Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women

ObjectiveThe appropriate management of endometrial polyps in asymptomatic postmenopausal patients remains controversial. The aim of the study was to evaluate the relationship between endometrial polyp size and malignancy risk among asymptomatic postmenopausal women.MethodsThis observational retrospective study investigated 472 postmenopausal asymptomatic women who underwent hysteroscopic polypectomy between 2010 and 2014 (Canadian Task Force Classification II-3).ResultsOf the 472 women, premalignant and malignant lesions were found in 11 (2.33%) cases; four (0.84%) had endometrial carcinoma, and seven (1.49%) had atypical endometrial hyperplasia. The incidence of premalignant or malignant lesions among various cut-offs of polyp size (10, 15, 20 mm) was not significantly different.ConclusionIn the current series no significant risk factor for malignancy was found among different cut-offs of polyp size.     

Office Operative Hysteroscopy: An Update

Hysteroscopy is considered the gold standard for the evaluation of intracavitary pathology in both premenopausal and postmenopausal patients associated with abnormal uterine bleeding, as well as for the evaluation of infertile patients with suspected cavity abnormalities. Office-based operative hysteroscopy allows patients to resume activities immediately and successfully integrates clinical practice into a “see and treat” modality, avoiding the added risks of anesthesia and the inconvenience of the operating room. For 2017, the Centers for Medicare and Medicaid Services has provided a substantial increase in reimbursement for a select number of office-based hysteroscopic procedures. This review provides an update on the indications, equipment, and procedures for office hysteroscopy, as well as the management of complications that may arise within an office-based practice.     

Endometrial hyperplasia involving endometrial polyps: report of a series and discussion of the significance in an endometrial biopsy specimen

Objectives  Endometrial polyps are a common cause of abnormal uterine bleeding. Rarely, a hyperplasia, either complex or atypical in type, is identified within a polyp in a biopsy or polypectomy specimen. Currently, it is not known whether the hyperplasia is likely to be confined to the polyp or also involve nonpolypoid endometrium. We aim to assess the likelihood of hyperplasia being confined to an endometrial polyp.
Design  In this study, we identified 32 women from pathology archives in whom endometrial hyperplasia was present within a polyp. The number of endometrial polyps during the study period was 1031 and therefore 3.1% of all endometrial polyps diagnosed during the study period contained a hyperplasia.
Setting  A major teaching hospital in the UK.
Methods  The biopsies were retrieved from the pathology archives of Royal Group of Hospitals, Belfast, between 2000 and 2006. We traced any follow-up biopsy or hysterectomy specimens to evaluate the status of the surrounding endometrium.
Results  The hyperplasias were complex ( n = 23) or atypical ( n = 9) in type. In 14 of 27 (52%) women in whom nonpolypoid endometrium was available for histological evaluation, either on the original biopsy or in a follow-up specimen, hyperplasia involved the nonpolypoid endometrium, and in three other women, hyperplasia was present in a polyp in follow-up specimens. Women with atypical hyperplasia in a polyp were slightly more likely to have hyperplasia in the surrounding endometrium than those with complex hyperplasia.
Conclusions  Our study illustrates that the risk of endometrial hyperplasia in a polyp concurrently involving nonpolypoid endometrium is significant. We suggest a strategy for the management of women with hyperplasia identified within an endometrial polyp in a biopsy or polypectomy specimen.     

Risk Factors for Endometrial Carcinoma in Women with Postmenopausal Bleeding

ObjectivesMost patients with postmenopausal bleeding do not have endometrial cancer. The primary objective was to evaluate risk factors for endometrial cancer among postmenopausal women with bleeding.MethodsThis was a retrospective cross-sectional study. Women with postmenopausal bleeding presenting to a gynecology clinic were included in the study. Data on potential risk factors for endometrial cancer or atypical hyperplasia were collected. Univariate and multivariate analyses were performed to assess the risk factors.ResultsAmong 212 women studied, 24 (11.3%) women had endometrial cancer. There were 38 (17.9%) with cervical cancer and 3 (1.4%) with ovarian cancer. Women 55 or older had an odds ratio of 7.5 (95% CI 2.2 to 26.2) as compared to women below 55 years (p value = 0.002). Women with 2 or more episodes of postmenopausal bleeding had an odds ratio of 4.9 (95% CI 1.1 to 23.0) and those who had either diabetes or hypertension had an odds ratio of 3.1 (95% CI 1.3 to 7.4) of endometrial cancer as compared to those who did not.ConclusionsA third of patients with postmenopausal bleeding had a gynecological cancer. Age, frequency of bleeding, diabetes and hypertension, and increased endometrial thickness were independent risk factors for endometrial cancer.     

绝经后子宫内膜增厚与子宫内膜病变的相关性研究

目的:探讨绝经后子宫内膜增厚与子宫内膜病变的相关性,重点探讨无症状子宫内膜增厚预测内膜恶变风险的内膜厚度阈值.方法:选择245例绝经后经阴道超声检查提示子宫内膜厚度≥5 mm的患者作为研究对象,分为绝经后出血(PMB)组(124例)和无PMB组(121例),均行宫腔镜下子宫内膜活检,分析其临床病理资料.结果:①PMB组...     

宫腔镜在诊断绝经后妇女子宫内膜病变中的临床价值

目的:探讨宫腔镜在诊断绝经后妇女子宫内膜病变中的临床价值。方法:回顾性分析160例行诊断性刮宫或宫腔镜检查的绝经患者,分析宫腔镜组(90例)与诊刮组(70例)的手术指征、术前超声与术后病理诊断等。结果:宫腔镜与诊刮术相比,在超声提示内膜厚或宫腔占位的患者中均有较高的病变检出率。其中6例宫腔镜诊为内膜恶性病变的患者,腹水中未找到瘤细胞。结论:宫腔镜损伤小、阳性检出率高,不易造成肿瘤细胞的盆、腹腔扩散,适宜广泛应用于子宫内膜病变的诊断。     

Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Ovarian Malignancy

Study ObjectiveTo investigate the clinical presentation, operative outcome, and incidence of malignancy in postmenopausal women who were diagnosed with adnexal torsion.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingTertiary university-affiliated hospital.PatientsPostmenopausal women diagnosed with adnexal torsion between 1995 and 2014 (study group) were reviewed and compared with 220 premenopausal patients diagnosed with adnexal torsion during the same time period.InterventionDemographic data, clinical signs and symptoms, and intra- and postoperative characteristics were compared between the 2 groups.Measurements and Main ResultsDuring the study period 44 postmenopausal women were diagnosed with adnexal torsion. Continuous dull pain was the most common presenting symptom in the postmenopausal group (57%), whereas acute-onset sharp pain was the predominant symptom in the premenopausal group (86%). The time interval from admission to surgery was significantly longer in the postmenopausal group (24 vs 6 hours, p < .001). Laparoscopic surgery was performed in 84.5% of the cases in the premenopausal group, whereas it was carried out in only 50% of cases in the postmenopausal group (p < .001). Four women in the postmenopausal group were diagnosed with malignancy, whereas only 1 case of malignancy was found in the premenopausal group (9% vs .4%, respectively; p = .003).ConclusionsAdnexal torsion in postmenopausal women is an uncommon event with a unique presentation. Because ovarian malignancy is not an uncommon finding in this group of patients, preparation for more extensive surgery should be contemplated.     

177例不孕症患者宫腔镜下子宫内膜息肉摘除术的临床疗效分析

目的:探讨宫腔镜下子宫内膜息肉摘除术对不孕患者生育功能的改善和治疗效果。方法:对177例子宫内膜息肉(endometrial polyp,EP)的不孕患者(研究组)行宫腔镜下内膜息肉摘除结合刮宫术,术后追踪观察EP复发情况,并与374例同期行宫腔镜检查提示宫腔正常的不孕患者(对照组)进行术后妊娠情况的比较。结果:术后妊娠率研究组(25.99%,46/177)与对照组(29.14%,109/374)无差异,术后平均获得妊娠时间研究组为4.8±3.8个月,对照组为5.0±3.9个月,组间也无统计学差别(P>0.05)。研究组中131例EP患者未妊娠,另76例于术后1￣36个月进行了第二次宫腔镜检查:结果宫腔正常53例,EP复发23例。结论:子宫内膜息肉是引起不孕症的主要宫腔病因之一,宫腔镜下子宫内膜息肉摘除术可去除病因,使患者获得妊娠。     

富血小板血浆促子宫内膜增殖对妊娠结局的影响

目的:探讨富血小板血浆(PRP)促子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的应用价值。方法:选择薄型子宫内膜患者94例,其中53例予PRP治疗(PRP组),于冷冻胚胎移植周期中给予PRP宫腔内灌注治疗,另41例未予PRP治疗(对照组)。ELISA法检测PRP组中PRP与全血中血小板计数(PLT)、血小板源生长因子(PDGF)-AB、PDGF-BB及转化生长因子β(TGF-β)的表达量,并比较PRP组与对照组黄体酮日子宫内膜厚度、胚胎种植率、生化妊娠率、临床妊娠率,同时采用Logistic多变量逻辑回归分析变量因素与妊娠结局的相关性。结果:153例行PRP宫腔内灌注的患者术后均未出现不良反应,制备的PRP中PLT、PDGF-AB、PDGF-BB及TGF-β表达量均较全血中明显升高(P0.01)。2PRP组黄体酮日子宫内膜可达7.56±0.38 mm,较对照组6.41±0.36 mm明显升高,差异有统计学意义(P0.05)。PRP组生化妊娠率、临床妊娠率、胚胎种植率均比对照组明显升高(P0.05)。3Logistic回归分析结果示,子宫内膜厚度与妊娠率有关(OR 1.48,95%CI 1.04~2.21,P0.05);PRP与妊娠率有关(OR 3.16,95%CI 1.48~6.74,P0.05)。结论:制备的PRP达到治疗标准,结果满意。PRP具有促进子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的临床效果,可作为菲薄子宫内膜的临床治疗中一种安全、有效的方法。     

子宫内膜异位症患者在位子宫内膜神经纤维分布的研究

目的:研究子宫内膜异位症(EMT)患者的在位子宫内膜的功能层中神经纤维的分布状况.方法:选取2005年1月至2008年12月以痛经为主诉并行子宫切除的EMT患者25例为研究组,随机选取同期无此疾病的行子宫切除的患者40例作为对照组,利用免疫组织化学技术,使用多克隆家兔抗人抗蛋白基因产物9.5染色标记子宫在位内膜的神经纤维,用数码相机照相,分析其神经纤维密度.结果:在EMT患者子宫内膜的功能层中出现神经纤维,而非EMT患者子宫内膜的功能层中未出现神经纤维(P<0.01).结论:EMT患者子宫内膜的功能层中神经纤维异常增多,可能与EMT患者的疼痛症状有关.     

The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study

To investigate the impact of a 3 months preoperative administration of an oral contraceptive, containing dienogest (DNG) and estradiol valerate (E₂V) on the outcome of office operative hysteroscopy (OOH). One-hundred and forty-two patients diagnosed at office hysteroscopy as having an asynchronous endometrium associated with either a broad-base sessile endometrial polyp (>1.5, <2.5 cm) or a uterine septum (>1/3 uterine cavity) or scheduled for tubal sterilization were enrolled into a prospective case-control study at University “Federico II” of Naples. 86/142 patients accepted the preoperative hormonal treatment (Group A), while 56/142 refused, thus becoming controls (Group B). Group A underwent OOH during the 10th–20th days of the third cycle of treatment. In Group B OOH was performed at enrolment, together with the diagnostic procedure. The study outcomes were: endometrial pattern, success rate, operating time, degree of surgical difficulty and pain score. An overall improvement of the endometrium was reported in 100% of cases in Group A. A statistically significant difference in success rate could not be demonstrated between two groups. Operative procedures were performed significantly quicker and easier in Group A than Group B (p < 0.001 and p < 0.05, respectively). The mean Visual Analog Scale (VAS) score was significantly lower in Group A (p < 0.001). A short pretreatment with combined oral contraceptive (COC) containing E₂V/DNG seems to have a favorable impact on endometrium which in turn may result in an improvement of the overall outcomes of OOH.     

绝经后子宫内膜癌癌周内膜病理学特征及其与预后的关系

目的：研究绝经后子宫内膜癌癌周内膜的病理学特点及其与预后的关系。方法：根据癌周内膜的组织学表现分为增生型和萎缩型两组，对２０４例子宫内膜癌患者的临床与病理特点和长期随访结果进行回顾性分析。结果：癌周内膜呈增生型的子宫内膜癌患者伴发高血压、肥胖、糖尿病、不孕及子宫内膜增生过长史的机率显著高于癌周内膜呈萎缩型的子宫内膜癌患者（Ｐ＜０．００１）；具有较高恶性程度的非内膜样腺癌（包括透明细胞型腺癌、鳞腺癌、浆液型腺癌）在癌周内膜呈萎缩型组占２７．０％，在增生型组占５．５％（Ｐ＜０．００１）。癌周内膜呈萎缩型者较增生型者呈低分化倾向及深肌层、脉管浸润（Ｐ＜０．００１）；５年生存率，癌周内膜呈增生型子宫内膜癌患者为９６．７％，萎缩型为８６．２％（Ｐ＜０．０１）。结论：子宫内膜癌癌周内膜的病理学特征与预后相关，癌周内膜呈增生型者的预后好于萎缩型。     

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

Objective

This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy.

Methods

One hundred and fifty women aged 29–52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome.

Results

Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p < 0.001; OR 4.61; CI 1.9–27), polyp volume >10 ml (p < 0.001; OR 5.83; CI 4.31–9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09–3.76). Notably, the odds ratio of polyp volume >10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women.

Conclusion

Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume ≤10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.     

子宫肌瘤患者的子宫内膜病理特征分析

目的:探讨子宫肌瘤患者的子宫内膜病理特征及相关因素。方法:选取2002~2004年479例子宫肌瘤患者,分析其子宫内膜病理特征。结果:479例患者中有97例表现阴道不规则流血,单发肌瘤220例,多发肌瘤259例,子宫肌瘤变性70例,67例子宫肌瘤为富于细胞型平滑肌瘤。109例患者发生子宫内膜病变,包括子宫内膜息肉42例(8.77%)、子宫内膜单纯增生41例(8.56%)、复杂增生12例(2.51%)、非典型增生3例(0.63%)、子宫内膜癌11例(2.30%)。结论:子宫肌瘤可同时合并子宫内膜病变及子宫内膜癌,子宫肌瘤单发或多发、子宫肌瘤变性等情况与子宫内膜病变无关。不规则阴道流血、绝经与子宫内膜病变及子宫内膜癌的发生有关。     

Recurrent Postmenopausal Bleeding: a Prospective Cohort Study

Study ObjectiveTo estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways.DesignProspective cohort study (Canadian Task Force classification: II-2).SettingLarge urban teaching hospital.PatientsOf 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations.InterventionsAll women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy.Measurements and Main ResultsThe risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07–2.02; p = .02).ConclusionRecurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 women PMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.     

Outcomes of endometrial-polyp treatment with hysteroscopy in operating room

To assess the results of using a resectoscope in the hysteroscopic resection of endometrial polyps that were previously diagnosed by office hysteroscopy and to demonstrate the necessity of extraction for histological study. A prospective long-term follow-up study (level of evidence II-2). University Hospital. 303 women presenting a hysteroscopic image of an endometrial polyp. Interventions: Office hysteroscopy, hysteroscopic resection of polyps by means of a resectoscope and an anatomopathological study of the polyps. Statistical analysis was performed. 303 diagnosed endometrial polyp formations were resected by means of hysteroscopy during surgery. In all cases, biopsies of the uterine cavity or of the polyp were negative. Resection of the polyps with hysteroscopy in the operating room using a resectoscope proved to be a safe technique. The anatomopathological study of the polyps showed hyperplasia with atypias in 10 cases (3.3%) and endometrial cancer in 9 women (3.0%). Our study data suggest that endometrial polyps should be resected because they may harbor malignant or premalignant lesions. Hysteroscopic surgery is recommended for its simplicity and scant complications.     

白血病抑制因子在子宫内膜异位症并发不孕患者黄体中期子宫内膜中的表达

目的:探讨白血病抑制因子(LIF)在子宫内膜异位症(EM)导致不孕机制中的作用。方法:采用原位杂交及免疫组织化学方法对15例异位症并发不孕患者黄体中期子宫内膜中的LIF mRNA及其蛋白的表达进行定位及半定量分析,并以15例有生育妇女作为对照组。结果:子宫内膜异位症组LIF mRNA平均光密度为3.12±0.32,LIF蛋白平均光密度为9.31± 2.10,显著低于对照组的6.25±2.14与15.70±1.52(P<0.05)。结论:子宫内膜异位症组黄体中期子宫内膜LIF表达下降可能是其不孕的原因之一。