Residual disease after operative hysteroscopy in patients with endometrioid endometrial cancer associated with polyps / Doença residual após histeroscopia cirúrgica em pacientes com câncer de endométrio endometrioide associado a pólipo endometrial

Abstract Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In78cases (75%), thepolyphad EC, and in 40(38.5%), itwas restricted tothe polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Resumo Objetivo Avaliar a presença de doença residual no exame anatomopatológico definitivo de pacientes com câncer de endométrio endometrioide após polipectomia ou biópsia de pólipo histeroscópica. Métodos Analisamos 104 pacientes (92 casos do Hospital AC Camargo e 12 casos do Hospital do Servidor Público Estadual de São Paulo) com pólipos diagnosticados durante histeroscopia e cuja biópsia histeroscópica ou exame patológico final do útero acusaram câncer de endométrio endometrioide. As pacientes foram submetidas a cirurgia para câncer de endométrio de janeiro de 2002 a janeiro de 2017. Os dados clínicos e anatomopatológicos de cada paciente foram retirados dos prontuários médicos Resultados Em 78 casos (75%), o pólipo continha a neoplasia, e em 40 (38.5%), ela estava restrita ao tecido do pólipo, sem envolvimento endometrial adjacente. O estadio final foi IA em 96 casos (92.3%) e em 90 (86.5%) tratava-se de grau 1 ou 2. Em 18 casos (17.3%), não havia doença residual no espécime uterino, mas emapenas 9 deles a histeroscopia sugeriu doença restrita ao pólipo. Em 5 casos (4.8%), não havia doença aparente extrapólipo na histeroscopia, mas havia invasão miometrial, sugerindo extravasamento do tumor pela base do pólipo. Conclusão Pacientes com câncer de endométrio associado a pólipos podem ter o tumor completamente removido durante a histeroscopia, mas, com as variáveis avaliadas, é difícil predizer com segurança qual paciente ficará sem tumor residual.

Footprint lesion: a mirror image of an endometrial polyp

Endometrial polyps may present with a variety of symptomatology. They are mostly benign and commonly encountered in the reproductive age group. Hysteroscopy is an emerging tool for diagnostic as well as a therapeutic purposes. We report a case of endometrial polyp diagnosed on hysteroscopy, with a “footprint”, that is contact lesion visible. This is a relatively rare phenomenon, and there is sparse information and literature regarding this entity. Hence the true nature of its effects is yet unknown.

The effect of levonorgestrel-releasing intrauterine system on IGF-Ⅰ and IGF-IR expression after transcervical resection of polyp / 中国医师杂志

Objective To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on insulin-like growth factor-Ⅰ (IGF-Ⅰ) and insulin-like growth factor-Ⅰ receptor (IGF-IR) expression after transcervical resection of polyp (TCRP).Methods 100 cases of endometrial polyps were selected.The control group (n =50) was treated with TCRP only,while the observation group (n =50) was treated with LNG-IUS after TCRP.The scores of pictorial blood loss assessment chart (PBCA),endometrial thickness,recurrence rate,mRNA expression of IGF-Ⅰ and IGF-IR in endometrial tissue were compared between the two groups.Results At 1,3,6,12 months follow-up,the PBAC score and endometrial thickness of observation group were significantly lower than control group (P ≤ 0.05).At 12 months after operation,the mRNA expression levels of IGF-Ⅰ and IGF-IR in the endometrium of the observation group were significantly lower than those of the control group (P ≤ 0.05).After 12 months of follow-up,the recurrence rates of the control group and the observation group were 16.0％ (8/50) and 4.0％ (2/50),respectively.The recurrence rate of the observation group was significantly lower than that of the control group (P ≤ 0.05).Conclusions TCRP combined with LNG-IUS treatment can significantly reduce EP recurrence,and down-regulation of the mRNA expression of IGF-Ⅰ and IGF-IR maybe its possible mechanism.

Efficacy comparison of different hysteroscopic surgical procedures in treatment of endometrial polyps / 实用医学杂志

Objective To compare the efficacy of different hysteroscopic surgical procedures in the treatment of endometrial polyps. Methods Ninety-two patients with endometrial polyps from January 2016 to December 2017 were selected. Among them, 37 patients with fertility requirements underwent polypectomy with MyoSure as group A; 25 patients without fertility requirements underwent polypectomy with resectoscopic hysteroscopy as group B, and 30 patients underwent polypectomy with hysterosopy and curettage as group C. The duration of the procedure, blood loss and hospital stays, effective rate, recurrence rate and postoperative pregnancy rate of the3 groups were compared. Results There was no significant difference in intraoperative blood loss and hospital stays among the 3 groups (P> 0.05). The duration of the procedure of group A and B was longer than that of group C, and the difference was statistically significant (P < 0.05). The effective rate of treatment was high in all 3 groups, and inter-group comparison indicated no statistically significant difference, but the recurrence rate of group C was significantly higher than that of group A and B. For those with fertility requirements, the pregnancy rate in group A was slightly higher than that in group C within one year after surgery, but the difference was not statistically significant. Conclusion Hysteroscopic procedures of endometrial polypectomy has the advantages of accuracy, safety, effectiveness and rapid recovery. The treatment with MyoSure and resectoscopic hysteroscopy can reduce the recurrence rate of patients effectively. For women with fertility requirements, the treatment with MyoSure can protect the endometrium and improve the postoperative pregnancy rate.

Sangrado y terapia hormonal en la menopausia (THM) / Bleeding during menopause hormone therapy (MHT)

La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.

Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.

Addition of power Doppler to grey scale transvaginal ultrasonography for improving the prediction of endometrial pathology in perimenopausal women with abnormal uterine bleeding

Background & objectives: Transvaginal ultrasonography (TVS) is a non-invasive procedure and can be used as a screening tool among women with abnormal uterine bleeding (AUB). Power Doppler is useful in depicting the vascular architecture better than the conventional Doppler. Hence, this study was conducted to evaluate whether addition of power Doppler to grey scale TVS can replace invasive hysteroscopy for the prediction of endometrial pathology in perimenopausal women with AUB. Methods: One hundred women (>45 yr) with perimenopausal AUB underwent evaluation with TVS, power Doppler and hysteroscopy-guided biopsy after a detailed history and examination. Histopathology was considered as gold standard and other tools such as grey scale TVS with power Doppler and hysteroscopy were compared with it. Results: Fifty six per cent women had no vascularity on power Doppler. Among those who had vascularity, the vascular patterns noted were single-vessel in 18 per cent, scattered-vessel in 15 per cent and multiple-vessel in 11 per cent. The sensitivity, specificity, positive predictive value and negative predictive value of TVS-endometrial thickness with power Doppler in detecting hyperplasia were 50, 86.5, 13.3 and 97.6 per cent, respectively, whereas the same for hysteroscopy were 100, 97.6, 88.1 and 100 per cent, respectively. Interpretation & conclusions: Addition of power Doppler to grey scale TVS improved the specificity and negative predictive value almost comparable to hysteroscopy for evaluation of AUB, but sensitivity and positive predictive value remained poor.

Novel use of GnRH agonist as neoadjuvant treatment for giant endometrial polyps

@#Endometrial polyp, being one of the most common causes of abnormal uterine bleeding, is formed from localized overgrowths of endometrial tissue brought about by increased estrogen levels. Sizes of polyps usually are less than 2cm, while those >4 cm are labeled as giant polyps. Such polyps can even occupy the entire endometrial cavity, making complete hysteroscopic removal difficult and prone to failure and morbidity. Limited literature regarding use of GnRH agonist in endometrial polyps are published, but given the idea that it induces a state of hypoestrogenism, it could be a promising approach for neoadjuvant treatment in such cases. In this paper, 3 cases of giant endometrial polyps with fertility problems were given GnRH agonists prior to resection. All cases have shown significant decrease in size of their polyps, making complete and successful hysteroscopic removal feasible.

Relevancia clínica del signo del pedículo en el diagnóstico del pólipo endometrial / Clinical relevance of the pedicle sign in diagnosing of the endometrial polyp

Objetivo: Valorar la rentabilidad diagnóstica del signo del pedículo vascular detectado mediante Doppler color/potencia para el diagnóstico del pólipo endometrial. Método: Se realiza una revisión sistemática y metanálisis. Para ello, se llevó a cabo una búsqueda electrónica de los siguientes términos: "endometrial polyp", "Doppler", "ultrasound" (MeSH) y "pedicle sign". Se incluyeron: estudios prospectivos o de cohortes retrospectivos; investigaciones de mujeres con enfermedad orgánica endometrial y pacientes con pólipos endometriales; estudios que tuvieran como objetivo la evaluación de la prueba diagnóstica la ecografía mediante Doppler color/potencia para el diagnóstico de pólipo endometrial, y trabajos que usaran el diagnóstico anatomopatológico como prueba de referencia. El período comprendió de enero de 2003 a mayo de 2015. Todos los análisis se realizaron mediante el módulo MIDAS y METANDI de la versión STATA 12.0 para Windows (Stata Corporation, College Station, TX, EE.UU.). Un valor de p < 0.05 fue considerado estadísticamente significativo. Resultados: Se identificaron un total de 629 artículos, de los que se excluyeron 623, por lo que fueron incluidos en el metanálisis final 6 artículos. Dichos estudios incluían 1237 mujeres y 362 pólipos endometriales (prevalencia del 29.3%). La sensibilidad, la especificidad, la razón de verosimilitud (LR, likelihood ratio), tanto positiva como negativa (LR-) para el signo del pedículo fueron 77% (intervalo de confianza [IC] del 95%: 53% a 91%), 95% (IC 95%: 87% a 98%), 16.0 (IC 95%: 7.1 a 35.9) y 0.24 (IC 95%: 0.11 a 0.54), respectivamente. Se detectó una heterogeneidad importante en los estudios. Conclusión: El signo del pedículo ofrece un rendimiento aceptable para el diagnóstico de los pólipos endometriales.

Objective: To evaluate the diagnostic performance of vascular pedicle sign detected by color Doppler/power ultrasound for the diagnosis of endometrial polyp. Method: A systematic review and meta-analysis was performed. An electronic search (Pubmed) was conducted using the following terms: "endometrial polyp", "Doppler", "ultrasound" (MeSH), and "pedicle sign". Criteria for inclusion were as follows: prospective or retrospective cohort studies; studies of women with endometrial organic pathology and women with endometrial polyps; studies to evaluate the diagnostic test using color Doppler ultrasound/power for the diagnosis of endometrial polyp, and studies using pathological diagnosis as the gold standard. The period covered was January 2003 to May 2015. All analyses were performed using the MIDAS and METANDI module STATA version 12.0 for Windows (Stata Corporation, College Station, TX, USA). A value of p < 0.05 was considered statistically significant. Results: A total of 629 papers were identified, of which 623 were excluded, including 6 studies in the meta-analysis. These studies included 1237 women and 362 endometrial polyps (29.3% prevalence). The sensitivity, specificity, LR and LR- for the sign of the pedicle were 77% (95% CI, 53%-91%), 95% (95% CI, 87%-98%), 16.0 (95% CI, 7.1-35.9) and 0.24 (95% CI, 0.11 to 0.54), respectively. Significant heterogeneity was detected in studies. Conclusion: The sign of the pedicle provides acceptable performance for diagnosis of endometrial polyp.

Comparison of the effect between gestrinone and levonorgestrel intrauterine system in the treatment of patients with endometrial polyps after transcervical resection of polyp / 新乡医学院学报

Objective To compare the clinical effect between gestrinone and levonorgestrel intrauterine system in the treatment of patients with endometrial polyps after transcervical resection of polyp (TCRP).Methods A total of 225 endometrial polyps patients underwent TCRP were selected from January 2014 to January 2017 in Zhengzhou Central Hospital.The patients were divided into group A,B and C according to the postoperative treatment,75 cases in each group.The patients in group A were treated with gestrinone from the fifth day after operation.The patients in the group B were treated with levonorgestrel intrauterine system at the 3-5 days of the first menstruation after operation.The patients in group C were not given any treatment after operation.All patients were followed up for 6 months.The endometrial thickness,the recurrence of endometrial polyps and the improvement of abnormal uterine bleeding of patients in the three groups were observed.Results The recurrence rate of endometrial polyps in group A,B and C was 16.00％ (12/75),1.33％ (1/75) and 38.67％ (29/75) respectively;the improvement rate of abnormal uterine bleeding was 92.00％ (69/75),86.67％ (65/75) and 88.00％ (66/75) respectively.The recurrence rate of endometrial polyps in group A and B was significantly lower than that in group C (x2 =9.700,32.667;P ＜ 0.05),and the recurrence rate of endometrial polyps in group B was significantly lower than that in group A (x2 =10.191,P ＜ 0.05).There was no significant difference in the improvement rate of abnormal uterine bleeding among the three groups (x2 =1.170,P ＞ 0.05).There was no significant difference in endometrial thickness among the three groups before and one month after operation (P ＞ 0.05).Three months after operation,the endometrial thickness in group A and B was significantly less than that in group C (P ＜ 0.05),but there was no significant difference in endometrial thickness between group A and B (P ＞ 0.05).Six months after operation,the endometrium thickness in group B was significantly less than that in group A and C (P ＜ 0.05),but there was no significant difference in endometrial thickness between group A and C (P ＞ 0.05).Conclusion Gestrinone and levonorgestrel intrauterine system assisted TCRP for endometrial polyps can significantly reduce the recurrence rate of endometrial polyps,inhibit endometrial hyperplasia,and the effect of levonorgestrel intrauterine system is better than that of gestrinone.

Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies / Acurácia da ultrassonografia transvaginal, histeroscopia e curetagem uterina na avaliação de patologias endometriais

Abstract Objective To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage. Methods Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012. Results One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia. Conclusion Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.

Resumo Objetivo avaliar a acurácia da ultrassonografia transvaginal, da histeroscopia e da curetagem uterina no diagnóstico de pólipo endometrial, mioma submucoso e hiperplasia de endométrio, utilizando como padrão-ouro a análise histopatológica de amostras obtidas por biópsia realizada durante a histeroscopia ou a curetagem. Métodos estudo transversal realizado no Hospital Universitário de Brasília (HUB), cujas informações foram obtidas nos prontuários das pacientes que foram submetidas à histeroscopia ou curetagem uterina no período de julho de 2007 a julho de 2012. Resultados Foram avaliadas 191 pacientes, sendo que 134 foram submetidas à histeroscopia e 57 à curetagem uterina. Observou-se acurácia diagnóstica maior que 90% para todas as patologias avaliadas por histeroscopia, enquanto que por ultrassonografia transvaginal observou-se acurácia de 65,9% para pólipo, 78,1% para mioma e 63,2% para hiperplasia endometrial. Nas 57 pacientes submetidas a curetagem uterina, observou-se acurácia de 56% para pólipo e de 54,6% para hiperplasia endometrial. Conclusão Idealmente, após a investigação inicial com ultrassonografia transvaginal, deveria, sempre que necessário, ser realizada histeroscopia com biópsia guiada da lesão, o que melhoraria a acurácia diagnóstica e posterior conduta clínica.

Pólipos endometriales: Actualización en diagnóstico y tratamiento / Endometrial polyps: update on diagnosis and treatment

ANTECEDENTES: Los pólipos endometriales son protrusiones nodulares benignas de la superficie endometrial con características clínico-patológicas propias y de origen desconocido. Su prevalencia es alta, especialmente en pacientes con sangrado uterino anormal, se asocia a infertilidad y a cáncer de endometrio, lo que se traduce en que se trata de una patología muy importante en el quehacer ginecológico habitual. OBJETIVOS: Revisar la patogenia, actualizar y evaluar los métodos diagnósticos, y definir las mejores opciones terapéuticas de esta frecuente patología. MÉTODO: Revisión sistemática de la literatura publicada en el tema, mediante búsqueda en base de datos Pub Med. RESULTADOS: La patogenia es aun desconocida, es una patología muy heterogénea y no hay causa única, se han reportado varios hallazgos relacionados con alteraciones genéticas. La ultrasonografía de alta definición, la hidrosonografia y la histeroscopia son el estándar actual en el diagnóstico. Las opciones terapéuticas se extienden desde la observación y seguimiento con imágenes, hasta la histerectomía con biopsia contemporánea, siendo la histeroscopia quirúrgica el método más costo efectivo. CONCLUSIÓN: La patogenia de los pólipos endometriales se encuentra actualmente en revisión, no hay ninguna teoría que explique la génesis de todos los pólipos. La ultrasonografía con contraste y la histeroscopia constituyen el estándar en el diagnóstico. En el tratamiento, la indicación es la cirugía histeroscopica y en especial la resección electroquirúrgica, que permite una extracción completa del pólipo bajo visión directa, con enfoque diagnóstico y terapéutico, con riesgos bajos y recurrencia mínima.

BACKGROUND: Endometrial polyps are benign nodular protrusions of the endometrial surface with clinical and pathological features of unknown origin. Its prevalence is high, especially in patients with abnormal uterine bleeding, it is associated with infertility and endometrial cancer, what constitutes a common and important disease. AIMS: To review the pathogenesis, to update and evaluate diagnostic methods, and to define the best treatment options for this common condition. METHODS: A systematic review of the published literature on the subject by searching PubMed database. RESULTS: The pathogenesis is still unknown, it is a very heterogeneous disease and there is no single cause, there have been several findings related to genetic alterations. High definition ultrasonography, the hidrosonography and hysteroscopy are the current standard in diagnosis. Therapeutic options range from observation and follow up with images to the hysterectomy using contemporary biopsy, surgical hysteroscopy being the most cost effective method. CONCLUSION: The pathogenesis of endometrial polyps are currently under review, there is no theory to explain the genesis of all polyps. Contrast ultrasonography and hysteroscopy are standard in the diagnosis. In the treatment, the indication is histeroscopy surgery and especially electrosurgical resection, which allows complete removal of polyps, diagnostic and therapeutic approach, with low risk and low recurrence.

Clinical research of oral contraceptive and levonorgestrel-releasing intrauterine system after hysteroscopic endometrial polypectomy in preventing recurrence / 中国医师进修杂志

Objective To explore the recurrence-prevention effect of oral contraceptive and levonorgestrel-releasing intrauterine system (Mirena) after hysteroscopic endometrial polypectomy.Methods One hundred and seventy-four patients who received hysteroscopic endometrial polypectomy were enrolled in this research.The patients were informed and divided into three groups according to their selection:51 cases were given oral contraceptive since one month until 12 months after the surgery (oral contraceptive group); 60 cases were received Mirena since one month after the surgery (Mirena group) ; and 64 cases were received no treatment after the surgery (control group).The groups were followed up at 3,6,12 months after the surgery and compared the recurrence rate,menstruation,level of hemoglobin and complication rate.Results The recurrence rate in oral contraceptive group,Mirena group and control group was 3.9％(2/51),3.3％ (2/60) and 19.0％ (12/63),respectively.The recurrence rate in control group was higher than that in oral contraceptive group and Mirena group,and there was significant difference (P ＜ 0.05).The proportion of low menstruation volume in control group was lower than that in oral contraceptive group and Mirena group,and there was significant difference (P ＜ 0.05).The level of hemoglobin in control group was lower than that in oral contraceptive group and Mirena group [(124.55 ±9.33) g/L vs.(133.71 ± 11.03),(135.89 ±6.88) g/L],and there was significant difference (P ＜ 0.05).The incidence of complication in Mirena group [18.3％ (11/60)] was less than that in oral contraceptive group[35.3％(18/51)],and there was significant difference (P ＜ 0.05).Conclusions Oral contraceptive and Mirena after hysteroscopy for endometrial polys significantly decrease the recurrence rate.The complication rate of Mirena is lower and it is a safe and effective way to treat and prevent the endometrial polyp.

Pólipo endometrial, una causa infrecuente de sangrado genital anormal en la adolescencia / Endometrial polyp, a rare cause of abnormal genital bleeding in adolescence

Antecedentes: El sangrado genital anormal es una causa frecuente de consulta en la adolescencia. En este período, la principal causa de sangrado es la metrorragia asociada a ciclos anovulatorios producto de la inmadurez del eje hipotálamo-hipofisario-gonadal. Dentro de las causas infrecuentes de sangrado genital anormal en ese período está el pólipo endometrial. Caso clínico: Presentamos el caso de una niña de 13 años cuya causa de sangrado correspondió a un pólipo endometrial, sospechado por ultrasonografía, resecado mediante histeroscopia y confirmado mediante estudio histológico. Discusión: Pese a su baja incidencia, los pólipos endometriales deben ser considerados como parte del diagnóstico diferencial en adolescentes que consultan por trastorno menstrual, particularmente en aquellos casos sin respuesta a la terapia hormonal y donde la ultrasonografía muestra engrosamiento endometrial.

Background: Abnormal genital bleeding is a common cause of medical consultation in patients during adolescence. In this period, the main cause of genital bleeding is metrorrhagia in relation to anovulatory cycles due to immaturity of hypothalamus- pituitary-gonadal axis. Among the uncommon causes of bleeding at this age is the endometrial polyp. Case report: We report a 13 year old girl with abnormal uterine bleeding due to endometrial polyp, suspected during a pelvic ultrasound, removed by hysteroscopy, and confirmed by histological analysis. Discussion: Despite its low incidence, endometrial polyps should be included in the differential diagnosis of adolescents presenting menstrual disorders, particularly in those with no response to hormonal therapy and endometrial thickness in ultrasound.

Carcinoma lobular invasivo de mama com pólipo endometrial metastático / Breast invasive lobular carcinoma with metastatic endometrial polyp

Tumores extragenitais com metástase para o útero são raros, e destes o mais comum é o da mama. O tamoxifeno é uma droga utilizada como terapia adjuvante em mulheres com câncer de mama. Trata-se de droga antiestrogênica; no entanto, no endométrio sua ação é agonista para receptores de estrogênio. Esta descrição de caso relata rara associação do uso do tamoxifeno em paciente com câncer de mama que apresentou metástase para pólipo endometrial. Trata-se de paciente de 70 anos, em hormonioterapia com tamoxifeno há 19 meses, com queixa de sangramento vaginal. Em histeroscopia, evidenciaram-se pólipo endometrial e sua exérese, com diagnóstico de adenocarcinoma metastático, com provável sítio primário em mama. A paciente havia sido submetida à mastectomia radical modificada há três anos, seguida de adjuvância. Pólipos endometriais são achados comuns em mulheres menopausadas e também são complicações da terapia com tamoxifeno. A metástase de carcinoma mamário em pólipo endometrial é rara. Na literatura, foram descritas as seguintes metástases em pólipos endometriais: cinco casos por carcinoma lobular invasivo, três casos por carcinoma ductal e um caso do carcinoma apócrino. Portanto, existe dificuldade em determinar o prognóstico para essas pacientes.

Extragenital tumors metastasizing to the uterine corpus is uncommon; out of those, the most common primary site is the breast. Tamoxifen is used as adjuvant treatment for breast carcinoma. It is an antiestrogenic drug; however has a partial agonist effect on estrogen receptor in the endometrium. This case report relates rare association between the use of tamoxifen in patient with breast cancer which presented metastasis to endometrial polyps. A 10 years old woman received tamoxifen for 19 months after surgery treatment and presented vaginal bleeding. She underwent hysteroscopy with biopsy, which showed endometrial polyp. The polyp was taken out and the pathological diagnosis was metastasis from breast adenocarcinoma. Endometrial polyps are found relatively common in postmenopausal women and they are also related complications to the tamoxifen therapy. Breast carcinoma metastasis to endometrial polyp is rare. There were some descriptions in the literature: five cases of invasive lobular carcinoma, three cases of ductal carcinoma and one case of the apocrine carcinoma. There are few cases shown in the literature and, therefore, there are difficulties in determining the prognosis of these patients.

Endometrial pathologies in tamoxifen-treated breast cancer patients / 대한산부인과학회지

OBJECTIVE: Tamoxifen is a nonsteroidal hormone that functions as a selective estrogen-receptor (ER) modulator in breast tissue. It is the first-choice drug for the postoperative treatment of ER-positive breast cancer patients. However, tamoxifen, if administered for a prolonged duration, has estrogen-like effects on the uterus, leading to an increased risk for the development of endometrial diseases such as endometrial hyperplasia, endometrial polyp, and endometrial cancer. This study was designed to investigate the effects of tamoxifen treatment on endometrium in breast cancer patients. METHODS: Fifty-five tamoxifen-treated breast cancer patients visited an outpatient gynecology clinic. We analyzed the endometrial pathology with consideration to the duration of tamoxifen treatment the patient symptoms and the endometrial thickness, as measured by transvaginal ultrasonography. Endometrial polypectomy was performed to obtained polyps from women presenting with abnormal bleeding (17 polyps from postmenopausal women who had not been treated with tamoxifen and 14 from women who had been treated with this drug). To investigate the effects of tamoxifen treatment on the endometrial polyps, we performed immunohistochemical staining for ER, the progesterone receptor (PR), and Ki67 on the polyps obtained from both groups of women. RESULTS: In 29 (52.7%) of 55 tamoxifen-treated breast cancer patients, the endometrium was more than 10 mm thick, and in 19 (65.5%) of these patients, the abnormalities noted comprised 11 endometrial polyps, 5 endometrial carcinomas, 2 submucosal myomas, and 1 endometrial hyperplasia. The incidence of endometrial proliferation was significantly higher in patients who had been treated with tamoxifen for less than 1 year (P=0.037) than in those who had been treated for more than 1 year. Although the endometrial carcinomas, submucosal myomas, and endometrial hyperplasia were found in the patients who had been treated for more than 1 year, this result was not statistically significantwhen compared with the other group. As compared to the endometrial polyps obtained from women who had not received tamoxifen treatment, those obtained from patients who had received the treatment exhibited significantly lower levels of ER expression (P=0.000) in the glands and increased levels of PR (P=0.031) and Ki-67 expression (P=0.000) in the stroma. CONCLUSIONS: During tamoxifen treatment for breast cancer, the endometrial pathology should be investigated if transvaginal ultrasonography reveals the tissue to be more than 10 mm thick. Although tamoxifen has significant effects on the expression of hormone receptors, the mechanism underlying the development of endometrial polyps does not appear to be mediated by the ER.

Increased Incidence of Endometrial Polyps in Women with Endometriosis; the Association with Severity / 대한불임학회지

OBJECTIVE: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. METHODS: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. RESULTS: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). CONCLUSION: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis

Sonographic Findings of Endometrial Polyps / 대한산부인과학회지

OBJECTIVE: To characterize the sonographic findings of endometrial polyp and to differentiate it from other endometrial lesions. METHODS: Using transvaginal sonography, preoperative sonographic findings of pathologically proven endometrial polyp in 24 patients were retrospectively evaluated for the size, margin, echogenicity, nature (cystic, solid, mixed), and blood flow signal by color Doppler sonography (CDS). The t-test was used to check the statistical significance for Resistive index (RI) between endometrial polyp and other endometrial lesions. RESULTS: Of 110 patients studied for abnormal vaginal bleeding, 24 (21.9%) patients had endometrial polyps, 4 (3.6%) patients had secretory phased endometriums, 4 (3.6%) patients had submucosal myomas, 4 (3.6%) had retained placentaes, 1 (0.9%) had endometrial hyperplasia, 1 (0.9%) had blood clot, 1 (0.9%) had endometrial carcinoma and 71 (64.6%) patients had normal findings. The sonographic findings of endometrial polyp were well defined (24 patients), round (16 patients), hyperechoic (20 patients), and solid mass (21 patients). Using transvaginal CDS, the location of blood flow (9 patients) showed a single feeding artery with a mean RI of 0.60. There were no statistical significant differences between endometrial polyp and other endometrial lesions in arterial waveform (mean RI: 0.6) by transvaginal CDS (p>0.05). CONCLUSION: Endometrial polyp has a characteristic sonographic appearance of a well-defined, hyperechoic round mass by transvaginal sonography. In addition, it contains a single feeding vessel to the vascular stalk with a characteristic color Doppler signal detected by transvaginal CDS. These findings enable us to make differential diagnosis from other endometrial lesions.

Increased Proliferating Activity of Endometrium in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: We investigated the expression of Ki-67, NF-kappa B, and COX-2 in endometrial tissue, and the incidence of polyps by hysteroscopic biopsy with or without endometriosis. METHODS: The study group was 92 patients with endometriosis and the control group was 90 patients without endometriosis. The subjects were 20 samples. The 10 samples consisted of eutopic endometrium with endometriosis. The control subjects were 10 samples of normal endometrium. Expression of Ki-67, NF-kappa B, and COX-2 was immunohistochemically investigated by polyclonal antibody. RESULTS: Endometrial polyps were found in 53 of 92 (57.6%) women with endometriosis but only in 15 of 90 (16.7%) women without endometriosis. High expression of Ki-67 was shown in eutopic endometrium with endometriosis. The expression of NF-kappa B and COX-2 was increased in eutopic endometrium with endometriosis, but normal endometrium showed lower expression. CONCLUSION: The increase of endometrial polyps and hyperexpression of NF-kappa B, COX-2, Ki-67 could explain that proliferation activity of eutopic endometrium with endometriosis is increased.

Toremifene-associated endometrial polyp: A case report and review of the literature / 대한산부인과학회잡지

Antiestrogens have been widely used in the treatment of breast cancer patients. Although tamoxifen is one of the most prevalent antiestrogens, some reported its hepatocarcinogenic effects and the long-term treatment may increase the risk of endometrial and gastrointestinal cancer. Toremifene is an interesting new antiestrogen and have a similar antitumor efficacy as tamoxifen, with less side-effect including less uterotrophic effect compared to tamoxifen, in mice. we report a case of endometrial polyp which were associated with toremifene use, in postmenopausal woman with breast cancer, with a brief review of literature.

Treatment of submucous leiomyomas and endometrial polyps by hysteroscopic resection / 中国微创外科杂志

Objective To study the feasibility,safety,and efficacy of hysteroscopic treatment of submucous leiomyomas and endometrial polyps.Methods Hysteroscopic resections were performed in 38 cases of submucous leiomyomas and 40 cases of endometrial polyps from January 2002 to July 2004,including 31 cases of transcervical resection of myoma(TCRM),7 cases of TCRM combined with transcervical resection of the endometrium(TCRE), 35 cases of transcervical resection of polyp(TCRP),and 5 cases of TCRP combined with TCRE.Results The operation was completed smoothly on one session in all the 78 cases.The intraoperative blood loss was ≥ 400 ml in 2 cases.There were 1 case of overhydration.No uterine perforation or infection occurred after operation.The patients were followed at 1,3,6,and 12 months after operation,respectively,and the surgical outcomes were assessed at 12 postoperative months.Follow-up findings revealed 8 cases of amenorrhea(10.3%),12 cases of irregular spotting(15.4%),33 cases of hypomenorrhea(42.3%),22 cases of normal menstrual flow(28.2%),and 3 cases of no improvement(3.8%).Conclusions Hysteroscopic resections for submucous leiomyomas and endometrial polyps offer advantages of good reliability and fewer complications,being worthy of recommendation.