Background: Endometrial polyps are generally benign, but can turn into premalignant or malignant lesions. Advanced age, menopausal status, abnormal uterine bleeding, polyp size, obesity, hypertension, diabetes, hormone therapy, breast cancer, and tamoxifen use are risk factors. Objective: The aim of this study was to determine the prevalence of malignant lesions on endometrial polyps with resection by hysteroscopy in both pre- and postmenopausal women, and risk factors for malignant transformation. Materials and Methods: This was a retrospective study with 303 women who underwent hysteroscopy-guided polypectomy in 2012 at the hospital of the University of Campinas (UNICAMP), Brazil. Polyps were classified as either benign or malignant. The variables analyzed were age, parity, body mass index, symptoms (asymptomatic, bleeding) associated pathologies (arterial hypertension, diabetes mellitus, breast cancer), endometrial line, and size of the polyp. Frequency, medians, and standard deviation of the study variables were obtained and risk factors for malignant transformation were subjected to multivariate analysis with the odds ratio (OR) adjusted to a 95% confidence interval. Results: Women had a median age of 58 ± 11 years, were 9.6 ± 8.5 years' old since menopause. Histopathologic analyses showed 6% of malignant and premalignant lesions. Risk factors associated with malignancy were age >60 (OR: 2.2; confidence interval [CI] 95%: 1.05–4.71) and postmenopausal bleeding (OR: 4.0; CI95%: 1.92–8.44). Multiparity appeared to be a protective factor (OR: 0.3; CI95%: 0.16–0.70). Conclusions: The malignancy transformation in endometrial polyps rate was low. Risk factors associated were postmenopausal bleeding and advanced age. Multiparity was the protective factor found. (J GYNECOL SURG 32:226)
Get full access to this article
View all access options for this article.
References
1.
RosaiJ, AckermanLV. Risk of malignancy in endometrial polyps. In: RosaiJ, ed. Rosai and Ackerman's Surgical Pathology, 9th ed. St. Louis: Mosby, 2004:3080.
ShermanME, MazurMT, KurmanRJ. Benign diseases of the endometrium. In: KurmanRJ, ed. Blaustein's Pathology of the Female Genital Tract. New York: Springer-Verlag, 2002:421.
4.
MuzaffarM, AkhtarKA, YasminS, et al.Menstrual irregularities with excessive blood loss: A clinico-pathological correlation. J Pak Med Assoc, 2005; 55:486.
DreislerE, Stampe SorensenS, IbsenPH, LoseG. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound Obstet Gynecol, 2009; 33:102.
7.
LeeSC, KaunitzAM, Sanchez-RamosL, RhatiganRM. The oncogenic potential of endometrial polyps: A systematic review and meta-analysis. Obstet Gynecol, 2010; 116:1197.
8.
BaiocchiG, ManciN, PazzagliaM, et al.Malignancy in endometrial polyps: A 12-year experience. Am J Obstet Gynecol, 2009; 201:462.e1.
9.
FerrazziE, ZupiE, LeoneFP, et al.How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol, 2009; 200:235.e1.
10.
Costa-PaivaL, GodoyCEJr, AtunesAJr, CaseiroJD, ArthusoM, Pinto-NetoAM. Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause, 2011; 18:1278.
11.
AntunesAJr, Costa-PaivaL, ArthusoM, CostaJV, Pinto-NetoAM. Endometrial polyps in pre- and postmenopausal women: Factors associated with malignancy. Maturitas, 2007; 57:415.
12.
WangJH, ZhaoJ, LinJ. Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: Management strategies. J Minim Invasive Gynecol, 2010; 17:53.
13.
CavkaytarS, KokanaliMK, CeranU, TopcuHO, SirvanL, DoganayM. Roles of sonography and hysteroscopy in the detection of premalignant and malignant polyps in women presenting with postmenopausal bleeding and thickened endometrium. Asian Pac J Cancer Prev, 2014; 15:5355.
14.
GregoriouO, KonidarisS, VrachnisN, et al.Clinical parameters linked with malignancy in endometrial polyps. Climateric, 2009; 12:454.
15.
Van den BoschT, Van SchoubroeckD, AmeyeL, De BrabanterJ, Van HuffelS, TimmermanD. Ultrasound assessment of endometrial thickness and endometrial polyps in women on hormonal replacement therapy. Am J Obstet Gynecol, 2003; 188:1249.
16.
DibiRP, ZettlerCG, PessiniSA, AyubAV, de AlmeidaSB, da SilveiraGP. Tamoxifen use and endometrial lesions: Hysteroscopic, histological, and immunohistochemical findings in postmenopausal women with breast cancer. Menopause, 2009; 16:293.
17.
BineshF, AkhavanA, BehniafardN, JalilianS. Endometrial adenocarcinoma: Clinicopathologic and survival characteristics in Yazd, Iran. Asian Pac J Cancer Prev, 2014; 15:2797.
18.
TrimbleCL, KaudererJ, ZainoR, et al.Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study. Cancer, 2006; 106:812.
19.
DeWaayDJ, SyropCH, NygaardIE, DavisWA, Van VoorhisBJ. Natural history of uterine polyps and leiomyomata. Obstet Gynecol, 2002; 100:3.
20.
American Association of Gynecologic Laparoscopists (AAGL). AAGL practice report: Practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol, 2012; 19:3.
21.
SavelliL, De IacoP, SantiniD, RosatiF, GhiT, PignottiE, BovicelliL. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol, 2003; 188:927.
22.
SAS Institute.. The SAS system for Windows: Release 9.2. Cary, NC: SAS Institute, 2011.
23.
Brazil. Ministry of Health. VIGITEL Brazil 2010: Surveillance risk factors and protection for chronic diseases through telephone interviews [in Portugese]. Online document at: http://portal.saude.gov.br/portal/arquivos/pdf/vigitel 180411 Accessed December19, 2013.
24.
JindalA, MohiMK, KaurM, KaurB, SinglaR, SinghS. Endometrial evaluation by ultrasonography, hysteroscopy and histopathology in cases of breast carcinoma on tamoxifen therapy. J Midlife Health, 2015; 6:59.
25.
Pérez-MedinaT, SalazarFJ, San-FrutosL, et al.Hysteroscopic dymanic assessment of the endometrium in patients treated with long term tamoxifen. J Minim Invasive Gynecol, 2011; 18:349.
