Swati Prakash*, Parulekar SV**, Pragati Sathe***
Year Resident, ** Professor and Head of Department. Department
of Obstetrics and Gynecology, *** Assistant Professor, Department of Pathology,
Seth GS Medical College and KEM Hospital, Mumbai,
57 year old woman, married for 27 years, para 2 abortion 1, menopausal for 14
years, presented with a complaint of post-menopausal vaginal spotting. She had
had 2 such episodes in the preceding 2 months. She had undergone
colpohysteroscopy with dilatation & curettage in just prior to menopausal 2
years ago, for abnormal uterine bleeding. Pelvic ultrasonography (USG) done
prior to the procedure had shown hypertrophied endometrium. Histopathology
report though, was not available. On per speculum examination; she had a
2x1x.3cm irregular polyp protruding from external os. Polypectomy with
fractional curettage was done. A 6×2×1 cm polyp was removed. The polyp had a 1
mm diameter pedicle. Histopathology report showed a benign polyp with
endometrial polyps is a localized overgrowth of endometrial tissue. It may be
pedunculated or sessile, single or multiple. Pedunculated polyps are more
common than sessile ones. Endometrium grows in response to
circulating estrogen, and localized growth results in formation of polyps.
Formation of new polyps should be unusual after menopause, because estrogen
production by the ovaries is low or absent. Similarly old polyps should not
grow after menopause. Uterine contractions may cause elongation of the pedicle
of a polyp, trying to extrude it from the uterine cavity. If the pedicle
finally necroses, the polyp may be expelled spontaneously. We present a case in
which a polyp grew after menopause and one which had a pedicle measuring 1 mm
in diameter, attaching it to the endometrial surface.
A 57 year
old woman, married for 27 years, para 2 abortion 1, presented with a complaint
of post-menopausal vaginal spotting. She had 2 such episodes. She had been
menopausal for 14 years. She had had 2 such episodes in the preceding 2 months,
for which she had not taken any treatment. She had undergone colpohysteroscopy
with dilatation & curettage in just prior to menopausal 2 years ago, for
abnormal uterine bleeding. Pelvic ultrasonography (USG) done prior to the
procedure had shown hypertrophied endometrium. Histopathology report was not
available, though the patient stated that there had been no cancer. On per
speculum examination; she had a 2x1x0.3cm irregular, soft polyp protruding from
external os which did not bleed on touch. It was free from cervix all around.
Polypectomy with fractional curettage was done, keeping in mind her
post-menopausal status. The polyp was held with sponge holding forceps and it
came off very easily on mild traction. It was soft, flat, and easured 6x2x0.3
cm (figure 1). It was attached to the endometrial surface with a pedicle 1 mm
in diameter. The patient made an uneventful post-operative recovery.
Histopathology report showed a benign polyp. Endometrium could not be commented
Gross appearance of the polyp. Arrow indicated the broken pedicle, 1 cm from
the upper end.
Figure 2. Microscopic appearance of the polyp. A. Low power; B. High power; C. Oil immersion.
endometrial polyp ranges in size from a few millimeters to many centimeters.
Its prevalence rate ranges from 10% to 40% in women with abnormal uterine
bleeding. Polyps may be found in up to 12% of asymptomatic women
in routine examinations. Malignancy is found in endometrial in
0.8% to 8% cases. Lee et al reported in a metaanalysis the
prevalence rate of premalignancy and malignancy in endometrial polyps of 3.57%.
Larger polyps are associated with a higher risk of malignancy.
Owing to low rates of malignancy, there is trend towards not removing such
polyps if asymptomatic. However all polyps must be removed if symptomatic, or
if a malignancy is considered likely. Polyps associated with endometrial
hyperplasia should also be removed. Polyps which are recurrent, or which appear
or grow after menopause should also be removed. In the case presented, the
polyp possibly appeared and grew after menopause. The endometrium lining the
uterine cavity did not show hyperplasia or malignancy, suggesting that the
polyp possibly had existed at the time of the first curettage, and had been
missed. Another unusual thing about the polyp was the size and location of its
pedicle. It measured just 1 mm in diameter, and was attached to the polyp 1 cm
from its upper end. It was very fragile and possibly would have broken by
itself some time. Whether the postmenopausal uterus would have been able to
expel it was doubtful. But would have necrosed after breaking of its pedicle,
got infected, and would have necessitated its removal eventually.
Sternberg SS.; Mills SE, Carter D.
Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins;
2004. p. 2460.
Anastasiadis PG, Koutlaki NG,
Skaphida PG, Galazios GC, Tsikouras PN, Liberis
VA. Endometrial polyps:
prevalence, detection, and malignant potential in women with abnormal uterine
bleeding. Eur J Gynaecol Oncol 2000;21:180–183.
Dreisler E, Stampe SS, Ibsen PH,
Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a
Danish population aged 20–74 years. Ultrasound Obstet Gynecol 2009;33:102–108.
Savelli L, De Iacco P, Santini D,
et al.. Histopathologic features and risk factors for benignity, hyperplasia,
and cancer in endometrial polyps. Am J Obstet Gynecol 2003;188:927–931.
Lee SC, Kaunitz AM, Ramos LS, Rhatigan RM. The oncogenic potential of
endometrial polyps. A systematic review and meta-analysis. Obstet Gynecol
Rahimi S, Marani C, Renzi C,
Natale ME, Giovannini P, Zeloni R. Endometrial polyps and the risk of atypical
hyperplasia on biopsies of unremarkable endometrium: a study on 694 patients
with benign endometrial polyps. Int J Gynecol Pathol 2009;28:522–528.
Prakash S, Parulekar SV, Sathe P. An Unusual Case of Endometrial Polyp. JPGO
2014 Volume 1 Number 6 Available from: http://www.jpgo.org/2014/06/an-unusual-case-of-endometrial-polyp.html