Pathogenesis and prediction of recurrent endometrial polyps

• Mekan R. Orazov
• Lyudmila M. Mikhaleva
• Olga А. Poymanova

Abstract

Endometrial polyps are a common pathology that, despite often being asymptomatic, is associated with reproductive disorders. Hysteroscopic resection of polyps is an effective treatment method, but recurrences are not uncommon. The recurrence rate after polypectomy varies from 13 to 43% according to various studies. Predisposing factors include characteristics such as hyperplastic type of polyps, a greater initial number of polyps, and the duration of follow-up. A detailed analysis of the hysteroscopic characteristics of the endometrium and the histological features of the removed polyps will optimize the management of patients after polypectomy for the timely detection and treatment of recurrences.

Aim– to identify morphological and hysteroscopic predictors of endometrial polyp recurrence in patients of reproductive age.

Material and methods. A prospective cohort comparative open study included 190 patients of childbearing age diagnosed with endometrial polyps. The age of the participants ranged from 28 to 43 years, with a median value of 36.96 years (interquartile range – 33.997–39.086). Medical history and anthropometric data were collected, sonographic examination of the pelvic organs, hysteroscopy of the uterine cavity with targeted endometrial biopsy, morphological and immunohistochemical studies were performed. Statistical analysis with odds ratio calculation was conducted.

Results. Significant (p<0.05) morphological predictors of endometrial polyp recurrence are: CD138 expression greater than 5 (OR 5.319), hyaline thickening of polyp vessels (OR 4.049), presence of collagen swirls in the glands (OR 3.830), diffuse stromal fibrosis (OR 3.154), CD20 expression greater than 0 (OR 2.786), and sclerosis of spiral arteries (OR 2.213). Significant (p<0.05) hysteroscopic predictors of endometrial polyp recurrence are: diffuse hyperemia (OR 5.120; 95% CI 2.224–11.788), vascularization (OR 5.135; 95% CI 2.131–12.372), micropolyposis (OR 4.625; 95% CI 1.799–11.891), stromal edema (OR 2.933; 95% CI 1.099-7.828), focal hyperemia (OR 2.321; 95% CI 1.201–4.485), and a broad polyp base (OR 1.936; 95% CI 1.039–3.607).

Keywords: endometrial polyps; recurrence; immunohistochemical studies; hysteroscopy; predictors

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