Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment

Abstract

Objectives:To provide an updated literature overview about the pathophysiology, natural history, diagnosis and treatment of endometrial polyps (EPs). Findings in Brief: EPs are focal, sessile or pedunculated projections of endometrial lining, resulting from the hyperplastic overgrowths of endometrial glands and stroma around a vascular core. These are the most common intrauterine diseases, affecting up to 34.9% of the women during their lifetime. EPs may vary in size, location, histopathology, natural history and clinical presentation. Importantly, EPs are common in women suffering with infertility (i.e., up to 32% in patients undergoing in-vitro-fertilization) and are not exempt from risk of malignant transformation (occurring in about 3.1% of patients). For these reasons, EPs represent one of the most significant gynaecological problems worldwide. Trans-vaginal ultrasound has fair diagnostic accuracy for EPs, with sensitivity and specificity of 91% and 90%, respectively. Nevertheless, the current gold standard for EPs diagnosis is hysteroscopy, which allows a direct visualization of EPs size and morphology. Moreover, this technique enables safe EPs excision, with a low risk of incomplete tissue removal (about 1.9% and 4.3% in inpatient and outpatient settings, respectively), and variable recurrence rate based on individual risk factors (ranging between 2.5% and 43.6%). Besides hysteroscopy, other management options for EPs can be considered on a case by case basis. Conclusions: Our review may be helpful for updating clinicians' knowledge on the management of EPs.

Pólipos endometriales: diagnóstico y tratamiento

“…Una de ellas es la genética, ya que se han relacionado a translocaciones en los cromosomas 6 y 12, específicamente en las bandas 12q14-14 y 6p21, que afectan la proliferación celular, que dan lugar al sobrecrecimiento del endometrio y por consiguiente a los pólipos (Bullerdiek et al, 2022;Redondo et al, 2022). Incluso se puede describir la susceptibilidad genética como factor de riesgo, ya que pacientes con síndrome de Lynch y de Cowden se asocian a mayor riesgo de pólipos endometriales y de cáncer endometrial (Vieira et al, 2022).…”

“…Se sugiere un origen inflamatorio ya que existe evidencia de la presencia de metaloproteinasas de la matriz extracelular, que son proteínas involucradas con los procesos de proliferación y apoptosis celular en pacientes con pólipos endometriales, así como otras afecciones uterinas (Vieira et al, 2022).…”

“…Cuenta con sensibilidad y especificidad de 90% y 93%, respectivamente. (Vieira et al, 2022). Se deben evitar métodos de LATAM Revista Latinoamericana de Ciencias Sociales y Humanidades, Asunción, Paraguay.…”

Large-scale genome-wide association study to determine the genetic underpinnings of female genital tract polyps

“…Very little is known about the heritability and genetic background of FGT polyps. Genetic factors, including chromosomal translocations in 6p21-22, 12q13-15, or 7q22 regions, may contribute to polypoid morphology (Dal Cin et al ., 1995; Nijkang et al ., 2019; Vieira et al ., 2022), and genetic disorders like Lynch or Cowden syndrome have been reported to be accountable for the development of EPs (Vieira et al ., 2022). However, a recent study by Sahoo et al did not confirm the presence of chromosomal rearrangements in endometrial polyps (Sahoo et al ., 2022).…”

“…In contrast, endocervical polyps occur only in 2% to 5% of cases, whereas vaginal polyps are rarer (Tanos et al, 2017); therefore, limited evidence is available about their biology and clinical implications. Some known risk factors for the development of EPs are advanced age, hypertension, diabetes, obesity, hyperoestrogenism, administration of hormone replacement therapy (HRT), and tamoxifen (Vitale et al, 2021;Vieira et al, 2022). Nevertheless, the exact pathogenesis of FGT polyps remains unclear.…”