Difference between revisions of "Benign endometrial polyp"

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

Latest revision as of 18:27, 30 August 2023

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:

Secretory phase endometrium.^[3]
Pedunculated leiomyoma.

Microscopic

Features - diagnostic criteria:^[3]

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:^[3]

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.^[3]
Endometrial carcinoma - esp. serous carcinoma of the endometrium.
Simple endometrial hyperplasia.
Disordered proliferative endometrium.

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.

References

↑ 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.
↑ 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.
↑ ^3.0 ^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/.
↑ 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.

[pmid24820306-1] 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.

[pmid25093134-2] 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.

[pmid16873562-3] 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/.

[pmid-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.

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
-#redirect [[Endometrium#Benign endometrial_polyp]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Benign endometrial polyp -- low mag.jpg
+| Width      =
+| Caption    = Endometrial polyp (right - fibrotic stroma). [[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]], [[simple endometrial hyperplasia]], [[disordered proliferative endometrium]]
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = polypoid mass in the endometrial cavity
+| Grossing   =
+| Site       = [[endometrium]]
+| Assdx      = [[invasive breast cancer]] - specifically assoc. with [[tamoxifen]]
+| Syndromes  =
+| Clinicalhx = bleeding ([[menorrhagia]])
+| Signs      =
+| Symptoms   =
+| Prevalence = common
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    = [[uterine leiomyoma|leiomyoma]], other polypoid masses
+}}
+:''Uterine polyp'' and ''endometrial polyp'' redirect here.
+'''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.
+==General==
+*Very common.
+*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==
+*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:
+*[[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]].
+*[[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==
+===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>
+====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>
+====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|1}}
 [[Category:Diagnosis]]
+[[Category:Endometrium]]