Premenapozal dönemde eksize edilen endometrial poliplerin farklı vücut kitle indekslerine göre histopatolojik sonuçlarının karşılaştırılması

Amaç: Premenapozal dönemde eksize edilen semptomatik endometrial poliplerin histopatolojik özelliklerini farklı vücut kitle indeksine sahip kadınlarda karşılaştırmak ve obezite varlığının poliplerin premalign/malign dejenerasyonu için bir risk faktörü olup olamayacağını araştırmak Yöntem: Anormal uterin kanama nedeniyle başvuran ve endometrial polip ön tansıyla operatif histereskopi uygulanan premenapozal dönemdeki kadınların histopatolojik sonuçları retrospektif olarak incelenmiştir. Sonuçları; benign (polip), premalign (hiperplastik polip±nükleer atipi), malign (polip zemininde gelişmiş karsinom) olarak kaydedilmiştir. Bulgular: Altıyüz onsekiz kadının 23 (%3.7) tanesinde premalign lezyon tespit edilirken, hiçbir olguda malignite izlenmemiştir. Premalign bulguların olduğu gruptaki obezite sıklığı benign bulgular tespit edilen gruba göre anlamlı derecede daha fazla idi. Regresyon analizi sonucunda obezite varlığı premalign endometrial polip ihtimalini normal kilolulara göre yaklaşık 4.5 kat arttırmaktaydı. Sonuç: Premenapozal dönemde anormal uterin kanama etyolojisinde tespit edilen endometrial poliplerin premalign/malign olma ihtimali oldukça düşüktür. Ancak, obezite varlığında bu ihtimalin gerçekleşmesi anlamlı derecede artmaktadır.

Anahtar Kelimeler:

endometrial polip, premenapoz dönem, histopatoloji, vücut kitle indeksi

Comparison of Histopathological Findings of Endometrial Polyps Excised in The Premenopausal Period According to Different Body Mass Indexes

Objective: To compare the histopathological features of symptomatic endometrial polyps excised in the premenopausal period in women with different body mass index and to investigate whether the presence of obesity may be a risk factor for premalignant / malignant degeneration of polyps. Methods: The histopathological findings of premenopausal women who applied for abnormal uterine bleeding and underwent operative hysteroscopy for endometrial polyps were retrospectively analyzed. Findings were recorded as benign (polyp), premalignant (hyperplastic polyp ± nuclear atypia), malignant (carcinoma developed on the basis of polyp). Results: While premalignant lesions were detected in 23 (3.7%) of six hundred and eighteen women, malignancy was not observed in any of the cases. The frequency of obesity in the group with premalignant findings was significantly higher than the group with benign findings. As a result of the regression analysis, the presence of obesity increased the probability of premalignant endometrial polyp approximately 4.5 times compared to normal weight individuals. Conclusion: Endometrial polyps detected in the etiology of abnormal uterine bleeding in the premenopausal period are unlikely to be premalignant / malignant. However, the realization of this possibility increases significantly in the presence of obesity.

Keywords:

endometrial polyp, premenopausal period, histopathology, body mass index,

PDF

___

1- Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol 2009;33:102–8.
2- Lieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review. Acta Obstet Gynecol Scand 2010;89:992–1002.
3- American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19:3–10.
4- Sasaki LMP, Andrade KRC, Figueiredo ACMG, Wanderley MDS, Pereira MG. Factors Associated with Malignancy in Hysteroscopically Resected Endometrial Polyps: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2018;25(5):777-85.
5- Savelli L, De Iacco P, Santini D, Rosati F, Ghi T, Pignotti E, et al. Histopathologic features and risk factors for benign, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol. 2003;188:927–31.
6- Papadia A, Gerbaldo D, Fulcheri E, et al. The risk of premalignant and malignant pathology in endometrial polyps: should every polyp be resected? Minerva Ginecol 2007;59:117–24.
7- Costa-Paiva L, Godoy CE Jr, Antunes A Jr, Caseiro JD, Arthuso M, Pinto-Neto AM. Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause. 2011;18:1278–82.
8- Minkin MJ. Menopause: Hormones, Lifestyle, and Optimizing Aging. Obstet Gynecol Clin North Am. 2019 Sep;46(3):501-14. 9- Giordano MV, Alvarenga TF, Bastos Júnior CS, Giordano MG, Baracat EC, Soares Júnior JM Does obesity modify the expression of cyclin D1 and pten in endometrial polyps in postmenopausal women? Gynecol Endocrinol. 2020 Dec 21:1-4.
10- Antunes A Jr, Costa-Paiva L, Arthuso M, Costa JV, Pinto-Neto AM. Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy. Maturitas. 2007;57:415–21.
11- van Dongen H, Janssen CA, Smeets MJ, et al. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG. 2009;116:1387–90.
12- Namazov A, Gemer O, Ben-Arie A, Israeli O, Bart O, Saphier O, et al. Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women. J Obstet Gynaecol Can. 2019;41(7):912-15
13- .Uglietti A, Mazzei C, Deminico N, Somigliana E, Vercellini P, Fedele L. Endometrial polyps detected at ultrasound and rate of malignancy. Arch Gynecol Obstet. 2014;289:839–43
14- Haimov-Kochman R, Deri-Hasid R, Hamani Y, Voss E. The natural course of endometrial polyps: could they vanish when left untreated? Fertil Steril. 2009;92:828, e11-e12.
15- Wong M, Crnobrnja B, Liberale V, Dharmarajah K, Widschwendter M, Jurkovic D. The natural history of endometrial polyps. Hum Reprod. 2017;32:340–5.
16- Elfayomy AK, Soliman BS. Risk factors associated with the malignant changes of symptomatic and asymptomatic endometrial polyps in premenopausal women. J Obstet Gynaecol India. 2015;65:186–92.
17- Kilicdag EB, Haydardedeoglu B, Cok T, Parlakgumus AH, Simsek E, Bolat FA. Polycystic ovary syndrome and increased polyp numbers as risk factors for malignant transformation of endometrial polyps in premenopausal women. Int J Gynaecol Obstet. 2011;112:200–3.
18- Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev. 2002;11:1531–43.
19- Gregoriou O, Konidaris S, Vrachnis N, et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric. 2009;12:454–8.