Endometrial polyp 1699062 221109587 2008-06-23T02:28:28Z DOI bot 6652755 Citation maintenance. Initiated by [[User:Fconaway|Fconaway]]. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{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]]