Search

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.

Objective: To compare results of hysteroscopic polypectomy of the endometrium performed in an outpatient clinic, under no anesthesia, to conventional hysteroscopic polypectomy under anesthesia in the operating theatre, assessing success rate, procedure time and complications; and to measure pain referred by patients in both groups., Methods: An observational cross-sectional study of 60 patients with hysteroscopic diagnosis of endometrial polyps, divided into two groups: the Outpatient Group, comprising patients submitted to outpatient's hysteroscopic polypectomy by continuous flow vaginoscopy using endoscopic forceps under no anesthesia, and the Conventional Group with patients submitted to hysteroscopic polypectomy in the operating theater, using a monopolar resectoscope under anesthesia., Results: The groups were similar as to age, parity, mode of delivery and menopausal status. Both groups presented 100% efficacy in exeresis of polyps. The mean time of procedure was 7 minutes in the Outpatient Group and 35.16 minutes in the Conventional Group. In the Outpatient Group, menopausal patients (p=0.04) and those with polyps >1cm (p=0.01) had longer procedures. Using the Verbal Analog Scale of Pain, the mean score of pain referred by patients during the procedure was 2.93 in the Outpatient Group and, after anesthetic effect, 1.42 in the Conventional Group. There were no complications in the Outpatient Group. There was one case of uterine perforation and one case of false passage in the Conventional Group., Conclusion: Hysteroscopic polypectomy performed in an outpatient setting under no anesthesia is a well-tolerated procedure. As compared to conventional treatment, it displays the same efficacy, but the procedure time is shorter and the complication rate is lower.

Study Objective: To investigate the presence of estrogen receptors (ER) and progesterone receptors (PR) in the glandular epithelium and stroma of endometrial polyps in women who underwent hysteroscopic polypectomy., Design: Prospective study (Canadian Task Force classification II-3., Setting: Hospital de Servidor Público Estadual de São Paulo "Francisco Morato de Oliveira.", Patients: Forty-eight patients with a solitary endometrial polyp who underwent hysteroscopic polypectomy and resection of an endometrial fragment., Intervention: The estrogen and progesterone receptor expression, in the polyp, was compared with the endometrial hormone expression of the same patients., Measurements and Main Results: The specimens were analyzed by immunohistochemistry. The percentage of staining cells was determined as follows: grade I, 0% to 25%; grade II, 26% to 50%; grade III, 51% to 75%; and grade IV, 76% to 100% of stained nuclei. The intensity of nuclear staining was classified as grade I, absent; grade II, weak; grade III, strong; and grade IV, very strong staining. The sum of both grades was the histochemical score. The total scores of polyp and endometrium were statistically compared. The total scores of ER of glandular epithelium were 258 in polyp and 211 in endometrium. As to stroma, it was 155 in polyp and 163 in endometrium. The total scores of PR of glandular epithelium were 286 in polyp and 211 in endometrium. As to stroma, the totals were 76 in polyp and 77 in endometrium. In immunohistochemistry, the concentrations of both ER and PR in glandular epithelium were significantly higher in endometrial polyp than in normal endometrium. The concentrations of ER and PR in the stroma were similar in the polyp and endometrium. The concentrations of these receptors in the glandular epithelium and stroma were similar in postmenopausal and premenopausal patients., Conclusion: The concentrations of ER and PR in glandular epithelium were significantly higher in endometrial polyp than in normal endometrium. The concentrations of these receptors in the glandular epithelium and stroma were similar in the postmenopausal and pre-menopausal patients.