Benign endometrial polyp

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

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
Prevalence common
Prognosis benign
Uterine polyp redirects here.

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:

Images

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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.[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