Malignancy in Endometrial Polyps: A 12-Year Experience

Abstract

Information is lacking from prospective studies on the incidence and risk factors for postoperative nerve injury after routine gynecologic surgery. In 2 retrospective studies, the reported risk of nerve injury from major gynecologic oncologic procedures was estimated to be between 1.1% and 1.9%. This prospective cohort study evaluated the overall incidence and time course of pelvic nerve injury in a population of 616 female patients undergoing elective gynecologic surgery for benign and malignant conditions. The study was conducted between 2007 and 2008 at a single academic medical center.Before surgery, neurologic evaluation found preexisting lower extremity neuropathies in 12 (1.9%) participants. After surgery, 14 new peripheral nerve injuries were observed in 11 patients; the overall incidence of postoperative neuropathy was 1.8% (11/616), with a 95% confidence interval of (1.0-3.2). The neuropathies detected included 1 ilioinguinal/ iliohypogastric, 1 saphenous, 1 genitofemoral, 1 common fibular, 5 lateral femoral cutaneous, and 5 femoral. There was a complete resolution of neuropathic symptoms in 91% (10/11) of the patients at a median time of 31.5 days (range: 1 day to 6 months).These findings are consistent with other studies suggesting a low risk of new onset neurologic injury after gynecologic surgery. GYNECOLOGYVolume 65, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Hypoestrogenism in postmenopausal women results in skin atrophy with a decrease in both elasticity and skin thickness. The fragility of the skin in aging women may be responsible for the reported 50% or more increase in major laparoscopic complications during the initial entry into the female abdomen. Several first-entry techniques in laparoscopy have been investigated to minimize entry-related complications. The Veress needle approach is the standard method used by most gynecologists. A promising new method is the direct optical access (DOA) which uses optically-guided trocars to provide visual guidance during entry. These 2 techniques have not been compared.The aim of this prospective randomized study was to evaluate the efficacy and safety of these 2 methods in postmenopausal women. The study was conducted at multiple European gynecology centers between 2004 and 2008. A total of 186 postmenopausal women scheduled to undergo laparoscopy for simple, persistent postmenopausal ovarian cysts were randomized to 2 groups: group I (n ϭ 89) was assigned to surgical entry using DOA, and group 2 (n ϭ 97) was assigned to entry using the Veress needle method. The 2 procedures were compared for the following parameters: the time needed for achieve adequate abdominal access, the occurrence of major and minor vascular and bowel injuries, and blood loss during laparoscopic access. Operative Gynecology 91 92Obstetrical and Gynecological Survey ABSTRACTMajor risk factors in the general surgical population for morbidity and mortality have been identified using a number of risk scoring systems. Such risk factors include older age, length of surgery,...

Thickness of preperitoneal fat as a predictor of malignancy in overweight and obese women with endometrial polyps

“…The present study, which was consistent with previously published data by Baiocchi et al (16), did not demonstrate any statistically significant difference between asymptomatic and symptomatic patients with regard to the presence of benign polyps and preneoplastic or neoplastic lesions. A potential explanation for this may be associated with the early diagnosis of polyps using transvaginal ultrasound, which is able to detect small polyps and endometrial thickness before they begin to bleed.…”

“…In previously published studies, advanced age (>60 years), menopausal status, HRT and AUB were observed to be risk factors for malignancy in women with EPs (4,7,(16)(17)(18)37). In the present study, an age of >60 years was significantly associated with the risk of malignant progression of EPs; however, none of the remaining clinical variables considered were found to demonstrate such an association.…”

“…The histopathological definitions of EP, hyperplasia and adenocarcinoma have been reported in a previous study (16 …”

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

“…These findings seem to be similar to those reported in previous studies in which malignancy rate was described to vary between 0.8 and 8 % [12,[19][20][21][22]. One study reported a high prevalence of hyperplasia without cytologic atypia (25.7 %) and a prevalence of hyperplasia with atypia (3.1 %), and it added that polyps represent a wide spectrum of alterations that range from normal endometrium to cancer [12].…”

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

“…In a meta-analysis performed by Lee et al 9 , it was determined that malignant endometrial polyps were present in 0.8 to 8% of the patients, depending on the population studied and the methods used for diagnosis and resection [10][11][12][13][14][15][16][17] . In postmenopausal women, there is a direct relationship between the size of endometrial polyps and the existence of atypical hyperplasia and endometrial carcinoma.…”