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Benign endometrial polyp (view source)
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# | {{ 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]] | |||