Английская Википедия:Endometrial polyp
Шаблон:Infobox medical condition (new) An endometrial polyp or uterine polyp is a mass in the inner lining of the uterus.[1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).[2][3] Pedunculated polyps are more common than sessile ones.[4] They range in size from a few millimeters to several centimeters.[3] If pedunculated, they can protrude through the cervix into the vagina.[2][5] Small blood vessels may be present, particularly in large polyps.[2]
Signs and symptoms
They often cause no symptoms.[4] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.[3][6] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.[7] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[5]
Cause
No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.[3] Risk factors include obesity, high blood pressure and a history of cervical polyps.[3] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.[3][8] The use of an intrauterine system containing levonorgestrel in women taking tamoxifen may reduce the incidence of polyps.[9]
Diagnosis
Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.[3] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).[2] Larger polyps may be missed by curettage.[10]
Endometrial polyps can be solitary or occur with others.[11] They are round or oval and measure between a few millimeters and several centimeters in diameter.[7][11] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.[7] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.[7] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.[11] Pedunculated polyps are more common than sessile ones.[4]
Treatment
Polyps can be surgically removed using curettage with or without hysteroscopy.[12] When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.[7] Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through the cervix. Large polyps can be cut into sections before each section is removed.[7] The presence of cancerous cells may suggest a hysterectomy (surgical removal of the uterus).[3] A hysterectomy is usually not considered when cancer is not present.[7] In either procedure, general anesthetic is typically supplied.[10]
The effects of polyp removal on fertility has not been studied.[13]
Prognosis
Endometrial polyps are usually benign although some may be precancerous or cancerous.[3] About 0.5% of endometrial polyps contain adenocarcinoma cells.[14] Polyps can increase the risk of miscarriage in women undergoing IVF treatment.[3] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.[3] Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[7] Untreated, small polyps may regress on their own.[15]
Epidemiology
Endometrial polyps usually occur in women in their 40s and 50s.[3] Endometrial polyps occur in up to 10% of women.[2] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.[8]
See also
References
External links
Шаблон:Medical resources Шаблон:Diseases of the pelvis, genitals and breasts
- ↑ Шаблон:Cite book
- ↑ 2,0 2,1 2,2 2,3 2,4 Шаблон:Cite book
- ↑ 3,00 3,01 3,02 3,03 3,04 3,05 3,06 3,07 3,08 3,09 3,10 3,11 Шаблон:Cite web
- ↑ 4,0 4,1 4,2 Шаблон:Cite book
- ↑ 5,0 5,1 Шаблон:MerckManual
- ↑ Шаблон:Cite web
- ↑ 7,0 7,1 7,2 7,3 7,4 7,5 7,6 7,7 Шаблон:Cite book
- ↑ 8,0 8,1 Шаблон:Cite book
- ↑ Шаблон:Cite journal
- ↑ 10,0 10,1 Шаблон:Cite web
- ↑ 11,0 11,1 11,2 Шаблон:Cite book
- ↑ Шаблон:Cite web
- ↑ Шаблон:Cite journal
- ↑ Шаблон:Cite book
- ↑ Шаблон:Cite web
