Endometrial polyp
| Endometrial polyp | |
|---|---|
| Classification and external resources | |
 Endometrial polyp, viewed by sonography. |
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| ICD-10 | N84.0 |
| ICD-9 | 621 |
An endometrial polyp or uterine polyp is a mass in the inner lining of the uterus.[1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).[1][2] Pedunculated polyps are more common than sessile ones.[3] They range in size from a few millimeters to several centimeters.[2] If pedunculated, they can protrude through the cervix into the vagina.[1][4] Small blood vessels may be present, particularly in large polyps.[1]
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[edit] 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.[2] They often cause no symptoms.[3] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.[2][5] 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.[6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[4]
[edit] Diagnosis
Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.[2] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).[1] Larger polyps may be missed by curettage.[7]
[edit] Treatment
Polyps can be surgically removed using curettage with or without hysteroscopy.[8] When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.[6] Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through the cervix. If it is a large polyp, it can be cut into sections before each section is removed.[6] If cancerous cells are discovered, a hysterectomy (surgical removal of the uterus) may be performed.[2] A hysterectomy would usually not be considered if cancer has been ruled out.[6] Whichever method is used, polyps are usually treated under general anesthetic.[7]
[edit] Prognosis and complications
Endometrial polyps are usually benign although some may be precancerous or cancerous.[2] About 0.5% of endometrial polyps contain adenocarcinoma cells.[9] Polyps can increase the risk of miscarriage in women undergoing IVF treatment.[2] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.[2] Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[6] Untreated, small polyps may regress on their own.[10]
[edit] Risk factors and epidemiology
Endometrial polyps usually occur in women in their 40s and 50s.[2] Risk factors include obesity, high blood pressure and a history of cervical polyps.[2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.[2][11] The use of an IntraUterine System containing levonorgestrel in women taking Tamoxifen may reduce the incidence of polyps.[12] Endometrial polyps occur in up to 10% of women.[1] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.[11]
[edit] Structure
Endometrial polyps can be solitary or occur with others.[13] They are round or oval and measure between a few millimeters and several centimeters in diameter.[6][13] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.[6] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.[6] 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.[13] Pedunculated polyps are more common than sessile ones.[3]
[edit] See also
[edit] References
- ^ a b c d e f Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0.
- ^ a b c d e f g h i j k l "Uterine polyps". MayoClinic.com. 2006-04-27. http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1.
- ^ a b c Sternberg, Stephen S.; Stacey E. Mills, Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0781740517. http://www.google.co.uk/books?id=ko3Hew4xaj4C&d.
- ^ a b Dysmenorrhea: Menstrual abnormalities at Merck Manual of Diagnosis and Therapy Professional Edition
- ^ "Endometrial Polyp". GPnotebook. http://www.gpnotebook.co.uk/simplepage.cfm?ID=1214971910. Retrieved 2007-10-20.
- ^ a b c d e f g h DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0838514014. http://books.google.com/?id=9xD0inFiEIAC&pg=PA703.
- ^ a b Macnair, Trisha. "Ask the doctor - Uterine polyps". BBC Health. http://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml. Retrieved 2007-10-21.
- ^ "Uterine bleeding - Signs and Symptoms". UCSF Medical Center. 2007-05-08. http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html. Retrieved 2007-10-20.
- ^ Rubin, Raphael; David S Strayer (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 806. ISBN 0781795168. http://books.google.com/?id=kD9VZ267wDEC&pg=RA3-PA805.
- ^ Kaunitz, Andrew M. (2002-08-26). "Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?". Medscape Ob/Gyn & Women's Health. http://www.medscape.com/viewarticle/440353. Retrieved 2008-04-20.
- ^ a b Edmonds, D. Keith; Sir John Dewhurst (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing. p. 637. ISBN 1405156678. http://www.google.co.uk/books?id=450c5k81lEgC&d.
- ^ Chan SS, Tam WH, Yeo W, et al. (2007). "A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women". BJOG 114 (12): 1510–5. doi:10.1111/j.1471-0528.2007.01545.x. PMID 17995495.
- ^ a b c Bajo Arenas, José M.; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 184214331X. http://books.google.com/?id=N_QMGLWEgzgC&pg=PA503.
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