Endometrial polyps - PowerPoint PPT Presentation

1 / 18
About This Presentation
Title:

Endometrial polyps

Description:

endometrial intraepithelial carcinoma may be identified in an atrophic polyp. Benign polyp in a hysterectomy specimen ... Endometrial polyp (high power) ... – PowerPoint PPT presentation

Number of Views:2704
Avg rating:3.0/5.0
Slides: 19
Provided by: hgv
Category:

less

Transcript and Presenter's Notes

Title: Endometrial polyps


1
Endometrial polyps
  • Dr Shaun Monagle
  • MBBS 1991

2
Definition
  • Benign localised overgrowth of endometrial glands
    and stroma, covered by epithelium, projecting
    above the adjacent epithelium
  • Clonal lesions
  • chromosome 6

3
Clinical features
  • Prevalence 24
  • More common in women gt 40
  • Present with
  • intermenstrual or post-menopausal bleeding
  • Infertility
  • Persistent bleeding following curettage
  • Common association with Tamoxifen use

4
Pathological findings
  • Sessile or pedunculated
  • Size 1mm and beyond may fill the endometrial
    cavity and project through the cervical os
  • May be multiple
  • May originate anywhere, but most commonly fundus

5
polyp
6
Histopathology
  • Irregularly outlined glands that may be out of
    phase with endometrium
  • Fibrovascular stalk or fibrous stroma with
    numerous thick walled vessels
  • Metaplastic epithelium particularly squamous may
    be present
  • Those in the lower uterine segment may contain
    endocervical glands
  • Mesenchymal component contains endometrial
    stroma, fibrous tissue or smooth muscle.
  • Absence of cytological atypia
  • hyperplasia, carcinoma (any type) and
    carcinosarcoma may involve or be entirely
    confined to a polyp
  • endometrial intraepithelial carcinoma may be
    identified in an atrophic polyp

7
  • Benign polyp in a hysterectomy specimen
  • Note
  • Endometrial epithelium on three surfaces
  • Dilated glands
  • Fibrotic stroma
  • Scattered dilated thick walled blood vessels

8
  • Endometrial polyp
  • Note
  • Dilated thick-walled blood vessels
  • Stromal fibrosis (less than previous image)
  • Proliferative endometrial glands

9
Endometrial polyp (low power)features cystically
dilated glands of various sizes and shapes
10
Endometrial polyp (high power)characteristic
features of thick walled blood vessels in a
fibrous core
11
Classification
  • Morphologically diverse lesions that are
    difficult to subclassify.
  • Most are either hyperplastic, atrophic or
    functional.
  • Hyperplastic
  • resemble diffuse non polypoid endometrial
    hyperplasia
  • no evidence that these have the same significance
    as diffuse hyperplasia, so best to avoid the term
    hyperplastic in the diagnosis
  • Atrophic
  • low columnar or cuboidal cells lining cystically
    dilated glands
  • typically in post-menopausal patients
  • Functional
  • resemble normal cycling endometrium
  • relatively uncommon

12
Tamoxifen related polyps
  • Larger, sessile with a honeycomb appearance
  • bizarre stellate shape of glands and frequent
    epithelial and stromal metaplasias
  • often periglandular stromal condensation
  • malignant transformation in up to 3
  • interestingly the cytogenetic profile is similar
    to non-iatrogenic lesions

13
Differential Diagnosis
  • Endometrial hyperplasia
  • diffuse process, majority of fragments in
    curettage, absence of thick walled vessels
  • polypoid endometrial carcinoma
  • malignant epithelial cells
  • adenofibroma
  • adenosarcoma
  • stromal cells cytologically atypical and
    mitotically active
  • stromal cells packed tightly around non malignant
    glands
  • leaf like pattern

14
Adenosarcoma
15
Adenosarcomanote the cellular stroma
16
Adenosarcomastromal cells condensing around
cytologically benign glands
17
Clinical behavior and treatment
  • At most 5 of polyps contain carcinoma
  • polyps may represent a marker of increased cancer
    risk, but no evidence suggests they are more
    likely to become cancer than the adjacent
    endometium
  • those containing atypical hyperplasia or
    carcinoma should be treated as per similar flat
    lesions

18
References
  • http//www.pathologyoutlines.com
  • Blausteins Pathology of the Female Genital
    Tract. 5th Edition. RJ Kurman. Springer-Verlag
    New York. 2002.
  • Differential Diagnosis in Surgical Pathology.
    Haber, Gattuso, Spitz and David. Saunders, 2002
  • WHO Classification of Tumour. Pathology and
    Genetics. Tumours of the breast and female
    genital organs. Tavassoli and Devilee. IARC
    Press, 2003
  • Sternbergs Diagnostic Surgical Pathology, 4th
    edition. SE Mills. Lippincott, Williams and
    Wilkins, 2004
Write a Comment
User Comments (0)
About PowerShow.com