Malignancy in endometrial polyps: a 12-year experience (original) (raw)
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Endometrial polyps in pre- and postmenopausal women: Factors associated with malignancy
Maturitas, 2007
Objective: To evaluate the prevalence of premalignant and malignant polyps and their association with menopausal status, hormone therapy and clinical characteristics in perimenopausal and postmenopausal women. Methods: A surgical database was used to select pre-and postmenopausal women ≥40 years of age, submitted to hysteroscopic resection of endometrial polyps. The medical records of 475 women were reviewed and clinical characteristics and histological diagnosis of resected polyps were assessed. Results: The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia without atypia. Polyps with endometrial hyperplasia with atypia comprised 1.05% of cases, while 2.74% were carcinomatous polyps. Analysis using prevalence ratios showed that premalignant and malignant lesions were associated with age and postmenopausal bleeding. Women >60 years of age had a prevalence ratio 3.28 times greater (95%CI: 1.19-9.07) of premalignant or malignant polyps. When only postmenopausal women were evaluated for the effect of age, those over 60 years of age had a prevalence 5.31 times greater (95%CI: 1.22-23.09), while those with postmenopausal bleeding had an age-adjusted prevalence ratio of 3.71 (95%CI: 1.21-11.34) compared to asymptomatic women. No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy. Conclusions: There was a low prevalence of premalignant and malignant lesions in endometrial polyps. Older women and those with postmenopausal bleeding had a greater prevalence of malignancy and in these cases hysteroscopic resection of endometrial polyps is mandatory.
Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases
European journal of obstetrics, gynecology, and reproductive biology, 2014
To assess the prevalence of polyps carrying a malignancy and match association between clinical factors and oncologic progression. A retrospective study (Canadian Task Force classification II-3) at a university hospital in Rome, Italy. We retrospectively analyzed data from 1027 women consecutively treated for endometrial polyps at our center in the period 2002-2011. The association of malignancy with hormonal status, tamoxifen, hypertension, symptoms, diabetes mellitus, obesity, and hormonal replacement therapy in pre- and post-menopausal women was assessed. Mean age was 45.8±10.8 years. Benign polyps accounted for 95.8% of the total, pre-malignant for 2.67%, malignant for 1.54%. Our data showed that post-menopausal and older women (>60y) with endometrial polyps have a higher risk of developing a related endometrial cancer (OR: 3.05, 95% CI [1.54, 6.19], p<0.001 and OR: 2.8, 95% CI [1.38, 5.56], p≤0.003. Also we observed that women with AUB in the post-menopausal period displa...
Premalignant and malignant changes in endometrial polyps
Gaziantep Medical Journal, 2013
The objective of this study was to evaluate the risk of premalignant and malignant changes in endometrial polyps that were removed entirely by operative hysteroscopy. The study group was comprised of 101 cases of endometrial polyps diagnosed by diagnostic hysteroscopy, transvaginal ultrasonography and saline contrast sonohysterography in our Obstetrics and Gynecology Clinic from January 2010 to July 2012. A retrospective chart review was then performed with the use of medical records. The operative procedure was performed under general anesthesia. The specimens were placed in 10% formaldehyde for histological examination. Clinical characteristics such as age, parity, menopausal status, hypertension (defined as diastolic pressure ≥90 mm Hg and/or systolic pressure ≥140 mm Hg), abnormal uterine bleeding, diabetes (fasting glucose ≥110 mg/dl) were also reported from the medical records. Statistical Analysis was performed by using the SPSS 11.5 statistical software package (SPSS, Chicago, IL, USA). The mean age of the study group was 45 (25-73) years-old. The most common indication for performing operative hysteroscopy was abnormal uterine bleeding 82.2% (n=83). It is worthwhile to note that 3 patients (2.9%) had premalignant and malignant changes of polyps. One patient who was 58 years old had invasive endometrial cancer. None of the clinical variables considered (diabetes mellitus, hypertension, hormone replacement therapy) were statistically related to the histopathological results. Although the prevalence of premalignant and malignant endometrial polyps is very low, the early diagnosis of malignancy is very important. The most common indication was abnormal uterin bleeding for performing operative hysterescopy.
The Risk of Premalignant and Malignant Pathology in Endometrial Polyps
Obstetrical & Gynecological Survey, 2000
Objective. To evaluate the risk of premalignant and malignant pathology among endometrial polyps. Design. Prospective cohort study. Setting. Minimal Access Surgical Training (MAST) center in a large teaching hospital. Methods. Among 248 patients seen in outpatient hysteroscopy clinic (1996-97), 62 had endometrial polyps. All patients had endometrial sampling for histological assessment. To determine the magnitude of malignant potential among polyps, we compared the pathological findings in polyps (cases) with non-polypoidal specimens (controls). Results. Out of 62 polyps, histologically 53 (85.5%) were benign, seven (11.3%) had hyperplasia, and two (3.2%) were associated with malignancy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (11.3% vs 4.3%, pΩ0.04), but the incidence of carcinoma in the two groups was the same (3.2% vs 3.2%, pΩ1.0). Conclusion. In abnormal uterine bleeding, hyperplasia was, but cancer was not, more common in women with endometrial polyps compared to those without polyps.
American Journal of Obstetrics and Gynecology, 2003
The purpose of this study was to determine the rate of benign, hyperplastic, and malignant endometrial polyps and whether clinical data can predict histopathologic outcome. STUDY DESIGN: Five hundred nine patients with endometrial polyps who consecutively underwent hysteroscopic removal of endometrial polyps over 48 months were identified from our gynecologic oncology surgical database. Medical reports provided clinical data. Statistical analysis was performed. RESULTS: Histologically, 358 polyps (70.3%) were benign; 131 polyps (25.7%) had simple or complex endometrial hyperplasia, 16 polyps (3.1%) had hyperplasia with atypia, and 4 polyps (0.8%) were cancerous. Polyps were divided into group A and group B, according to the risk of malignancy (group A, benign; group B, atypical hyperplastic and cancerous). Age, menopause status, and hypertension were associated significantly with group B. CONCLUSION: Endometrial polyps rarely become malignant, but hyperplastic changes are more common. Age, menopause status, and hypertension may increase the risk of premalignant and malignant polyps. To achieve complete removal of the polyp and a reliable histologic analysis, operative hysteroscopy should be offered to symptomatic patients or to patients with risk factors. (Am J Obstet Gynecol 2003;188:927-31.)
Risk and Predictors of Malignancy in Women with Endometrial Polyps
Annals of Surgical Oncology, 2011
Background. Endometrial polyps commonly affect premenopausal and postmenopausal women and carry a small risk of cancer. Consensus guidelines to direct the management of women with endometrial polyps are lacking. We examined the risk of malignancy in symptomatic and asymptomatic women with endometrial polyps. Methods. Institutional databases were analyzed to identify women with pathologically confirmed endometrial polyps diagnosed from 2002 to 2007. Demographic, clinical, and pathologic outcomes were reviewed. The most significant pathologic diagnosis was recorded for each subject. Endometrial hyperplasia and cancer were characterized as arising in the polyp or the adjacent endometrium. Factors associated with atypical hyperplasia and cancer were analyzed. Results. A total of 1011 women with endometrial polyps were identified. On pathology review, 964 (95.4%) polyps were reported as benign, 13 (1.3%) as hyperplasia without atypia, 5 (0.5%) as hyperplasia with atypia, and 13 (1.3%) as endometrial cancer. The only clinical or demographic factor associated with atypical hyperplasia and cancer was menopausal status (P = .02). Among premenopausal women the risk of cancer or atypical hyperplasia was 0.9% in patients without bleeding and 1.0% in women with bleeding. In postmenopausal women cancer or atypical hyperplasia was found in 1.9% of patients without bleeding and in 3.8% of women with bleeding.
Endometrial polyps during menopause: characterization and significance
Acta Obstetricia et Gynecologica Scandinavica, 2000
Background. To characterize postmenopausal women with endometrial polyps and to evaluate their significance. Methods. The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. Results. Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p∞0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. Conclusions. Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.
How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study
American Journal of Obstetrics and Gynecology, 2009
The objective of the study was to evaluate the prevalence of cancer and premalignant lesions in polyps on atrophic endometrium in asymptomatic postmenopausal women to compare these findings with a similar cohort of patients with abnormal uterine bleeding. STUDY DESIGN: One thousand one hundred fifty-two asymptomatic and 770 consecutive postmenopausal women with abnormal uterine bleeding were included in a retrospective multicenter study. Recruited patients underwent hysteroscopic polypectomy based on a sonohysterographic or hysteroscopic diagnosis. The pathologic report was the main outcome measure.
Journal of Minimally Invasive Gynecology, 2009
To estimate the prevalence, 1-year regression rate, and clinical significance of endometrial polyps in women aged 45 to 50 years. Design: Cross-sectional study (Canadian Task Force II-2). Setting: University teaching hospital. Patients: Two hundred fifty-seven of 1000 randomly selected women aged 45 to 50 years. Interventions: Transvaginal ultrasonography and saline infusion sonography were performed in all study participants and were repeated in women with endometrial polyps after 12 months. Polyps present at follow-up were removed by hysteroscopic polyp resection. Measurements and Main Results: Endometrial polyps were diagnosed in 31 women (12.1%). At 1 year, the polyp regression rate was 27%. Myomas occurred more often in women with endometrial polyps, and women with polyps experienced significantly heavier periodic bleeding compared with women without polyps. Conclusion: Our study findings suggest that endometrial polyps are common in women aged 45 to 50 years and that women with such polyps experience heavier periodic bleeding. Although some polyps seem to regress spontaneously during 1-year follow-up, most seem to persist.