Endometrial polyp in the exam
Getting a film with endometrial polyp in the exam is one of the many exam set-pieces that can be prepared for.
Transabdominal and transvaginal pelvic ultrasound images in a lady with post-menopausal bleeding show an anteverted uterus with focal increased endometrial thickness to 17 mm with a separate endometrial stripe. There is a multicystic, echogenic mass within the endometrium with vascularity on colour Doppler within its stalk.
The myometrium and uterine serosa are normal. The ovaries have a normal post-menopausal appearance and no adnexal mass seen.
This is consistent with an endometrial polyp and could optimally be assessed with 3D ultrasound and sonohysterography. The differential would include focal hyperplasia, submucosal leiomyoma, endometrial carcinoma and haematometra.
Even if she is on HRT or Tamoxifen, this lady needs referral to a gynaecologist for hysteroscopy and biopsy to exclude malignancy.
- 20% are multiple
- 15-35% of patients with endometrial cancer have an associated polyp
- 0.5% are malignant