Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy

Objective : To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods : The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results : Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion : Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.

研究目的：评估接受宫腔镜息肉切除术（hysteroscopic polypectomy）的患者中，子宫内膜息肉（endometrial polyps）内癌前病变（premalignant lesions）与癌变的发生情况。
研究方法：本研究分析了1020例行宫腔镜息肉切除术患者的病理检查结果，以及其诊断性宫腔镜与手术宫腔镜检查所见。按月经状态分组，295例（28.9%）患者处于绝经前育龄期（menacme）；其中193例（65.4%）表现为异常子宫出血，102例（34.6%）无明显临床症状，但经阴道超声（transvaginal ultrasound）提示子宫内膜回声异常。725例（71.1%）为绝经后患者，其中171例（23.6%）存在异常子宫出血症状，554例（76.4%）无明显症状，但子宫内膜回声厚度＞5.0mm。
研究结果：21例（2.0%）患者的息肉中检出癌前病变，其中13例为单纯性腺体增生（simple glandular hyperplasia），5例无细胞非典型性（atypia），8例伴细胞非典型性；8例息肉存在局灶性复杂性增生（complex hyperplasia），其中4例伴非典型性，4例无病变。5例（0.5%）息肉检出癌变。在21例检出癌前病变的息肉中，12例在诊断性宫腔镜与手术宫腔镜检查中被判定为良性病变；在5例检出癌变的息肉中，4例宫腔镜下亦被判定为正常表现。
研究结论：绝经前育龄期有症状的息肉患者以及所有绝经后息肉患者均应接受息肉切除术并行组织病理学检查，因为即使息肉存在细胞非典型性区域或癌变，宫腔镜下仍可能表现为良性外观。