Levent YAŞAR, Hüseyin CENGİZ, Mehmet Can KEVEN, İsa Aykut ÖZDEMİR, Bülent ARICI

Endometriyal poliplerde sayı, çap ve lokalizasyonun; laboratuvar, klinik ve histopatolojik bulgularla ilişkisi

Bu çalışma endometriyal poliplerde sayı, çap ve lokalizasyonun; laboratuvar, klinik ve histopatolojik bulgularla ilişkisini değerlendirmek amacıyla yapıldı. Ocak 2008 ile Temmuz 2009 tarihleri arasında Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Jinekoloji Kliniğinde endometriyal polip nedeniyle histeroskopik polip rezeksiyonu yapılan 73 olgu retrospektif olarak değerlendirildi. Hastaların sosyodemografik özellikleri, semptomları ve menopozal durumları kaydedildi. Tüm vakalarda polipektomiler ameliyathanede genel anestezi altında bipolar rezektoskopla yapıldı. Hemoglobin değerleri hemen ameliyat öncesi ve ameliyattan 3 ay sonra ölçüldü. Histopatolojik olarak endometriyal poliplerin 70ine (%95,8) benign, 2sine (%2,73) atipili kompleks hiperplazi ve 1ine (%1,36) adenokarsinom tanısı konuldu. Menopozal gruptaki hastaların %90ı ve reprodüktif dönemdeki hastaların %84,9u semptomatikti. Reprodüktif gruptaki hastaların %88,6sı ve menopozal gruptaki hastaların %85inde polip sayısı tekildi. Endometrial poliperde sayı, çap ve yerleşim yerinin semptomatoloji (sırasıyla P=0,346, P=0,350 ve P=0,742) ve histopatolojik tanıları (sırasıyla P=0,825, P=0,751 ve P=0,099) arasında anlamlı ilişki kurulamadı. Poliplerde sayı, çap ve yerleşim yeri ile histopatolojik tanılar ve semptomatoloji arasında ilişki kurulamadı. Hemoglobin düzeyleri semptomatik vakalarda anlamlı olarak düşük bulundu.

The effects of the number, location, dimension and histopathological diagnosis of endometrial polyps on laboratory and clinical findings

The aim of this study was to evaluate the effects of the number, location, dimension and histopathological diagnosis of endometrial polyps on laboratory and clinical findings. Seventy three women with endometrial polyps who underwent hysteroscopic polyp resection at Gynecology Clinic of Bakirkoy Dr. Sadi Konuk Education and Research Hospital were evaluated retrospectively from January 2008 to July 2009. Sociodemographic characteristics, symptomatology and menopausal status of the patients were documented. Polypectomy was performed by bipolar resectoscope in all cases under general anesthesia in operating room. Hemoglobin levels were measured just before and after 3 months later operation. The number, location, dimension, histopathological diagnosis of endometrial polyps and clinical symptoms were recorded. The histopathological diagnosis were benign endometrial polyp in 70 (%95,8) cases, complex endometrial hyperplasia with atypia in two cases (%2,73) and endometrial carcinoma in one case (%1,36). Ninety percent of the patients in the menopausal group and %84,9 of the patient in the reproductive age group were symptomatic. In addition, %88,6 of polyp in the reproductive-age and %85 of polyp in the menopausal group were single. The polyp number, dimension and location were not statistically correlated with symptomatology (P=0,346, P=0,350 and P=0,742, respectively) and histopathological diagnosis (P=0,825, P=0,751 and P=0,099, respectively). Polyp location, number and dimension do not correlate with histopathological diagnosis and symtomatology. The hemoglobin levels were significantly lower in cases with symptoms.

PDF

___

1. Peterson WF, Novak ER. Endometrial polyps. Obstet Gynecol 1956;8(1):40-9.
2. Van Bogaert LJ. Clinicopathologic findings in endometrial polyps. Obstet Gynecol 1988;71(5):771-3.
3. Dallenbach-Hellweg G. Histopatology of the endometrium, 4th ed. New York: Springer-Verlag; 1987;130.
4. Berek JS, Novak E. Berek & Novak's Gynecology. 14th ed., Philadelphia: Lippincott Williams & Wilkins, 2007.
5. Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol 2000;21(2):180-3.
6. Bacskó G, Major T. Hysteroscopic diagnosis and treatment of endometrial polyps. Orv Hetil 1999;140(37):2041-5.
7. Bakour SH, Khan KS, Gupta JK. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand 2000;79(4):317-20.
8. Goldstein SR, Monteagudo A, Popiolek D, Mayberry P, Timor- Tritsch I. Evaluation of endometrial polyps. Am J Obstet Gynecol 2002;186(4):669-74.
9. Kamel HS, Darwish AM, Mohamed SA. Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstet Gynecol Scand 2000;79(1):60-4.
10. Emanuel MH, Verdel MJ, Wamsteker K, Lammes FB. A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications. Am J Obstet Gynecol 1995;172(2 pt 1):547-52.
11. Bettocchi S, Ceci O, Di Venere R, Pansini MV, Pellegrino A, Marello F, et al. Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr bipolar electrode. Hum Reprod 2002;17(9):2435-8.
12. Wong SF, Luk KL, Wong AYK, Tang LCH. Findings in women with postmenopausal bleeding investigated with hysteroscopy. J Obstet Gynaecol 2001;21(4):392-5.
13. Elliott J, Connor ME, Lashen H. The value of outpatient hysteroscopy in diagnosing endometrial pathology in postmenopausal women with and without hormone reeplacement therapy. Acta Obstet Gynecol Scand 2003;82(12):1112-9.
14. Fay TN, Khanem N, Hosking D. Out-patient hysteroscopy in asymptomatic postmenopausal women. Climacteric 1999;2(4):263-7.
15. Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 2004;8(2):103-7.
16. Hassa H, Tekin B, Senses T, Kaya M, Karatas A. Are the site, diameter and number of endometrial polyps related with symptomatology? Am J Obstet Gynecol 2006;194(3):718-21.
17. Fernández-Parra J, Rodríguez Oliver A, López Criado S, Parrilla Fernández F, Montoya Ventoso F. Hysteroscopic evaluation of endometrial polyps. Int J Gynaecol Obstet 2006;95(2):144-8.
18. Marcone E, Zupi E, Valli E, Di Felice M, Solima E, Romanini C. Hysteroscopic appearance of benign and malignant endometrial polyps. What are the differences? J Am Assoc Gynecol Laparosc 1994;1(4 pt 2):S21.
19. Papadia A, Gerbaldo D, Fulcheri E, Ragni N, Menoni S, Zanardi S, et al. The risk of premalignant and malignant pathology in endometrial polyps: Should every polyp be resected? Minerva Gynecol 2007;59(2):117-24.
20. Bettocchi S, Nappi L, Ceci 0, Selvaggi L. Office hysterooscopy. Obstet Gynecol Clin North Am 2004;31(3):641-54.
21. DeWaay DJ, Syrop CH, Nygaard IE, Davis WA, Van Voorhis BJ. Natural history of uterine polyps and leiomyoma. Obstet Gynecol 2002;100(1):3-7.
22. Ben-Arie A, Goldchmit C, Laviv Y, Levy R, Caspi B, Huszar M et al. The malignant potential of endometrial polyps. Eur J Obstet Gynecol Reprod Biol 2004;115(2):206-10.
23. Martinez MA, Jou P, Nonell R, Cardona M, Alonso I, Vanrell JA. Polipos endometriales: riesgo de malignizacion y correlacion clinico-anatomica. Prog Obstet Ginecol 2004;47(11):506-10.
24. Perez-Medina T, Bajo J, Huertas MA, Rubio A. Predicting atypia inside endometrial polyps. J Ultrasound Med 2002;21(2):125-8.
25. Reslova T, Tosner J, Resl M, Kugler R, Vavrova I. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999;262(2-3):133-9.
26. Maia Jr. H, Calmon LC, Marques D, Coelho JC, Oliveira M, Coutinho EM. Polypectomy and endometrial resection in postmenopausal patients. J Am Assoc Gynecol Laparosc 1997;4(5):577-82.
27. Herman P, Gaspard U, Foidart JM. Surgical hysteroscopy or hysterectomy in the treatment of benign uterine lesions. What to choose in 1998? Rev Med Liege 1998;53(12):756-61.
28. Pace S, Grassi A, Franceschini P, Villani C, Frega A, Lotti G. Diagnostic and therapeutic aspects of endometrial polyps. Minerva Ginecol 1992;44(5):227-31.