Benign endometrial polyp
Jump to navigation
Jump to search
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
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:
- 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
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
- ↑ 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.