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Endometrial polyp
Classification and external resources
Endometrial polyp, viewed by sonography.
ICD-10 N84.0
ICD-9 621

An endometrial polyp or uterine polyp is a polyp or lesion in the lining of the uterus (endometrium) that takes up space within the uterine cavity. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. A polyp is an abnormal growth of tissue ( Tumor) projecting from a Mucous membrane. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma The endometrium is the inner membrane of the Mammalian Uterus. Commonly occurring, they are experienced by up to 10% of women. [1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). Sessile is a term in Biology with two distinct meanings In botany and medicine In Botany, sessile means "without a stalk Pedunculated is a medical term that is used to describe having or supported on a peduncle which is a stalk [1][2] Pedunculated polyps are more common than sessile ones. [3] They range in size from a few millimeters to several centimeters. [2] If pedunculated, they can protrude through the cervix into the vagina. The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus [1][4] Small blood vessels may be present, particularly in large polyps. [1]

Contents

Cause and symptoms

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, [2] They often cause no symptoms. [3] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause. Menorrhagia is an abnormally heavy and prolonged menstrual period at regular intervals Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan [2][5] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause. [6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result. Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe Uterine Pain during Menstruation. [4]

Diagnosis

Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage. The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus Gynecologic ultrasonography or Gynecologic sonography refers to the application of Medical ultrasonography to the female pelvic organs specifically the Uterus Hysteroscopy is the inspection of the uterine cavity by Endoscopy. Dilation (dilatation and curettage literally refers to the dilation (opening of the Cervix and surgical removal of the contents of the Uterus. [2] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium). Endometrial hyperplasia is a condition of excessive proliferation of the cells of the Endometrium, or inner lining of the Uterus. [1] Larger polyps may be missed by curettage. [7]

Treatment

Polyps can be surgically removed using curettage or hysterescopy. Curettage, in Surgery, is the use of a Curette to remove tissue by scraping or scooping [8] When curettage is performed, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure. Forceps are a handheld hinged instrument used for grasping and holding objects [6] During hysterescopy, the polyp can be visualized and removed through the cervix. The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. If it is a large polyp, it can be cut into sections before each section is removed. [6] If cancerous cells are discovered, a hysterectomy may be performed. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist. [2] A hysterectomy would usually not be considered if cancer has been ruled out. [6] Whichever method is used, polyps are usually treated under general anesthetic. A general anaesthetic (or anesthetic, see Spelling differences) drug is an anaesthetic drug that brings about a reversible loss of Consciousness. [7]

Prognosis and complications

Endometrial polyps are usually benign although some may be precancerous or cancerous. A benign tumor is a Tumor that lacks all three of the Malignant properties of a Cancer. A premalignant condition is a Disease, Syndrome, or finding that if left untreated may lead to Cancer. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled [2] About 0. 5% of endometrial polyps contain adenocarcinoma cells. Adenocarcinoma is a cancer that originates in Glandular tissue [9] Polyps can increase the risk of miscarriage in women undergoing IVF treatment. Miscarriage or spontaneous abortion is the natural or spontaneous end of a Pregnancy at a stage where the embryo or fetus is incapable of surviving generally defined In vitro fertilisation ( IVF) is a process by which [2] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant. The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges ( singular salpinx) are two very fine tubes lined with ciliated [2] Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent. [6] Untreated, small polyps may regress on their own. [10]

Risk factors and epidemiology

Endometrial polyps usually occur in women in their 40s and 50s. [2] Risk factors include obesity, high blood pressure and a history of cervical polyps. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated A cervical polyp is a common Benign polyp or Tumour on the surface of the cervical canal. [2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps. Tamoxifen is an orally active Selective estrogen receptor modulator (SERM that is used in the treatment of Breast cancer and is currently the world's largest Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male [2][11] The use of an IntraUterine System containing levonorgestrel in women taking Tamoxifen may reduce the incidence of polyps. Levonorgestrel (or' l - Norgestrel or D - Norgestrel) is a synthetic progestogen used as [12] Endometrial polyps occur in up to 10% of women. [1] It is estimated that they are present in 25% of women with abnormal vaginal bleeding. [11]

Structure

Endometrial polyps can be solitary or occur with others. [13] They are round or oval and measure between a few millimeters to several centimeters in diameter. [13][6] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red. [6] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium. In Cell biology, stromal cells are Connective tissue cells of an organ found in the loose connective tissue In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body [6] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall. [13] Pedunculated polyps are more common than sessile ones. [3]

See also

References

  1. ^ a b c d e f Bates, Jane (2007). A cervical polyp is a common Benign polyp or Tumour on the surface of the cervical canal. Uterine fibroids (singular Uterine Fibroma) ( leiomyomata, singular leiomyoma) are Benign Tumors which grow from the muscle layers of Practical Gynaecological Ultrasound. Cambridge University Press, 65. Cambridge University Press (known colloquially as CUP is a Publisher given a Royal Charter by Henry VIII in 1534 ISBN 1900151510.  
  2. ^ a b c d e f g h i j k l Uterine polyps. MayoClinic. com (2006-04-27). Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 1124 - David I becomes King of Scotland. 1296 - Battle of Dunbar: The Scots are defeated Retrieved on 2007-10-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1740 - Maria Theresa takes the throne of Austria. France, Prussia, Bavaria and Saxony
  3. ^ a b c Sternberg, Stephen S. ; Stacey E. Mills, Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins, 2460. ISBN 0781740517.  
  4. ^ a b Dysmenorrhea: Menstrual abnormalities. Merck Manual of Diagnosis and Therapy (2005). The Merck Manual of Diagnosis and Therapy, often called simply The Merck Manual, is the world's best-selling medical textbook Retrieved on 2007-10-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1740 - Maria Theresa takes the throne of Austria. France, Prussia, Bavaria and Saxony
  5. ^ Endometrial Polyp. GPnotebook. GPnotebook is a British medical database for General practitioners (GPs Retrieved on 2007-10-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1740 - Maria Theresa takes the throne of Austria. France, Prussia, Bavaria and Saxony
  6. ^ a b c d e f g h DeCherney, Alan H. ; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional, 703. ISBN 0838514014.  
  7. ^ a b Macnair, Trisha. Ask the doctor - Uterine polyps. BBC Health. Retrieved on 2007-10-21. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1512 - Martin Luther joins the theological faculty of the University of Wittenberg.
  8. ^ Uterine bleeding - Signs and Symptoms. UCSF Medical Center (2007-05-08). Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 589 - Reccared summons the Third Council of Toledo 1450 - Jack Cade's Rebellion: Kentishmen Retrieved on 2007-10-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1740 - Maria Theresa takes the throne of Austria. France, Prussia, Bavaria and Saxony
  9. ^ Rubin, Raphael; David S Strayer (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine, 806. ISBN 0781795168.  
  10. ^ Kaunitz, Andrew M. (2002-08-26). See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. Events 1071 - Battle of Manzikert: The Seljuk Turks defeat the Byzantine Army at Manzikert. Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?. Medscape Ob/Gyn & Women's Health. Retrieved on 2008-04-20. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1303 - The University of Rome La Sapienza is instituted by Pope Boniface VIII.
  11. ^ a b Edmonds, D. Keith; Sir John Dewhurst (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing, 637. Blackwell Publishing Ltd was a Learned society publishing company based in Oxford, England. ISBN 1405156678.  
  12. ^ "Intrauterine Levonorgestrel Protects Against Uterine Effects of Tamoxifen" . BJOG 2007 (114): 1510-1515. .  
  13. ^ a b c Bajo Arenas, José M. ; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis, 502. ISBN 184214331X.  
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