REMOVAL:
ENDOMETRIUM ("POLYPS"), REMOVAL:
- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
WITHOUT APPARENT PROLIFERATIVE ACTIVITY.  
  WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
</pre>
 
====Extensive surface denudation====
<pre>
POLYP, ENDOMETRIUM, REMOVAL:
- BENIGN LARGE ENDOMETRIAL POLYP WITH EXTENSIVE DENUDATION OF THE SURFACE
  AND INFLAMMATION, WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
- BLOOD (ABUNDANT), FIBRIN AND CELLULAR DEBRIS.
</pre>
</pre>


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==References==
==References==
{{Reflist|2}}
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Endometrium]]
[[Category:Endometrium]]

Latest revision as of 18:27, 30 August 2023

Benign endometrial polyp
Diagnosis in short

Endometrial polyp (right - fibrotic stroma). H&E stain.
LM large blood vessels (muscular), fibrotic stroma, polypoid shape (epithelium on three sides), +/-gland dilation
LM DDx adenofibroma, cervical polyp - have endocervical mucosa, lower uterine segment, endometrial carcinoma, simple endometrial hyperplasia, disordered proliferative endometrium
Gross polypoid mass in the endometrial cavity
Site endometrium
Associated Dx invasive breast cancer - specifically assoc. with tamoxifen
Clinical history bleeding (menorrhagia)
Prevalence common
Prognosis benign
Clin. DDx leiomyoma, other polypoid masses
Uterine polyp and endometrial polyp redirect here.

Benign endometrial polyp, abbreviated BEP, is a common diagnosis in endometrial specimens.

It is also simply known as endometrial polyp which is a somewhat ambiguous descriptor as not all endometrial polyps are benign.

General

  • Very common.
  • May be a cause of menorrhagia (heavy & long menses).
  • Malignant endometrial polyps are uncommon: <2% in one series of 965 cases.[1]

Gross

  • Polypoid mass in the endometrial cavity.

Notes:

  • May be large - 10 cm.[2]

Gross DDx:

Microscopic

Features - diagnostic criteria:[3]

  1. Large blood vessels (muscular) - key feature.
  2. Fibrotic stroma - key feature.
  3. Polypoid shape - epithelium on three sides.
    • May not be seen... as polyp is fragmented on removal.

Glandular changes common:[3]

  • Endometrial glands may be out of phase with surrounding endometrium.
    • Often proliferative.
  • +/-Cystic dilation of glands/unusual shapes
  • +/-Focal gland crowding.

Notes:

  1. Apparently benign polyps should be examined closely at the surface for in situ & invasive malignancies.
  2. Stroma often cellular.

DDx:

Images

  • Endometrial polyp - low mag. (WC)

  • Endometrial polyp - intermed. mag. (WC)

  • Endometrial polyp - intermed. mag. (WC)

  • Endometrial polyp - low mag. (WC)

IHC

  • p16 stroma usually +ve.[4]

Sign out

Non-proliferative

ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP.

ENDOMETRIUM ("POLYPS"), REMOVAL:
- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
  WITHOUT APPARENT PROLIFERATIVE ACTIVITY.

Extensive surface denudation

POLYP, ENDOMETRIUM, REMOVAL:
- BENIGN LARGE ENDOMETRIAL POLYP WITH EXTENSIVE DENUDATION OF THE SURFACE
  AND INFLAMMATION, WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
- BLOOD (ABUNDANT), FIBRIN AND CELLULAR DEBRIS.

Suggestive of polyp

ENDOMETRIUM, CURETTAGE:
- POLYPOID NONPROLIFERATIVE ENDOMETRIUM WITH FOCALLY PROMINENT SMALL BLOOD VESSELS AND
  FIBROUS STROMA, SUGGESTIVE OF BENIGN POLYP.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.

Proliferative

ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE ACTIVITY.

Note:

  • It is useful to comment on whether non-polypoid endometrium is proliferative (if present), esp. in menopausal women.[3]

Polyp with disordered proliferative phase in the background

ENDOMETRIUM, BIOPSY:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE GLANDS AND FOCAL GLAND DILATION.
- SUSPICIOUS FOR A BACKGROUND OF DISORDERED PROLIFERATIVE
  PHASE ENDOMETRIUM, SEE COMMENT.
- STRIPPED BENIGN ENDOCERVICAL EPITHELIUM.

COMMENT:
The endometrium sampled is proliferative with focal gland dilation throughout. The
features of a polyp (large muscular blood vessels, fibrous stroma and polypoid fragments of
endometrium) are only focally present, suggesting there is a background of disordered
proliferative phase endometrium.  Clinical correlation is suggested.

Clinically a polyp but not apparent on histology

 UTERUS (POLYP), REMOVAL:
- LARGE FRAGMENT OF SECRETORY PHASE ENDOMETRIUM WITH LARGE BLOOD VESSELS, A
  NON-FIBROUS STROMA AND NO DISCERNIBLE SURFACE EPITHELIUM.

See also

References

  1. ↑ Tang, Z.; Zhou, R.; Bao, D.; Liu, C.; Wei, L. (Mar 2014). "[Clinical characteristics of 42 cases of malignant endometrial polyps].". Zhonghua Fu Chan Ke Za Zhi 49 (3): 204-7. PMID 24820306.
  2. ↑ Unal, B.; Doğan, S.; Karaveli, FŞ.; Simşek, T.; Erdoğan, G.; Candaner, I. (2014). "Giant Endometrial Polyp in a Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding.". Case Rep Obstet Gynecol 2014: 518398. doi:10.1155/2014/518398. PMID 25093134.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings.". J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702. PMC 1860448. PMID 16873562. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/.
  4. ↑ Moritani, S.; Ichihara, S.; Hasegawa, M.; Iwakoshi, A.; Murakami, S.; Sato, T.; Okamoto, T.; Mori, Y. et al. (Aug 2012). "Stromal p16 expression differentiates endometrial polyp from endometrial hyperplasia.". Virchows Arch 461 (2): 141-8. doi:10.1007/s00428-012-1276-1. PMID 22772724.
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