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Wong M, Thanatsis N, Nardelli F, Amin T, Jurkovic D. Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis. Diagnostics (Basel) 2021; 11:diagnostics11061094. [PMID: 34203810 PMCID: PMC8232598 DOI: 10.3390/diagnostics11061094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient's preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. METHODS Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model's misclassification risk. RESULTS There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45-94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient's body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%-≤20%), or high-risk (>20%) groups. CONCLUSIONS Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.
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Affiliation(s)
- Michael Wong
- Institute for Women’s Health, University College London Hospitals, London NW1 2BU, UK; (M.W.); (N.T.); (T.A.)
| | - Nikolaos Thanatsis
- Institute for Women’s Health, University College London Hospitals, London NW1 2BU, UK; (M.W.); (N.T.); (T.A.)
| | - Federica Nardelli
- Department of Women’s and Children’s Health, Catholic University of Sacred Heart, 1, 00168 Rome, Italy;
| | - Tejal Amin
- Institute for Women’s Health, University College London Hospitals, London NW1 2BU, UK; (M.W.); (N.T.); (T.A.)
| | - Davor Jurkovic
- Institute for Women’s Health, University College London Hospitals, London NW1 2BU, UK; (M.W.); (N.T.); (T.A.)
- Correspondence: ; Tel.: +44-20-3447-9411
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Giordano MV, Lucas HDS, Fiorelli RKA, Giordano LA, Giordano MG, Baracat EC, Júnior JMS. Expression levels of BCL2 and MKI67 in endometrial polyps in postmenopausal women and their correlation with obesity. Mol Clin Oncol 2020; 13:69. [PMID: 33014368 DOI: 10.3892/mco.2020.2139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022] Open
Abstract
Obesity is associated with numerous diseases, including endometrial disorders in postmenopausal women, such as adenocarcinoma, hyperplasias and endometrial polyps, and the risk of malignant transformation of these structures. The present study evaluated the influence of body mass index (BMI) on cell proliferation (BCL2 and MKI67) in endometrial polyps in postmenopausal women. A prospective cross-sectional study using immunohistochemical analysis of the expression of a cell proliferation marker (MKI67) and an anti-apoptotic gene (BCL2) in endometrial polyps in postmenopausal women was performed. The patients were divided into three groups depending on BMI: i) <24.9 kg/m2 (normal); ii) >25 and <29.9 kg/m2 (overweight); and iii) >30 kg/m2 (obese). The present study analyzed the expression of these markers in relation to polyp size, histological type and time since menopause in 38 patients. The interpretation of MKI67 and BCL2 expression accounted for the percentage of positive cells (scores): 1 (weak), <5% of cells showed expression; 2 (moderate), between 5 and 50%; and 3 (intense), >50%. Statistical analysis was performed using GraphPad InStat version 3.00 software. ANOVA was used to analyze BCL2 and MKI67 expression. A significance level of P<0.05 was adopted for rejecting the null hypothesis. There was greater glandular expression of MKI67 in obese women than in normal weight women (P=0.02) and greater expression of BCL2 in the stroma of polyps >2 cm (P=0.03). Hyperplastic polyps exhibited hyperexpression of MKI67 (P=0.04) compared with atrophic polyps. No difference in MKI67 and BCL2 expression was identified in the glands and stroma of polyps when comparing overweight and obese postmenopausal patients. The present findings suggest that BMI has an influence on proliferation markers (MKI67) in the polyps of postmenopausal women and that polyps >2 cm exhibit hyperexpression of BCL2 in the stroma.
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Affiliation(s)
- Mario Vicente Giordano
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital (HUGG), Rio de Janeiro 20270-004, Brazil.,Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo 05403-000, Brazil
| | - Hiram Da Silveira Lucas
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital (HUGG), Rio de Janeiro 20270-004, Brazil
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital (HUGG), Rio de Janeiro 20270-004, Brazil
| | - Luiz Augusto Giordano
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital (HUGG), Rio de Janeiro 20270-004, Brazil
| | - Mario Gáspare Giordano
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital (HUGG), Rio de Janeiro 20270-004, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo 05403-000, Brazil
| | - José Maria Soares Júnior
- Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo 05403-000, Brazil
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Dibi RP, Zettler CG, Vanin CMDM, Ribeiro RVP, de Oliveira JM, Kremer TG, Borges J, Kato SK. Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study. SAO PAULO MED J 2020; 138:64-68. [PMID: 32215462 PMCID: PMC9673849 DOI: 10.1590/1516-3180.2018.0346.r4.19112019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING Cross-sectional analytical study in a tertiary-level academic hospital. METHODS 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.
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Affiliation(s)
- Raquel Papandreus Dibi
- MD, PhD. Professor, Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); and Professor, Gynecology and Obstetrics Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Claudio Galleano Zettler
- MD, PhD. Pathologist, Pathology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Carla Maria de Martini Vanin
- MD, PhD. Professor, Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); and Professor, Gynecology and Obstetrics Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | | | - Júlia Monteiro de Oliveira
- Undergraduate Medical Student, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Thaysa Guglieri Kremer
- Undergraduate Medical Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Josiane Borges
- MD. Pathologist, Pathology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Sérgio Kakuta Kato
- PhD. Epidemiologist, Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.
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PINHEIRO ANDERSON, ANTUNES ARMANDO, ANDRADE LILIANA, DE BROT LOUISE, PINTO-NETO AARÃOMENDES, COSTA-PAIVA LÚCIA. Expression of hormone receptors, Bcl-2, Cox-2 and Ki67 in benign endometrial polyps and their association with obesity. Mol Med Rep 2014; 9:2335-41. [DOI: 10.3892/mmr.2014.2125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 02/18/2014] [Indexed: 11/06/2022] Open
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Leão RBF, Andrade L, Vassalo J, Antunes A, Pinto-Neto A, Costa-Paiva L. Differences in estrogen and progesterone receptor expression in endometrial polyps and atrophic endometrium of postmenopausal women with and without exposure to tamoxifen. Mol Clin Oncol 2013; 1:1055-1060. [PMID: 24649292 DOI: 10.3892/mco.2013.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/13/2013] [Indexed: 11/06/2022] Open
Abstract
Postmenopausal women who use tamoxifen present with an increased incidence of endometrial alterations, such as polyps and hyperplasia, in addition to a higher risk of malignant endometrial neoplasms. Among these endometrial changes, polyps are the most common, with a pathogenesis associated with hormonal influence. The objective of this study was to compare the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in endometrial polyps from tamoxifen users with that in endometrial polyps and the atrophic endometrium of postmenopausal tamoxifen non-users. Among women undergoing surgical hysteroscopy, 84 tamoxifen users with benign endometrial polyps were selected. This group was compared to 84 samples of atrophic endometrium and to 252 benign polyps from postmenopausal women who were not treated with tamoxifen. The expression of ER/PR was assessed by immunohistochemical analysis, according to the percentage of stained cells, intensity of nuclear staining and final score. The polyps from tamoxifen users exhibited a higher expression of ER and PR in the glandular epithelium and stroma compared to the atrophic endometrium (P<0.0001). Compared to the polyps from women not treated with tamoxifen, tamoxifen users exhibited a higher PR expression in the epithelium (P=0.0014) and stroma (P=0.0056), with no difference in the expression of ER. In conclusion, endometrial polyps frequently exhibit an increase in ER expression, regardless of tamoxifen use. High levels of PR expression appear to be consistent with the estrogen agonist effects of tamoxifen.
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Affiliation(s)
- Rogerio Barros Ferreira Leão
- Departments of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Liliana Andrade
- Pathological Anatomy, School of Medicine, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Jose Vassalo
- Pathological Anatomy, School of Medicine, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Armando Antunes
- Departments of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Aarão Pinto-Neto
- Departments of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Lucia Costa-Paiva
- Departments of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
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Zitao Liu, Kuokkanen S, Pal L. Steroid Hormone Receptor Profile of Premenopausal Endometrial Polyps. Reprod Sci 2010; 17:377-83. [DOI: 10.1177/1933719109356803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zitao Liu
- Department of Obstetrics and Gynecology, Bronx-Lebanon Hospital Center, Bronx, New York
| | - Satu Kuokkanen
- Departments of Obstetrics and Gynecology & Women's Health, Division of Reproductive Endocrinology & Infertility, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
| | - Lubna Pal
- Departments of Obstetrics and Gynecology & Women's Health, Division of Reproductive Endocrinology & Infertility, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Misirlioglu D, Nak D, Ozyigit MO, Nak Y, Akkoc A. HER-2/neu (c-erbB-2) oncoprotein in hyperplastic endometrial polyps detected in two cats. J Feline Med Surg 2009; 11:885-8. [PMID: 19560383 PMCID: PMC11135513 DOI: 10.1016/j.jfms.2009.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
Abstract
The presence of HER-2/neu (c-erbB-2) oncoprotein, oestrogen-alpha receptor (ER), and progesterone receptor (PR) in hyperplastic endometrial polyps (EPs) of two cats with cystic endometrial hyperplasia-pyometra (CEH-P) complex was investigated. Immunohistochemistry assay for ER, PR and c-erbB-2 oncoprotein in the glandular and stromal tissue of the EPs was performed. ER and c-erbB-2 immunoreactivity was observed in the glandular epithelium of the EPs whereas PR immunoreactivity was detected only in the stromal fibroblasts. The c-erbB-2 oncoprotein may play a role with the ER in the pathogenesis of the hyperplastic EPs, although the role of this oncoprotein in the pathogenesis of EPs has yet to be determined.
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Affiliation(s)
- Deniz Misirlioglu
- Department of Pathology, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey.
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Peng X, Li T, Xia E, Xia C, Liu Y, Yu D. A comparison of oestrogen receptor and progesterone receptor expression in endometrial polyps and endometrium of premenopausal women. J OBSTET GYNAECOL 2009; 29:340-6. [DOI: 10.1080/01443610902878775] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and its relationship to clinical parameters. Arch Gynecol Obstet 2009; 281:479-83. [DOI: 10.1007/s00404-009-1142-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
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Antunes A, Costa-Paiva L, Arthuso M, Costa JV, Pinto-Neto AM. Endometrial polyps in pre- and postmenopausal women: Factors associated with malignancy. Maturitas 2007; 57:415-21. [PMID: 17587515 DOI: 10.1016/j.maturitas.2007.04.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 04/26/2007] [Accepted: 04/28/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the prevalence of premalignant and malignant polyps and their association with menopausal status, hormone therapy and clinical characteristics in perimenopausal and postmenopausal women. METHODS A surgical database was used to select pre- and postmenopausal women >or=40 years of age, submitted to hysteroscopic resection of endometrial polyps. The medical records of 475 women were reviewed and clinical characteristics and histological diagnosis of resected polyps were assessed. RESULTS The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia without atypia. Polyps with endometrial hyperplasia with atypia comprised 1.05% of cases, while 2.74% were carcinomatous polyps. Analysis using prevalence ratios showed that premalignant and malignant lesions were associated with age and postmenopausal bleeding. Women >60 years of age had a prevalence ratio 3.28 times greater (95%CI: 1.19-9.07) of premalignant or malignant polyps. When only postmenopausal women were evaluated for the effect of age, those over 60 years of age had a prevalence 5.31 times greater (95%CI: 1.22-23.09), while those with postmenopausal bleeding had an age-adjusted prevalence ratio of 3.71 (95%CI: 1.21-11.34) compared to asymptomatic women. No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy. CONCLUSIONS There was a low prevalence of premalignant and malignant lesions in endometrial polyps. Older women and those with postmenopausal bleeding had a greater prevalence of malignancy and in these cases hysteroscopic resection of endometrial polyps is mandatory.
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Affiliation(s)
- A Antunes
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Rua Alexander Flemming, 101, 13081-970 Campinas, São Paulo, Brazil
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