Endometrial Intraepithelial Neoplasia Involving Polyps: A Followup Study
Charles M Quick, George L Mutter, Anna R Laury, Christopher P Crum, Marisa R Nucci. UAMS, Little Rock, AR; Brigham and Women's Hospital, Boston, MA; UCLA, Los Angeles, CA
Background: Endometrial intraepithelial neoplasia (EIN) is a precancerous neoplasm of the endometrium that carries a 45-fold higher risk of endometrioid carcinoma on followup. For this reason, when EIN is detected, management includes either hysterectomy or hormonal therapy and close followup. EINs have also been reported in endometrial polyps (EMPs), but the implications of this diagnosis are unclear. We examined a consecutive series of EINs associated with EMPs to determine their likelihood of persisting or progressing to adenocarcinoma on followup sampling.
Design: Consecutive cases coded as both EMP and EIN in the pathology files between 2009 and 2010 were identified. Cases designated as arising in polyps were culled from this group, examined histologically and followup determined by a search of the pathology records.
Results: Eighty-four cases coded as both EIN and EMP were identified. Of these, the diagnosis of EIN occurring in EMP were confirmed in 37. Followup endometrial sampling was obtained in 29 (78%). Of these 29, 13 (45%) showed no evidence of EIN, 12 (41%) contained persistent EIN, with or without a polyp and 4(14%) contained a well differentiated endometrioid adenocarcinoma.
Conclusions: Close followup of women with EIN apparently confined to polyps will reveal the absence of EIN in nearly one-half of cases. Nevertheless, a nearly equal proportion will have persistence of their disease and 14% will be shown to have endometrial adenocarcinoma. Thus, while the possibility of complete removal of the EIN by polypectomy exists, the risk of persistence/recurrence requires close followup. The range of EIN morphologies seen in polyps will be illustrated.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 132, Tuesday Afternoon