3.
5 GYNECOLOGY
ENDOMETRIAL POLYPS
CASE PRESENTATION
ENDOMETRIAL POLYPS
• localized overgrowths of endometrial glands and stroma
that project beyond the surface of the endometrium
• soft; pliable; may be single or multiple
• Most arise from the fundus of the uterus.
• Polypoid hyperplasia
o benign
o numerous small polyps are discovered
throughout the endometrial cavity
• vary from few millimeters to several centimeters in
diameter
o single large polyp may fill endometrial cavity
• broad base (sessile) or attached by slender pedicle
(pedunculated)
• all age groups; peak incidence: ages of 40-49
• prevalence in reproductive-age women is 20-25%
• unknown cause (associated with endometrial hyperplasia
 unopposed estrogen)
• majority are asymptomatic
• if symptomatic, associated with abnormal bleeding
patterns
o menorrhagia
o premenstrual and postmenstrual staining
o scanty postmenstrual spotting
• pedunculated endometrial polyp with long pedicle may
protrude from the external cervical os
• if large, may contribute to infertility
• succulent and velvety with large central vascular core
• color is usually gray or tan but may be red or brown
• Histologically, has 3 components:
o endometrial glands
o endometrial stroma
o central vascular channels
Note cystic glands in the polyp.
The fibrous stroma of the polyp
contrasts with the cellular
stroma of the adjacent
endometrium.
• Epithelium identified on three sides, like a peninsula.
• two thirds- immature endometrium that does not respond
to cyclic changes in circulating progesterone
o differs from surrounding endometrium
o “Swiss cheese” cystic hyperplasia during all
phases of menstrual cycle
• one third- functional endometria that undergo cyclic
histologic changes
• Tip of prolapsed polyp often undergoes squamous
metaplasia, infection, or ulceration.
CAPILI
Endometrial polyp showing multiple cystic glands with
flattened epithelial lining.
• Clinician can’t distinguish whether the abnormal bleeding
is from polyp or is secondary to coexisting endometrial
hyperplasia.
• 1 in 4 reproductive-age women w/ abnormal bleeding will
have endometrial polyps discovered in her uterine cavity.
• Malignancy related to patient’s age and often of low stage
and grade. (Incidence 3-4%)
• 20% of uteri removed for endometrial carcinoma
• Unusual polyps in association with chronic administration
of nonsteroidal antiestrogen tamoxifen.
• Endometrial abnormalities associated with chronic
tamoxifen therapy
o Polyps 20-35%
o Endometrial hyperplasia 2-4%
o Endometrial carcinoma 1-2%
• Diagnosis is not usually established until uterus is opened
following hysterectomy for other reasons
• May be discovered by:
o vaginal ultrasound
o w/ or w/o hydrosonography
o hysteroscopy
o hysterosalpingography
During the diagnostic workup of woman with refractory
case of abnormal uterine bleeding or pelvic mass.
Endocervical polyp was seen at
hysteroscopy
• Benign: well-defined, uniformly hyperechoic mass <2 cm
diameter, identified by vaginal ultrasound within
endometrial cavity
• Management: REMOVAL by hysteroscopy with D&C
• Because of the frequent association of endometrial polyps
and other endometrial pathology, it is important to
examine histologically both polyp and associated
endometrial lining.
• Because of their mobility, often tend to elude the curette
• Post-curettage hysteroscopic studies have demonstrated
that routine use of long, narrow polyp forceps at the
curettage at best results in discovery and removal of only
1 in 4 endometrial polyps.
• Differential diagnosis:
o submucous leiomyomas
o adenomyomas
o retained products of conception
o endometrial hyperplasia
o carcinoma
o uterine sarcomas
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