Polyps Flashcards
1
Q
Definition
A
- CERVICAL: benign tumours arising from the endocervical epithelium and may be seen as smooth, reddish protrusions
- ENDOMETRIAL: focal endometrial outgrowths containing a variable amount of glands, stroma and blood vessels, which influence their macroscopic appearance
Projects into the uterine cavity and attached by a pedicle
Can be either:
- Sessile (broad-based)
- Pedunculated (on a narrow stalk)
There may be multiple or just a single polyp
2
Q
Epidemiology
A
In 10-20% of women with abnormal uterine bleeding (AUB)
In 10% of women with subfertility
Incidence rises steadily with increasing age
Risk of polyp malignancy increases with age
3
Q
Aetiology / Risk factors
A
- Endometrial polyps are insensitive to hormonal changes and so may cause unscheduled vaginal bleeding
- Endometrial polyps contain hyperplasic foci in 10-25% of symptomatic cases
- <1% are malignant
Risk Factors
- Obesity
- Late menopause
- Use of partial oestrogen agonist – tamoxifen
- HRT use
4
Q
Signs and symptoms
A
Cervical
- ASYMPTOMATIC
- Vaginal discharge
- CONTACT bleeding- post-coital, post-VE bleeding
Endometrial
- AUB (abnormal uterine bleeding)
- Menorrhagia
- Intermenstrual bleeding/ spotting
- Post-menopausal bleeding
Signs
- Usually NORMAL
- Smooth, reddish protrusion on the cervix- speculum
- Polyp may be soft and indented with the tip of the optic
- Move with the movement of liquid distending solution
- Vaginal discharge
5
Q
Investigations
A
Basic observations
- Bloods
Cervical polyp
- Speculum
Endometrial
- TVUSS
- May see thickened endometrium
- Outpatient hysteroscopy
- Used to visualise polyp(s) and allow miniature instruments to be passed down in order to remove the polyp with scissors, electrodes or morcellators
- Saline infusion sonography (also known as Sonohysterography)
- Sub-mucous leiomyomas (fibroids) and endometrial polyps may be seen
6
Q
Management
A
Cervical
Management -> reassurance
- Generally advised to remove (twist off if small or surgery)
- Send for histology
Endometrial
Management:
- May resolve spontaneously (if small)
- Polypectomy to alleviate AUB symptoms, optimise fertility and exclude hyperplasia/cancer
· Day-case under GA or under LA in OPD
7
Q
Complications / Prognosis
A
- NOTE: the risk of polyps harbouring serious endometrial disease is increased after menopause and with use of tamoxifen
- Small risk of malignancy
Prognosis
- Smaller endometrial polyps can spontaneously resolve but most persist once diagnosed
- Endometrial polyps can be ‘washed out’ with a period in pre-menopausal women
