Gynaecological polyp (cervical, endometrial)

Question 1

What do cervical polyps arise from?

Answer 1

Endocervical epithelium

Question 2

What is shown? Describe it.

Answer 2

Cervical polyp - reddish protrusion of the endocervical epithelium

Question 3

What are the signs and symptoms of cervical polyps?

Answer 3

• Usually asymptomatic, being identified incidentally during a routine
• cervical smear
• vaginal discharge
• IMB
• PCB

Question 4

What is the defnitive management for cervical polyps?

Answer 4

removed by avulsion with polyp forceps as an outpatient.

Question 5

What is an endometrial polyp and what does it consist of?

Answer 5

Endometrial polyps are focal endometrial outgrowths

Contain a variable amount of glands, stroma and blood vessels, which influence their macroscopic appearance

Question 6

What are the signs and symptoms of endometrial polyps?

Answer 6

• May be asymptomatic
• Abnormal uterine bleeding (AUB) (heavy menstrual bleeding [HMB], IMB and postmenopausal bleeding [PMB])
• May adversely impact on fertility

Question 7

How common are endometrial polyps?

Answer 7

They are common and estimated to be present in around 10–20% of women with AUB and 10% of women with subfertility.

Question 8

What are the risk factors for endometrial polyps?

Answer 8

• obesity,
• late menopause,
• the use of the partial oestrogen agonist tamoxifen
• possibly the use of hormone replacement therapy (HRT).

Question 9

Why can endometrial polyps cause unscheduled vaginal bleeding?

Answer 9

Most polyps do not appear to be subject to the normal cellular mechanisms that regulate the endometrium.

Consequently, they are relatively insensitive to cyclical hormonal changes, leading them to persist and –> unscheduled vaginal bleeding

Question 10

What % of endometrial polyps are malignant?

Answer 10

• There are hyperplastic foci in 10–25% of symptomatic cases
• 1% are frankly malignant

Question 11

What are the risk factors for malignant foci within endometrial polyps?

Answer 11

• Post-menopause
• Use of tamoxifen

Question 12

Describe the chacteristics of endometrial polyps on examination.

Answer 12

Endometrial polyps may be:

• pedunculated or sessile,
• single or multiple
• vary in size (0.5–4 cm).

Question 13

How are endometrial polyps diagnosed?

Answer 13

Endometrial polyps can be diagnosed by:

1. Outpatient hysteroscopy (OPH)
2. Saline infusion sonography (SIS) - involves distending the uterine cavity with fluid, thereby aiding detection
3. TVUSS - not as good as they are focal intracavity pathologies

Question 14

How are endometrial polyps managed?

Answer 14

Smaller endometrial polyps = can spontaneously resolve but most persist such that once diagnosed, removal is indicated.

Symptomatic polyps = polypectomy in order to alleviate AUB symptoms, optimize fertility and exclude hyperplasia or cancer.

Polypectomy is a simple procedure that can be performed as a day-case under general anaesthesia, but is now increasingly performed as an outpatient with or without local anaesthesia. A hysteroscope is used to visualize the polyp(s) and to allow miniature instruments to be passed down its operating channel in order to remove the polyp with scissors, electrodes or morcellators.