Difference between revisions of "Benign endometrial polyp"

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#redirect [[Endometrium#Benign endometrial_polyp]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Nucleated red blood cells - endometrial polyp - low mag.jpg
| Width      =
| Caption    = Endometrial polyp. [[H&E stain]].
| Micro      = large blood vessels (muscular), fibrotic stroma, polypoid shape (epithelium on three sides), +/-gland dilation
| Subtypes  =
| LMDDx      = [[adenofibroma]], [[cervical polyp]] - have endocervical mucosa, lower uterine segment, [[endometrial carcinoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = polypoid mass in the endometrial cavity
| Grossing  =
| Site      =
| Assdx      = [[invasive breast cancer]] - specifically assoc. with tamoxifen
| Syndromes  =
| Clinicalhx = bleeding
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
:''Uterine polyp'' redirects here.
'''Benign endometrial polyp''', abbreviated '''BEP''', is a common diagnosis is [[endometrium|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).
 
==Gross==
*Polypoid mass in the endometrial cavity.
 
Gross DDx:
*[[Secretory phase endometrium]].<ref name=pmid16873562/>
*Pedunculated [[uterine leiomyoma|leiomyoma]].
==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>
#Large blood vessels (muscular) - '''key feature'''.
#Fibrotic stroma - '''key feature'''.
#Polypoid shape - epithelium on three sides.
#*May not be seen... as polyp is fragmented on removal.
 
Glandular changes common:<ref name=pmid16873562/>
*Endometrial glands may be out of phase with surrounding endometrium.
**Often proliferative.
*+/-Cystic dilation of glands/unusual shapes
**[[Simple endometrial hyperplasia]] should ''not'' be diagnosed in a polyp!
*+/-Focal gland crowding.
 
Notes:
#Apparently benign polyps should be examined closely at the surface for in situ & invasive malignancies.
#Stroma often cellular.
 
DDx:
*[[Adenofibroma]].
*[[Cervical polyp]] - have endocervical mucosa.
*Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.<ref name=pmid16873562/>
*[[Endometrial carcinoma]] - esp. [[serous carcinoma of the endometrium]].
 
==Sign out==
===Non-proliferative===
<pre>
ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP.
</pre>
 
<pre>
ENDOMETRIUM ("POLYPS"), REMOVAL:
- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
</pre>
 
====Suggestive of polyp====
<pre>
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.
</pre>
 
===Proliferative===
<pre>
ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE ACTIVITY.
</pre>
 
Note:
*It is useful to comment on whether non-polypoid endometrium is proliferative (if present), esp. in menopausal women.<ref name=pmid16873562/>
 
===Polyp with disordered proliferative phase in the background===
<pre>
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.
</pre>
 
===Clinically a polyp but not apparent on histology===
<pre>
UTERUS (POLYP), REMOVAL:
- LARGE FRAGMENT OF SECRETORY PHASE ENDOMETRIUM WITH LARGE BLOOD VESSELS, A
  NON-FIBROUS STROMA AND NO DISCERNIBLE SURFACE EPITHELIUM.
</pre>
 
==See also==
*[[Endometrium]].
 
==References==
{{Reflist|2}}


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

Revision as of 02:00, 3 November 2013

Benign endometrial polyp
Diagnosis in short

Endometrial polyp. 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
Gross polypoid mass in the endometrial cavity
Associated Dx invasive breast cancer - specifically assoc. with tamoxifen
Clinical history bleeding
Prevalence common
Prognosis benign
Uterine polyp redirects here.

Benign endometrial polyp, abbreviated BEP, is a common diagnosis is 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).

Gross

  • Polypoid mass in the endometrial cavity.

Gross DDx:

Microscopic

Features - diagnostic criteria:[1]

  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:[1]

  • 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:

Sign out

Non-proliferative

ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP.

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

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.[1]

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. ↑ 1.0 1.1 1.2 1.3 1.4 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/.
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