p16 immunoreactivity in endometrial stromal cells: stromal p16 expression characterises but is not specific for endometrial polyps

Endometrial polyps with bizarre stromal cells: a Benign or a low-grade lesion?

BACKGROUND

Polyps containing bizarre stromal cells are occasionally observed in the lower gynecologic tract, including the vagina, cervix, and endometrium, predominantly in perimenopausal or postmenopausal patients. These cases have traditionally been considered benign without subsequent recurrence or malignancy.

CASE PRESENTATION

We describe a rare instance of a rapid enlarging endometrial polyp characterized by atypical stromal cells in a 76-year-old postmenopausal woman, who presented with vaginal bleeding. Histologically, the polyp was noted for its abundance of atypical stromal cells interspersed among thick-walled vascular channels. Higher magnification revealed eosinophilic cytoplasm in the stromal cells, which exhibited both mono- and multinucleation, hyperchromasia with coarse chromatin, and an absence of conspicuous nucleoli and mitotic figures. A consensus among two of three consulting expert gynecological pathologists supported a benign endometrial polyp diagnosis; however, one pathologist raised the possibility of adenosarcoma, highlighting the diagnostic dilemma these unique lesions present. Despite a hysterectomy recommendation, the patient chose monitoring over immediate surgery. Persistent vaginal bleeding led to her return six months later, whereupon a 7-cm polypoid lesion in the endometrial cavity was found and removed via hysterectomy. The histopathology mirrored the initial findings, showing no myometrial invasion, prompting a re-evaluation of the presumed benign nature of the polyp given its rapid growth. Remarkably, RNA sequencing analysis of the polyp detected a JAK2::NFIB gene fusion, a novel finding for endometrial polyps with atypical stromal cells, the clinical implications of which remain to be elucidated.

CONCLUSION

The rapid recurrence of the polyp within six months raises new questions about the true biological nature of these entities and the relevance of gene fusions like JAK2::NFIB in their pathogenesis, meriting further investigation.

Assessment of Long- and Short-Term Outcomes of Hysteroscopic Polypectomy in Patients with Uterine Polyps

Background

Polyps are a common diagnosis in women of different ages. They can cause a variety of symptoms from bleeding to infertility and can even be the progenitor for malignancies.

Materials and Methods

This was a retrospective cohort study conducted in Isfahan. A total of 1004 patients were included in this study. After hysteroscopic polypectomy, patients had their information regarding the complications and recurrence recorded.

Results

Symptoms improved in 639 (63.8%). Recurrence of polyps was seen in 143 (14.2%) patients. A total of 170 had a successful pregnancy, with 110 of them spontaneous. Using scissors had lower recurrence compared to graspers. Eight cases had complications during the treatment, two of which were major.

Conclusion

Hysteroscopic polypectomy is the treatment of choice for uterine polyps. We show hysteroscopic polypectomy to have a high success rate and a low complications rate, with polypectomies done using scissors to have lower risk of complications or recurrence compared to graspers.

Endometrial polyps: Pathogenesis, sequelae and treatment

Endometrial polyps are overgrowths of endometrial glands that typically protrude into the uterine cavity. Endometrial polyps are benign in nature and affect both reproductive age and postmenopausal women. Although endometrial polyps are relatively common and may be accompanied by abnormally heavy bleeding at menstruation. In asymptomatic women, endometrial polyps may regress spontaneously, in symptomatic women endometrial polyps can be treated safely and efficiently with hysteroscopic excision.