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Benign endometrial polyp

From Libre Pathology

Uterine polyp and endometrial polyp redirect here.

Benign endometrial polyp
Benign endometrial polyp, abbreviated BEP, is a common Diagnosis in short
diagnosis in endometrial specimens.

It is also simply known as endometrial polyp which is a

somewhat ambiguous descriptor as not all endometrial polyps
are benign.

Contents
1 General
2 Gross
3 Microscopic Endometrial polyp (right - fibrotic stroma). H&E
3.1 Images stain.
4 IHC
5 Sign out
5.1 Non-proliferative LM large blood vessels (muscular), fibrotic
5.1.1 Extensive surface denudation stroma, polypoid shape (epithelium on
5.1.2 Suggestive of polyp three sides), +/-gland dilation
5.2 Proliferative LM DDx adenofibroma, cervical polyp - have
5.3 Polyp with disordered proliferative phase in
endocervical mucosa, lower uterine
the background
5.4 Clinically a polyp but not apparent on segment, endometrial carcinoma, simple
histology endometrial hyperplasia, disordered
6 See also proliferative endometrium
7 References
Gross polypoid mass in the endometrial cavity
Site endometrium

General
Associated invasive breast cancer - specifically
Very common. Dx assoc. with tamoxifen
May be a cause of menorrhagia (heavy & long menses). Clinical bleeding (menorrhagia)
Malignant endometrial polyps are uncommon: <2% in history
one series of 965 cases.[1]
Prevalence common

Gross Prognosis benign

Clin. DDx leiomyoma, other polypoid masses
Polypoid mass in the endometrial cavity.

Notes:

May be large - 10 cm.[2]

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Gross DDx:

Secretory phase endometrium.[3]

Pedunculated leiomyoma.

Microscopic
Features - diagnostic criteria:[3]

1. Large blood vessels (muscular) - key feature.

2. Fibrotic stroma - key feature.
3. Polypoid shape - epithelium on three sides.
May not be seen... as polyp is fragmented on removal.

Glandular changes common:[3]

Endometrial glands may be out of phase with surrounding endometrium.

Often proliferative.
+/-Cystic dilation of glands/unusual shapes
Simple endometrial hyperplasia should not be diagnosed in a polyp!
+/-Focal gland crowding.

Notes:

1. Apparently benign polyps should be examined closely at the surface for in situ & invasive malignancies.
2. Stroma often cellular.

DDx:

Adenofibroma.
Cervical polyp - have endocervical mucosa.
Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.[3]
Endometrial carcinoma - esp. serous carcinoma of the endometrium.
Simple endometrial hyperplasia.
Disordered proliferative endometrium.

Images

Endometrial polyp - Endometrial polyp - Endometrial polyp - Endometrial polyp -

low mag. (WC) intermed. mag. (WC) intermed. mag. (WC) low mag. (WC)

IHC
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p16 stroma usually +ve.[4]

Sign out
Non-proliferative

ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP.

ENDOMETRIUM ("POLYPS"), REMOVAL:

- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
WITHOUT APPARENT PROLIFERATIVE ACTIVITY.

Extensive surface denudation

POLYP, ENDOMETRIUM, REMOVAL:

- BENIGN LARGE ENDOMETRIAL POLYP WITH EXTENSIVE DENUDATION OF THE SURFACE
AND INFLAMMATION, WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
- BLOOD (ABUNDANT), FIBRIN AND CELLULAR DEBRIS.

Suggestive of polyp

ENDOMETRIUM, CURETTAGE:
- POLYPOID NONPROLIFERATIVE ENDOMETRIUM WITH FOCALLY PROMINENT SMALL BLOOD VESSELS AND
FIBROUS STROMA, SUGGESTIVE OF BENIGN POLYP.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.

Proliferative

ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE ACTIVITY.

Note:

It is useful to comment on whether non-polypoid endometrium is proliferative (if present), esp. in

menopausal women.[3]

Polyp with disordered proliferative phase in the background

ENDOMETRIUM, BIOPSY:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE GLANDS AND FOCAL GLAND DILATION.
- SUSPICIOUS FOR A BACKGROUND OF DISORDERED PROLIFERATIVE
PHASE ENDOMETRIUM, SEE COMMENT.
- STRIPPED BENIGN ENDOCERVICAL EPITHELIUM.

COMMENT:
The endometrium sampled is proliferative with focal gland dilation throughout. The
features of a polyp (large muscular blood vessels, fibrous stroma and polypoid fragments of
endometrium) are only focally present, suggesting there is a background of disordered
proliferative phase endometrium. Clinical correlation is suggested.

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Clinically a polyp but not apparent on histology

UTERUS (POLYP), REMOVAL:

- LARGE FRAGMENT OF SECRETORY PHASE ENDOMETRIUM WITH LARGE BLOOD VESSELS, A
NON-FIBROUS STROMA AND NO DISCERNIBLE SURFACE EPITHELIUM.

See also
Endometrium.

References

1. Tang, Z.; Zhou, R.; Bao, D.; Liu, C.; Wei, L. (Mar 2014). "[Clinical characteristics of 42 cases of malignant endometrial
polyps].". Zhonghua Fu Chan Ke Za Zhi 49 (3): 204-7. PMID 24820306 (http://www.ncbi.nlm.nih.gov/pubmed/2482030
6).
2. Unal, B.; Doğan, S.; Karaveli, FŞ.; Simşek, T.; Erdoğan, G.; Candaner, I. (2014). "Giant Endometrial Polyp in a
Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding.". Case Rep Obstet Gynecol 2014: 518398.
doi:10.1155/2014/518398 (http://dx.doi.org/10.1155%2F2014%2F518398). PMID 25093134 (http://www.ncbi.nlm.nih.g
ov/pubmed/25093134).
3. McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings." (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/). J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702 (http://dx.d
oi.org/10.1136%2Fjcp.2005.029702). PMC 1860448 (http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez
&artid=1860448). PMID 16873562 (http://www.ncbi.nlm.nih.gov/pubmed/16873562).
//www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/.
4. Moritani, S.; Ichihara, S.; Hasegawa, M.; Iwakoshi, A.; Murakami, S.; Sato, T.; Okamoto, T.; Mori, Y. et al. (Aug 2012).
"Stromal p16 expression differentiates endometrial polyp from endometrial hyperplasia.". Virchows Arch 461 (2): 141-8.
doi:10.1007/s00428-012-1276-1 (http://dx.doi.org/10.1007%2Fs00428-012-1276-1). PMID 22772724 (http://www.ncbi.
nlm.nih.gov/pubmed/22772724).

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