Endometrial polyp-like mass

Endometrial polyp-like masses refer to polyps within the uterine cavity. The formation of polyps has a lot to do with one's own physical constitution. You need to pay attention to your physical health in daily life to effectively avoid it. Uterine polyps can cause abnormal bleeding, often in middle-aged women. Although most polyps are benign, they should still be carefully examined to rule out the possibility of cancer. Let us learn more about this disease through the following article.

Any mass that is attached to the inner wall of the uterine cavity by a thin pedicle can be clinically called a uterine polyp. Therefore, polyp-like masses in the uterine cavity may be pedunculated submucosal fibroids, endometrial polyps, adenomyoma-like polyps, and malignant polyps (cancer or sarcoma). The causes of endometrial polyps may be related to inflammation, endocrine disorders, and especially excessive estrogen levels. Most scholars believe that polyps come from the immature endometrium, especially the base.

Overview

Endometrial polyps are caused by excessive proliferation of the endometrium and can occur at any age. They are a very common type of localized endometrial tumor that protrudes into the uterine cavity and is smooth and fleshy in hardness. The pedicles vary in length, with the older ones protruding outside the cervical os and some having shorter pedicles. Any mass that is attached to the inner wall of the uterine cavity by a thin pedicle can be clinically called a uterine polyp. Therefore, polyp-like masses in the uterine cavity may be pedunculated submucosal fibroids, endometrial polyps, adenomyoma-like polyps, and malignant polyps (cancer or sarcoma). Smaller polyps generally have no clinical symptoms. Some polyps protruding from the cervix are discovered when bleeding occurs after sexual intercourse and the patient is consulted for treatment. For polyps with longer pedicles, laser surgery can be used to remove them under direct hysteroscopy, and any smaller polyps found at the same time can be treated together. Uterine polyps are the best indication for endoscopic laser surgery.

symptom

The main symptoms are increased menstrual volume or irregular uterine bleeding; polyps can be seen or touched at the cervical opening and the uterine body is slightly enlarged. Hysteroscopy or segmental diagnostic curettage and sending the removed tissue or polyps for pathological examination can confirm the diagnosis and differentiate it from dysfunctional uterine bleeding, submucosal uterine fibroids and endometrial cancer.

pathology

Grossly, the most common type is localized endometrial tumors protruding into the uterine cavity, which may be single or multiple, gray-red, shiny, and generally small in size, with an average diameter of 0.5 to 2 cm. The small ones are only 1 to 2 mm in diameter, while the large and multiple ones can fill the uterine cavity. The pedicles vary in thickness and length, and the longer ones may protrude beyond the cervical opening. Some have shorter pedicles and grow diffusely. The surface of the polyp often has hemorrhagic necrosis and may also be infected. If the pedicle is twisted, hemorrhagic infarction may occur.

Clinical diagnosis

The disease can occur at any age after puberty, but is more common in women over 35 years old. Single, small endometrial polyps often have no clinical symptoms and are often discovered during gross examination after hysterectomy due to other diseases, or diagnosed after diagnostic curettage. Patients with multiple diffuse type often have menorrhagia and prolonged menstruation, which are related to the increase in endometrial area and excessive endometrial hyperplasia. Large polyps or polyps that protrude into the cervical canal are prone to secondary infection and necrosis, causing irregular bleeding and foul-smelling bloody secretions.

Microscopic examination: Endometrial polyps are composed of endometrium, covered with a layer of cuboidal epithelium or low columnar epithelium. The middle part of the polyp forms a fibrous longitudinal axis, which contains blood vessels.

Due to the narrow pedicle and reduced blood supply, polyps are very prone to degeneration. Polyps are most prone to intravascular thrombosis, turning dark purple due to blood stasis, and often begin to necrotize at the top, and may eventually rot and fall off.

The pathological diagnostic criteria for malignant transformation of polyps are:

①The entire morphology of the polyp must be seen;

②Malignant transformation is limited to the polyp;

③There is no cancerous change in the endometrium around the polyp. Care should be taken to differentiate it from endometrial adenocarcinoma which presents a polyp-like growth.