Fibrous endometrial polyp is a benign connective tissue tumor on a broad base or pedicle originating from the inner lining of the uterus. In most cases, the disease is asymptomatic and only in the presence of a large neoplasm is manifested by uterine bleeding and pain in the lower abdomen. Ultrasound and contrast radiography of the uterus, hysteroscopy, histological examination of scraping are used for diagnosis. Treatment is operative: transcervical hysteroresectoscopy with cauterization of the tumor bed and subsequent curettage of the uterus or therapeutic and diagnostic curettage.
ICD 10
N84.0 Polyp of the uterus body
General information
Unlike other types of endometrial polyps, fibrous neoplasias are formed by connective tissue and only in some cases have a small number of glands in their composition. The sizes of most neoplasms do not exceed 1 cm, and the tumors themselves are isolated and develop against the background of atrophy of the uterine mucosa. Such neoplasms are characterized by a low level of vascularization and proliferation. As a rule, fibrotic polyps are insensitive to hormones. They rarely affect patients of reproductive age and are usually detected in women over 40 years of age during premenopause, menopause and postmenopause. In girls, connective tissue neoplasia of the endometrium does not develop before the onset of menarche.
Causes
Although in more than half of cases benign endometrial tumors are formed against the background of hormonal imbalance, patients with fibrous polyposis usually have normal or reduced estrogen levels. According to many specialists in the field of gynecology, the main cause of the formation of connective tissue polyps are non-hormonal causes:
- Chronic endometritis. Inflammation of the endometrium caused by nonspecific factors or STIs contributes to the violation of trophic tissues and is often accompanied by hyperplastic processes.
- Traumatic injuries of the endometrium. Neoplasia is more common in women who have had abortions, medical and diagnostic curettage in the past, and have used an intrauterine device for a long time.
- Termination of pregnancy and complications in childbirth. Blood clots and fragments of the fetal egg attached to the uterine wall can cause increased formation of connective tissue.
- Concomitant vascular and endocrine diseases. Fibrous polyps occur more often in patients with diabetes mellitus, thyroid pathology, hypertension and other diseases in which microcirculation is disrupted and tissue trophism worsens.
- Reduced immunity. Many women with a fibrotic polyp in the post-menopausal period have signs of immunosuppression with a decrease in the number of B-lymphocytes and inhibition of the activity of T-lymphocytes.
Pathogenesis
The exact mechanisms of formation of fibrous endometrial polyps are not known today. Presumably, this process is accompanied by a combined violation of humoral and cellular immunity, in which local atrophic, inflammatory and post-traumatic damage to the basal layer of the epithelium stimulate active proliferation of connective tissue. An important link in neogenesis is the resistance of morphologically altered cells to apoptosis (programmed death), which ensures the gradual growth of the polyp. As the neoplasm develops, its leg is formed, along which vessels pass to feed the slowly proliferating tissue.
Symptoms
Neoplasia of small sizes is usually asymptomatic and becomes an accidental finding during ultrasound of the uterus. At the reproductive age, there may be slight spotting from the vagina between menstruation. Women during premenopause complain of prolonged irregular bleeding, in menopause and postmenopause there are periodic meager bloody discharge from the genital tract, which can be both short-term and long-term. Small contact bleeding during sexual intercourse is characteristic.
With large neoplasms, there are pulling or cramping pain sensations in the lower abdomen. Extremely rarely, with necrobiosis of the tumor, vaginal whites appear in the form of moderate, milky-white secretions. It is worth noting that the symptoms of fibrous polyposis are nonspecific — similar manifestations are noted in other forms of polyps and a number of gynecological diseases.
Complications
Endometrial fibrous polyp are extremely rarely complicated. In women of childbearing age, a neoplasm growing in the area of the mouth of the fallopian tube can cause tubal ectopic pregnancy. Large polyps prevent egg implantation and lead to infertility. If the tumor is accompanied by bleeding, the patient develops posthemorrhagic anemia. In some cases, fibrous neoplasia undergoes necrosis, followed by inflammation and the appearance of signs of general intoxication. The risk of malignant degeneration of a fibrous polyp is low — 0.5-1.5%, but during postmenopause it increases to 7-8%.
Diagnostics
Taking into account the nonspecific nature of clinical manifestations and gynecological examination data, instrumental methods play a key role in diagnosis. If endometrial fibrous polyp is suspected, it is recommended:
- Ultrasound of the uterus. During transabdominal or transvaginal echography, one or more formations with clear boundaries and a homogeneous structure are detected in the uterine cavity.
- Contrast radiography of the uterus (hysterography). In the picture, the polyp is defined as a rounded filling defect with smooth edges.
- Hysteroscopy with RDV. Fibrous neoplasia usually has the form of a single rounded or oval neoplasm of pale color on the leg. Polyp sizes rarely exceed 1.0-1.5 cm.
- Histological examination of scraping. The most informative method that allows you to definitively establish the morphology of the tumor.
Fibrous polyp must be differentiated from other forms of polyps of the body and cervix, as well as submucous fibroids. During the examination, it is extremely important to exclude the malignancy of the neoplasm. In doubtful cases, an oncogynecologist is involved in the diagnosis.
Treatment of endometrial fibrous polyp
Since connective tissue neoplasms of the endometrium are insensitive to the action of hormones, correction of the hormonal background in such tumors is ineffective. In case of single neoplasias up to 1 cm in size and the absence of clinical manifestations, dynamic observation with hysteroscopic and ultrasound control is recommended. In other cases, one of the surgical methods of treatment is used:
- Curettage of the uterine cavity. Previously, this method was widely used to remove fibrous neoplasms. However, currently, due to the inability to coagulate the polyp bed, curettage is used only to a limited extent.
- Hysteroresectoscopy. The intervention is recognized as the gold standard of treatment for fibrotic polyposis of the uterus. During the operation, the polyp on the leg is unscrewed or cut off, after which its base is electrocoagulated, cauterized with a laser or subjected to cryodestruction. Polypectomy is completed by curettage of the uterus, followed by histological examination of the material, which makes it possible to exclude malignant degeneration of the endometrium. Unlike other types of polyps, the patient’s postoperative management scheme does not provide for the appointment of hormones.
Prognosis and prevention
The prognosis for fibrotic endometrial polyps is favorable. However, removal of the tumor without cauterization of its bed in 30% of cases is accompanied by a relapse of the disease. For preventive purposes, timely treatment of inflammatory diseases of the female genital area, concomitant endocrine diseases and hypertension, an orderly sexual life, the reasoned appointment of invasive medical and diagnostic procedures, pregnancy planning with the refusal of abortions is recommended. Regular examination by a gynecologist and periodic ultrasound of the uterus make it possible to diagnose neoplasia in time and choose the optimal treatment tactics for the prevention of possible complications.
