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Endometrial polyps are benign tumors consisting of surface endometrium, fibrous stroma, and thick-walled, centrally positioned blood vessels. A clonal rearrangement of chromosome 6p21 is common in the mesenchymal (stroma) cells in the polyp. The endometrial cells do not have the chromosome 6 rearrangement. One possible explanation of these findings is that an endometrial polyp begins when a stromal cell undergoes a rearrangement in chromosome 6p21 resulting in an abnormal signal to grow. The stromal elements proliferate and bring the endometrial glands along as "innocent bystanders."
Most endometrial polyps are solitary. In approximately 20% of cases multiple polyps are present. Polyps peak between ages 40 and 50 years, but many cases occur in menopausal women. In fewer than 1% of cases, polyps are associated with cancer. The usual presenting symptom is intermenstrual bleeding.
Polyps are typically diagnosed by sonography (especially sensitive in the follicular phase), saline infusion hysterosonography, hysterosalpingography, hysteroscopy, or curettage. Curettage often fails to remove endometrial polyps because of the mobility of their body and tip. In menopausal women taking hormone replacement therapy who have abnormal uterine bleeding, polyps are commonly found by hysteroscopy. Multiple case reports indicate that tamoxifen treatment may stimulate the development and growth of endometrial polyps.
Other Benign Uterine Disorders
Adenofibromas are benign tumors of epithelium and stroma that contain fewer that 4 mitoses per 10 high-power fields. Women with adenofibromas usually are elderly.
Uterine Conservation at the Time of Adnexal Removal
In women who desire future childbearing, every effort should be made to preserve ovarian tissue unless a cancer diagnosis necessitates the removal of both ovaries. Occasionally, the clinician is confronted.
For some conditions, both ovaries require surgical removal. The clinician then is confronted with the issue of uterine conservation. If the woman has clearly and consistently communicated.