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#Grand Rounds

Atypical Hyperplasia Confined to Polyps: What is the Incidence of Endometrial Carcinoma?

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BACKGROUND AND PURPOSE:

  • Incidence of endometrial carcinoma is high (approximately 40%) in women who undergo hysterectomy following a random endometrial biopsy
  • Jacobs et al. (BJOG, 2020) investigated the incidence of endometrial carcinoma in patients diagnosed with atypical hyperplasia confined to a polyp

METHODS:

  • Retrospective cohort study (2008 to 2016)
  • Participants
    • Women who had hysteroscopic polyp resection
    • Notes documented complete polyp removal
  • Data collection
    • Patient characteristics: Age | BMI | Menopausal status | Hormone use | Symptoms at presentation (pre- and postmenopausal bleeding)
    • Polyps reported as incidental findings or following investigation for abdominal pain or vaginal discharge were considered asymptomatic  
    • Histopathology results of the polyp
    • Histopathology results of the uterus, in the case of hysterectomy
  • Polyps divided into two groups
    • Benign polyps
    • (Pre‐)malignant polyps: Atypical hyperplasia or endometrial carcinoma
  • Primary outcome
    • Endometrial carcinoma

RESULTS:

  • 1,445 polyp resections
    • Benign histopathology results: 96.2% (1,390 polyps)
    • (Pre‐)malignant: 3.8% (55 polyps)
      • Atypical hyperplasia: 2.7% (39 polyps)
      • Endometrial carcinoma: 1.1% (16 polyps)
  • Hysterectomy (indication for (pre‐)malignant polyp pathology result for the polyp: 50 cases
    • Atypical hyperplasia confined to polyp: 35 cases
    • Endometrial carcinoma confined to the polyp: 15 cases
  • Endometrial histopathology among the 35 women with atypical hyperplasia confined to the polyp
    • No additional pre-malignant changes in the endometrium: 30.8% (12 women)
    • Atypical hyperplasia: 28.2% (11 women)
    • Endometrial carcinoma: 30.8% (12 women)
  • Older age, postmenopausal status, tamoxifen use or bleeding at presentation were not associated with whether a polyp had  (pre‐)malignant changes

CONCLUSION:

  • Endometrial carcinoma was found in 30.8% of hysterectomy specimens performed for atypical hyperplasia confined to a polyp
  • The authors conclude that the data in this study supports a recommendation “to perform a hysterectomy and bilateral salpingo-oophorectomy for polyps with confined atypical hyperplasia in postmenopause and surgery or progestogens in premenopausal women”

Learn More – Primary Sources:

Atypical endometrial polyps and the incidence of endometrial cancer: a retrospective cohort study

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Related ObG Topics:

Is Same-Day Discharge After Minimally Invasive Hysterectomy Safe for Women with Endometrial Cancer?
How Common is Unexpected Uterine Cancer at Hysterectomy?
Endometrial Polyps – Do They Always Need To Be Removed?

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