The Oncogenic Potential of Endometrial Polyps

Lee, Stephanie Cruz; Kaunitz, Andrew M.; Sánchez-Ramos, Luis; Rhatigan, Ronald M.

doi:10.1097/aog.0b013e3181f74864

Cited by 189 publications

(64 citation statements)

References 49 publications

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“…Data from observational studies report that both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial cancer. 11 Estrogen-producing tumors, unopposed estrogen therapy, cirrhosis, and tamoxifen also may result in excess estrogen stimulation to the endometrium. Although tamoxifen is an antiestrogen in breast tissue, it can have estrogenic activity in the endometrium.…”

Section: Risk Factorsmentioning

confidence: 98%

“…Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial cancer. 11 Whereas sonohysterography also can detect these lesions, a tissue diagnosis may be warranted depending on the clinical context ( Figs. 1 and 2).…”

Section: Diagnosis Of Endometrial Cancermentioning

confidence: 99%

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Endometrial Cancer

Sorosky

2012

Obstetrics & Gynecology

343

305

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The epidemiology, prevention, diagnosis, treatment, prognosis, and new International Federation of Gynecology and Obstetrics staging system of endometrial carcinoma are reviewed. Endometrial cancer has increased 21% in incidence since 2008, and the death rate has increased more than 100% over the past two decades. Precursor lesions of complex hyperplasia with atypia are associated with an endometrial carcinoma in more than 40% of cases. Endometrial cancer in white women occurs at twice the incidence as in black women, but, stage for stage, black women have a less favorable prognosis. Preoperative imaging cannot accurately assess lymph node involvement. Gross examination of depth of myometrial invasion does not have the sensitivity, specificity, positive predictive value, or negative predictive value to select women who can have lymphadenectomy safely omitted from the surgical procedure. Although surgical staging remains the most accurate method of determining the extent of disease, the therapeutic value of pelvic lymphadenectomy has not been established. The anatomical extent of lymphadenectomy and the number of lymph nodes removed to establish prognostic and therapeutic benefit are controversial. Research efforts are directed at identifying women with early stage endometrial cancer who only require total hysterectomy and bilateral salpingo-oophorectomy. Minimally invasive surgical techniques have become established as standard therapy for treating women with endometrial cancer. Women with a family history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Conservative treatment to allow for childbearing is possible in select situations. Women with endometrial cancer should be managed by physicians experienced in the complex multimodality treatment of this disease.

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Section: Risk Factorsmentioning

confidence: 98%

Section: Diagnosis Of Endometrial Cancermentioning

confidence: 99%

Endometrial Cancer

Sorosky

2012

Obstetrics & Gynecology

343

305

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“…In our previous study, a higher occurrence of premalignant and malignant polyps was observed in postmenopausal females aged over 60 years with vaginal bleeding (5). Other studies have also shown an association between malignancy and certain risk factors, including obesity, arterial hypertension, diabetes mellitus and tamoxifen use (4,6). …”

Section: Introductionmentioning

confidence: 94%

“…The malignancy rate associated with endometrial polyps is low, and in a recent meta-analysis on the oncogenic potential of polyps, it was observed that the malignancy rate of endometrial polyps ranged between 0.8 and 8% in the different studies analyzed (4). In our previous study, a higher occurrence of premalignant and malignant polyps was observed in postmenopausal females aged over 60 years with vaginal bleeding (5).…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps: A comparison between benign and malignant polyps in postmenopausal patients

et al. 2014

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The aim of the present study was to evaluate estrogen receptor (ER) and progesterone receptor (PR) expression in the glandular epithelium and stroma of benign and malignant endometrial polyps of postmenopausal patients. A total of 1,050 females underwent surgical hysteroscopy at the Professor Dr José Aristodemo Pinotti Women’s Hospital, Center for Integral Attention to Women’s Health of the State University of Campinas, between January 1998 and December 2008. Of the total number, 390 postmenopausal females with endometrial polyps were included in the study. Polypoid lesions were histologically classified as benign lesions (endometrial polyps and polyps with non-atypical simple hyperplasia or non-atypical complex hyperplasia) and premalignant and malignant lesions (polyps with atypical simple hyperplasia or atypical complex hyperplasia and carcinomatous polyps). ER and PR expression was evaluated by immunohistochemistry according to cell staining, intensity of nuclear staining and final score. The final score for receptor expression was compared between the benign and premalignant/malignant polyps. The prevalence of malignancy in endometrial polyps was 7.1% and was associated with postmenopausal bleeding. Only the final score for ER expression in the stroma of endometrial polyps was higher in the benign group than in the premalignant/malignant group, and this difference was significant. However, no difference was identified in PR expression. In addition, the risk of malignancy in endometrial polyps was significantly higher when the expression of ER and PR was negative in the stromal component of the polyp (P<0.01). The malignancy of endometrial polyps was also associated with a low expression of stromal ER, however, PR expression did not show any association with the risk of malignancy.

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“…A recent meta-analysis by Lee et al [29] showed that important risk factors for malignancy in endometrial polyps are postmenopausal status and symptomatic vaginal bleeding. Their meta-analysis included 10,572 patients and found that 3.57% of polyps were malignant or showed complex atypical hyperplasia, but that the proportion increased to 5.42% in postmenopausal women and 4.15% in women with symptomatic vaginal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Endometrial Thickness in 1,500 Asymptomatic Postmenopausal Women Not on Hormone Replacement Therapy

Hartman

Wolfman

Nayot

et al. 2013

Gynecol Obstet Invest

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Objective: To determine the normal endometrial thickness (ET) on transvaginal ultrasound (TVUS) of asymptomatic postmenopausal women not on hormone replacement therapy. A subgroup that was determined to be suspicious for having an endometrial polyp was compared with the remainder. Methods: This prospective study selected 1,500 consecutive asymptomatic postmenopausal women receiving TVUS assessment from January to August 2010. ET was recorded. Results were divided into those with a normal-appearing lining (n = 1,399) and those suspicious for polyp (n = 101). Results for the entire sample were obtained and the groups were compared using independent samples t tests. Results: Of 1,500 women aged 45-95 years, 77.1% had an ET of ≤4 mm and 92% were ≤5 mm. Independent samples t tests were performed to compare the mean age and mean ET based on polyp status (i.e. with or without a possible polyp). There was a significant difference in mean age, 67.71 vs. 62.36 years (p < 0.01) and mean ET 8.02 vs. 3.40 mm (p < 0.01) between groups. Conclusions: 92% of asymptomatic postmenopausal women not on hormone replacement therapy had an ET of ≤5 mm. The mean ET was 3.71 ± 1.9 mm. However, a significant group, 6.7%, had an endometrial lining suspicious for polyp. These women had a significant increase in mean age and ET.

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The Oncogenic Potential of Endometrial Polyps

Abstract: Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial malignancy.

Cited by 189 publications

References 49 publications

Endometrial Cancer

Endometrial Cancer

Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps: A comparison between benign and malignant polyps in postmenopausal patients

Endometrial Thickness in 1,500 Asymptomatic Postmenopausal Women Not on Hormone Replacement Therapy

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