- Endometrial polyp
Endometrial polyps can be detected by
vaginal ultrasound (sonohysterography), hysteroscopyand dilation and curettage. Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia(excessive thickening of the endometrium). Larger polyps may be missed by curettage.cite web
title =Ask the doctor - Uterine polyps
accessdate = 2007-10-21 ]
Polyps can be surgically removed using
curettageor hysterescopy.cite web
title =Uterine bleeding - Signs and Symptoms
UCSF Medical Center
accessdate =2007-10-20 ] When curettage is performed, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping
forcepsat the beginning of the curettage procedure. During hysterescopy, the polyp can be visualized and removed through the cervix. If it is a large polyp, it can be cut into sections before each section is removed. If cancerous cells are discovered, a hysterectomymay be performed. A hysterectomy would usually not be considered if cancer has been ruled out. Whichever method is used, polyps are usually treated under general anesthetic.
Prognosis and complications
Endometrial polyps are usually benign although some may be
precancerousor cancerous. About 0.5% of endometrial polyps contain adenocarcinomacells. [cite book
coauthors =David S Strayer
title =Rubin's Pathology: Clinicopathologic Foundations of Medicine
location =Lippincott Williams & Wilkins
url = http://books.google.com/books?id=kD9VZ267wDEC&pg=RA3-PA805&d
isbn = 0781795168] Polyps can increase the risk of
miscarriagein women undergoing IVFtreatment. If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant. Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent. Untreated, small polyps may regress on their own. [cite web
last = Kaunitz
first = Andrew M.
title = Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?
work = Medscape Ob/Gyn & Women's Health
date = 2002-08-26
url = http://www.medscape.com/viewarticle/440353
accessdate =2008-04-20 ]
Risk factors and epidemiology
Endometrial polyps usually occur in women in their 40s and 50s. Risk factors include
obesity, high blood pressureand a history of cervical polyps. Taking tamoxifenor hormone replacement therapycan also increase the risk of uterine polyps.cite book
first =D. Keith
coauthors =Sir John Dewhurst
title =Dewhurst's Textbook of Obstetrics and Gynaecology
isbn =1405156678 ] The use of an
IntraUterine Systemcontaining levonorgestrelin women taking Tamoxifen may reduce the incidence of polyps. [cite journal |author=Chan SS, Tam WH, Yeo W, "et al" |title=A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women |journal=BJOG |volume=114 |issue=12 |pages=1510–5 |year=2007 |pmid=17995495 |doi=10.1111/j.1471-0528.2007.01545.x |url=] Endometrial polyps occur in up to 10% of women. It is estimated that they are present in 25% of women with abnormal vaginal bleeding.
Endometrial polyps can be solitary or occur with others.cite book
last =Bajo Arenas
first =José M.
coauthors =Asim Kurjak
title =Donald School Textbook Of Transvaginal Sonography
publisher =Taylor & Francis
isbn =184214331X ] They are round or oval and measure between a few millimeters to several centimeters in diameter. They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red. The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial
epithelium. If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall. Pedunculated polyps are more common than sessile ones.
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