Endometrial polyps are benign nodular protrusions of the endometrial surface. They can either be sessile or pedunculated.
They tend to be most frequently seen in patients receiving Tamoxifen.
Most polyps are asymptomatic although they can be a common cause of post-menopausal bleeding (can account for approximately 30% of cases 5). In menstruating women, they may cause inter-menstrual bleeding, metrorrhagia, and infertility.
Polyps can be histologically characterized as localized hyperplastic overgrowths of glands and stroma. They consist of irregularly distributed endometrial glands and stroma and generally consist of three components:
- a stroma of focally or diffusely dense fibrous or smooth muscle tissue
- thick-walled vessels
- endometrial glands
There may be a predilection towards the fundal and cornual regions within the uterus. They can be multiple in ~ 20% of cases.
Although endometrial polyps may be visualised at trans-vaginal ultrasound as non-specific endometrial thickening, they are frequently identified as focal masses within the endometrial canal. The stalk to the polyp may either be thin or broad based. A feeding vessel may be seen extending to the polyp. cystic spaces corresponding to dilated glands filled with proteinaceous fluid may be seen within the polyp and is considered a relatively characteristic feature 3.
Sonohysterography - Polyps are best seen at sonohysterography and appear as echogenic, smooth, intra-cavitary masses outlined by fluid. The typical appearance of an endometrial polyp at sonohysterography is as a well-defined, homogeneous, polypoid lesion that is isoechoic to the endometrium with preservation of the endometrial-myometrial interface 5. There is usually a well-defined vascular pedicle within the stalk.
Colour Doppler interrogation may show flow within the stalk.
Polyps may be seen as pedunculated or sessile filling defects within the uterine cavity
Signal characteristics include
- T1 - often iso signal to endometrium
- T2 - endometrial polyps are often seen as low-signal-intensity intra-cavitary masses surrounded by high-signal-intensity fluid and endometrium.
- T1 C + (Gd) - can show either homogenous or heterogenous enhancement.
A very small percentage (0.5-3%) of polyps may contain endometrial carcinoma 4.
Treatment and prognosis
Most polyps are benign and are often treated with a polypectomy.
Entities that can potentially mimic an endometrial polyp include
- uterine leiomyoma(s) : especially if pedunculated and sub-mucosal - although most leiomyomas tend to be hypoechoic
- foci of endometrial hyperplasia
- endometrial carcinoma
For hyper-echoic content within the endometrium also consider
- 1. Grasel RP, Outwater EK, Siegelman ES et-al. Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology. 2000;214 (1): 47-52. Radiology (full text) - Pubmed citation
- 2. Nalaboff KM, Pellerito JS, Ben-levi E. Imaging the endometrium: disease and normal variants. Radiographics. 21 (6): 1409-24. Radiographics (full text) - Pubmed citation
- 3. Hulka CA, Hall DA, Mccarthy K et-al. Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography. Radiology. 1994;191 (3): 755-8. Radiology (abstract) - Pubmed citation
- 4. Jorizzo JR, Chen MY, Riccio GJ. Endometrial polyps: sonohysterographic evaluation. AJR Am J Roentgenol. 2001;176 (3): 617-21. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Davis PC, O'neill MJ, Yoder IC et-al. Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics. 22 (4): 803-16. Radiographics (full text) - Pubmed citation
- 6. Machtinger R, Korach J, Padoa A et-al. Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy. Int. J. Gynecol. Cancer. 15 (2): 325-8. doi:10.1111/j.1525-1438.2005.15224.x - Pubmed citation
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