Endometrial Polyps

 

Q. Definitions :-Endometrial polyps are localized overgrowths of   endometrial glands and stroma around vascular core that protrude from the surface of the endometrium into the uterine cavity.

Q.2: Histological Classification of Endo Polyps:-They can be A) hyperplastic (similar to endometrial hyperplasia), B) atrophic (cystically dilated atrophic glands), or C) functional (undergo cyclical changes). Polyps may be large (>2 cm), multiple, or show molecular alterations .

Single or multiple polyps (20% of the times, ) can occur that range from a few millimetres to several centimetres in size. They can be sessile or pdunculated they are found in the uterine fundus midwall cornua and cervix.

Q.3 Age :-Endometrial polyps The prevalenceof polyps can range from 10 to 24 % among women undergoing endometrial biopsy or hysterectomy to 8 to 36 % in postmenopausal women on tamoxifen therapy but polyps  are rare among women younger than 20 years of age. The incidence rises steadily with increasing age, picks in the fifth decade of life, and gradually declines after menopause.

.Q.4:  Who are more subjected to polyp formations? 1) PCOS women as a delayed squeal. 2) Women who are on Tamoxifen therapy in postmenopausal tears and 3) Women with Lynch syndrome may have an increased incidence of endometrial polyps compared to the general population

Genetics of Lynch syndrome :.In Lynch syndrome  there are several theories on the molecular mechanisms playing a role in the development of endomaterial polyps: monoclonal endomaterial hyperplasia gene mutations,  

Overexpression of endometrial aromatase and, like in leiomyomas, cytogenetic rearrangements and rearrangements in the HMG family of transcription factors

Q.5 How best to diagnose? :  careful search in endometrial lining by Sonography will pick up most cases . Saline infusion sonography is another avenue but the dictum is for and persistent AUB or metrorrhagia if there is no systemic caused than Hysteroscopy is best to visualize the number and location of polyp.  Although endometrial polyps are responsible for approximately one-fourth of cases of abnormal genital bleeding (monorrhagia, postmenopausal bleeding, prolapsed through the cervical os, and breakthrough bleeding during hormonal therapy) in both premenopausal and postmenopausal women [1], many polyps are asymptomatic .

 

Most cases have spontaneous regression of their polyps at the second scan without any form of therapy whatsoever , but a few women may progress to new polyp formation  over the couple of yrs. It has been observed that polyps which were larger than 1 cm at initial diag à were least likely to regress, and hormone use becomes a mandatory

Did not appear to affect the natural history of the polyps. The problem is that the natural course of polyps (I mean if ignored & left untreated) is variable.