Endometrial polyp
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2008-06-23T02:28:28Z
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{{Infobox_Disease
| Name = Endometrial polyp
| Image = Polyp.Uterus.jpg
| Caption = Endometrial polyp, viewed by sonography.
| DiseasesDB =
| ICD10 = {{ICD10|N|84|0|n|80}}
| ICD9 = {{ICD9|621}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID =
}}
An '''endometrial polyp''' or '''uterine polyp''' is a [[polyp (medicine)|polyp]] or [[lesion]] in the lining of the uterus ([[endometrium]]) that takes up space within the uterine cavity. Commonly occurring, they are experienced by up to 10% of women.<ref name="PGU">{{cite book
| last =Bates
| first =Jane
| title =Practical Gynaecological Ultrasound
| publisher =[[Cambridge University Press]]
| date =2007
| pages =65
| url =http://www.google.co.uk/books?id=oZ3RYlRAoxgC&pg=PP1&d
| isbn = 1900151510}}</ref> They may have a large flat base ([[sessile]]) or be attached to the uterus by an elongated [[pedicle]] ([[pedunculated]]).<ref name="PGU" /><ref name="Mayo">
{{cite web
| title =Uterine polyps
| publisher =MayoClinic.com
| date =2006-04-27
| url =http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1
| accessdate =2007-10-20 }}</ref> Pedunculated polyps are more common than sessile ones.<ref name="SDS">{{cite book
| last =Sternberg
| first =Stephen S.
| coauthors =Stacey E. Mills, Darryl Carter
| title =Sternberg's Diagnostic Surgical Pathology
| publisher =Lippincott Williams & Wilkins
| date =2004
| pages =2460
| url =http://www.google.co.uk/books?id=ko3Hew4xaj4C&d
| isbn =0781740517 }}</ref> They range in size from a few millimeters to several centimeters.<ref name="Mayo" /> If pedunculated, they can protrude through the [[cervix]] into the [[vagina]].<ref name="PGU" /><ref name="Merck">{{cite web
| title =Dysmenorrhea: Menstrual abnormalities
| publisher =[[Merck Manual of Diagnosis and Therapy]]
| date =2005
| url =http://www.merck.com/mmpe/sec18/ch244/ch244d.html
| accessdate =2007-10-20 }}</ref> Small blood vessels may be present, particularly in large polyps.<ref name="PGU" />
==Cause and symptoms==
No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating [[estrogen]].<ref name="Mayo" /> They often cause no symptoms.<ref name="SDS" /> Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding ([[menorrhagia]]), and vaginal bleeding after [[menopause]].<ref name="Mayo" /><ref name="GPN>{{cite web
| title =Endometrial Polyp
| publisher =[[GPnotebook]]
| url =http://www.gpnotebook.co.uk/simplepage.cfm?ID=1214971910
| accessdate =2007-10-20 }}</ref> Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.<ref name="OGDT">{{cite book
| last =DeCherney
| first =Alan H.
| coauthors =Lauren Nathan
| title =Current Obstetric & Gynecologic Diagnosis & Treatment
| publisher =McGraw-Hill Professional
| date =2003
| pages =703
| url =http://books.google.com/books?id=9xD0inFiEIAC&pg=PA703&d
| isbn =0838514014 }}</ref> If the polyp protrudes through the cervix into the vagina, pain ([[dysmenorrhea]]) may result.<ref name="Merck" />
==Diagnosis==
Endometrial polyps can be detected by [[vagina]]l [[Gynecologic ultrasonography|ultrasound]] (sonohysterography), [[hysteroscopy]] and [[dilation and curettage]].<ref name="Mayo" /> Detection by ultrasonography can be difficult, particularly when there is [[endometrial hyperplasia]] (excessive thickening of the endometrium).<ref name="PGU" /> Larger polyps may be missed by curettage.<ref name="BBC">{{cite web
| last =Macnair
| first =Trisha
| title =Ask the doctor - Uterine polyps
| publisher =[[BBC]] Health
| url =http://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml
| accessdate = 2007-10-21 }}</ref>
==Treatment==
Polyps can be surgically removed using [[curettage]] or hysterescopy.<ref name="UCSF">{{cite web
| title =Uterine bleeding - Signs and Symptoms
| publisher =[[UCSF Medical Center]]
| date =2007-05-08
| url =http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html
| accessdate =2007-10-20 }}</ref> When curettage is performed, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping [[forceps]] at the beginning of the curettage procedure.<ref name="OGDT" /> 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.<ref name="OGDT" /> If [[cancer]]ous cells are discovered, a [[hysterectomy]] may be performed.<ref name="Mayo" /> A hysterectomy would usually not be considered if cancer has been ruled out.<ref name="OGDT" /> Whichever method is used, polyps are usually treated under [[general anesthetic]].<ref name="BBC" />
==Prognosis and complications==
Endometrial polyps are usually [[Benign tumor|benign]] although some may be [[precancerous]] or [[cancerous]].<ref name="Mayo" /> About 0.5% of endometrial polyps contain [[adenocarcinoma]] cells.<ref>{{cite book
| last =Rubin
| first =Raphael
| coauthors =David S Strayer
| title =Rubin's Pathology: Clinicopathologic Foundations of Medicine
| date =2007
| location =Lippincott Williams & Wilkins
| pages =806
| url = http://books.google.com/books?id=kD9VZ267wDEC&pg=RA3-PA805&d
| isbn = 0781795168}}</ref> Polyps can increase the risk of [[miscarriage]] in women undergoing [[IVF]] treatment.<ref name="Mayo" /> If they develop near the [[fallopian tube]]s, they may lead to difficulty in becoming pregnant.<ref name="Mayo" /> Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.<ref name="OGDT" /> Untreated, small polyps may regress on their own.<ref>{{cite web
| last = Kaunitz
| first = Andrew M.
| title = Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?
| work = Medscape Ob/Gyn & Women's Health
| publisher =
| date = 2002-08-26
| url = http://www.medscape.com/viewarticle/440353
| accessdate =2008-04-20 }}</ref>
==Risk factors and epidemiology==
Endometrial polyps usually occur in women in their 40s and 50s.<ref name="Mayo" /> Risk factors include [[obesity]], [[high blood pressure]] and a history of [[cervical polyp]]s.<ref name="Mayo" /> Taking [[tamoxifen]] or [[hormone replacement therapy]] can also increase the risk of uterine polyps.<ref name="Mayo" /><ref name="Dew">{{cite book
| last =Edmonds
| first =D. Keith
| coauthors =Sir John Dewhurst
| title =Dewhurst's Textbook of Obstetrics and Gynaecology
| publisher =[[Blackwell Publishing]]
| date =2006
| pages =637
| url =http://www.google.co.uk/books?id=450c5k81lEgC&d
| isbn =1405156678 }}</ref> The use of an [[IntraUterine System]] containing [[levonorgestrel]] in women taking Tamoxifen may reduce the incidence of polyps.<ref>{{cite journal
| last =
| first =
| authorlink =
| coauthors =
| title = Intrauterine Levonorgestrel Protects Against Uterine Effects of Tamoxifen
| journal = [[BJOG]]
| volume = 2007
| issue = 114
| pages = 1510–1515.
| publisher =
| location =
| date =
| url = http://www.medscape.com/viewarticle/567850
| accessdate =2008-04-20 }}
</ref> Endometrial polyps occur in up to 10% of women.<ref name="PGU" /> It is estimated that they are present in 25% of women with abnormal vaginal bleeding.<ref name="Dew" />
==Structure==
Endometrial polyps can be solitary or occur with others.<ref name="DSTTS">{{cite book
| last =Bajo Arenas
| first =José M.
| coauthors =Asim Kurjak
| title =Donald School Textbook Of Transvaginal Sonography
| publisher =Taylor & Francis
| date =2005
| pages =502
| url =http://books.google.com/books?id=N_QMGLWEgzgC&pg=PA503&d
| isbn =184214331X }}</ref> They are round or oval and measure between a few millimeters to several centimeters in diameter.<ref name="DSTTS" /><ref name="OGDT" /> They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.<ref name="OGDT" /> The polyps consist of dense, fibrous tissue ([[Stromal cell|stroma]]), blood vessels and glandlike spaces lined with endometrial [[epithelium]].<ref name="OGDT" /> 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.<ref name="DSTTS" /> Pedunculated polyps are more common than sessile ones.<ref name="SDS" />
==See also==
*[[Cervical polyp]]
*[[Uterine fibroids]]
==References==
{{reflist}}
{{Diseases of the pelvis, genitals and breasts}}
[[Category:Gross pathology]]
[[Category:Gynecology]]