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Bougie O, Randle E, Thurston J, Magee B, Warshafsky C, Rittenberg D. Directive clinique n o 447 : Diagnostic et prise en charge des polypes endométriaux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102403. [PMID: 38331092 DOI: 10.1016/j.jogc.2024.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
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Bougie O, Randle E, Thurston J, Magee B, Warshafsky C, Rittenberg D. Guideline No. 447: Diagnosis and Management of Endometrial Polyps. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102402. [PMID: 38325734 DOI: 10.1016/j.jogc.2024.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the diagnosis and management of endometrial polyps. TARGET POPULATION All patients with symptomatic or asymptomatic endometrial polyps. OPTIONS Options for management of endometrial polyps include expectant, medical, and surgical management. These will depend on symptoms, risks for malignancy, and patient choice. OUTCOMES Outcomes include resolution of symptoms, histopathological diagnosis, and complete removal of the polyp. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with symptomatic or asymptomatic endometrial polyps and provide physicians with an evidence-based approach toward diagnosis and management (including expectant, medical, and surgical management) of polyps. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane: endometrial polyps, polyps, endometrial thickening, abnormal uterine bleeding, postmenopausal bleeding, endometrial hyperplasia, endometrial cancer, hormonal therapy, female infertility. All articles were included in the literature search up to 2021 and the following study types were included: randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Gynaecologists, family physicians, registered nurses, nurse practitioners, medical students, and residents and fellows. TWEETABLE ABSTRACT Uterine polyps are common and can cause abnormal bleeding, infertility, or bleeding after menopause. If patients don't experience symptoms, treatment is often not necessary. Polyps can be treated with medication but often a surgery will be necessary. SUMMARY STATEMENTS RECOMMENDATIONS.
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Koç N, Ertürk Coşkun AD. Glandular Crowdings in Endometrial Polyps: Clinical Follow-Up and Possible Worrisome Features. Int J Surg Pathol 2023:10668969231213395. [PMID: 38062647 DOI: 10.1177/10668969231213395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Interpretation of changes and premalignant lesions in endometrial polyps can be challenging. We evaluated the clinical course of patients with focal gland crowdings in endometrial polyps via repeat biopsies and searched for possible morphological findings in the initial biopsy that may foresee a premalignant course. METHODS Specimens diagnosed as endometrial polyp and focal gland crowding in patients who had a repeat biopsy in a 1-year period were reexamined. Morphological findings in the initial biopsies were recorded. The group whose repeat biopsies were "premalignant or malignant" (Group 1), and the group with "benign" repeat biopsies (Group 2) were compared. RESULTS "Endometrial polyp and gland crowdings" was diagnosed in 115 specimens of which 38 patients had repeat biopsies. Among these 8 (21%) were diagnosed as "endometrial intraepithelial neoplasia (EIN)" (Group 1) and 30 (79%) as "benign" (Group 2). Morphological features in the initial biopsies were evaluated; PAX2 loss was 6 of 8 (75%) for Group 1 and 7 of 30 (23%) for Group 2 (P = .020), and altered epithelial cytological features were present in 5 of 8 (62%) versus 4 of 30 (13%) (P = .015), both significantly higher in Group 1. Dark intraluminal secretion, intraluminal histiocytes, intraglandular epithelial proliferation, and mean diameter of crowded gland areas were not statistically different between the 2 groups. CONCLUSION "Focal gland crowdings" in endometrial polyps do carry a risk of EIN in subsequent biopsies. We suggest that the loss/decrease of PAX2 and altered epithelial cytological features in these areas in the initial biopsy are indicative of a premalignant course.
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Affiliation(s)
- Nermin Koç
- Department of Pathology, University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Deniz Ertürk Coşkun
- Department of Gynecology and Obstetrics, University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Cruz García AM, Pérez Morales E, Ocón Padrón L, Pérez Matos C, Santana Suárez A, Emergui Zrihen Y, Nieto Naya MÁ, Sánchez Sánchez V, Martín Martínez A. Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology? J OBSTET GYNAECOL 2022; 43:2160928. [PMID: 36576124 DOI: 10.1080/01443615.2022.2160928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.
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Affiliation(s)
- Alba María Cruz García
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Elena Pérez Morales
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Ludmila Ocón Padrón
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Cristina Pérez Matos
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alejandra Santana Suárez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Yonit Emergui Zrihen
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - María Ángeles Nieto Naya
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Victoria Sánchez Sánchez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alicia Martín Martínez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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Abstract
Recurrent implantation failure (RIF) is a major limiting factor in the success rates of in-vitro fertilisation despite the remarkable clinical and technological advancement made at improving assisted reproductive technology. The primary purpose of the endometrium is to provide a receptive site for the implantation of the blastocyst and support its growth and subsequent development. Endometrial pathologies such as endometrial polyps, adenomyosis, Asherman's syndrome, chronic endometritis, and congenital Müllerian ducts defect negatively influence the integrity and receptivity of the endometrium, as well as the implantation of the embryo. This review highlights the implications of these endometrial pathologies and their association with RIF.
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Affiliation(s)
| | - Babatunde Okewale
- IVF and Fertility Unit, St. Ives Specialist Hospital, Lagos, Nigeria
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Histopathological profile of women who had previously failed IVF and the association to the outcome in the subsequent IVF cycle. Obstet Gynecol Sci 2021; 65:64-73. [PMID: 34871478 PMCID: PMC8784933 DOI: 10.5468/ogs.21229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/17/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the endometrial histopathological profile of patients undergoing curettage and the association of the histopathological profile with the pregnancy outcome during the subsequent IVF cycle. Methods In this retrospective cohort study, a total of 248 women with at least one failed attempt of IVF and who underwent curettage and a subsequent IVF were included. Demographic data, endometrial histopathological records, stimulation information, and pregnancy outcomes were collected and analyzed. Results The histopathological analysis of endometrial tissues showed that 130 women (52.4%) had endometrial pathologies. Of these women, 103 (41.5%) had endometrial polyps, 22 (8.9%) had chronic endometritis, and five (2.0%) had both polyps and endometritis. No statistical difference was observed between the normal histopathology group and the abnormal histopathology group in the outcome of the subsequent IVF cycle. Subgroup analyses were performed to further characterize and compare women with normal histopathology and women with endometrial polyps (polyp subgroup) or chronic endometritis (endometritis subgroup). No statistical differences were found among the three groups in the rates of pregnancy (44.1% vs. 49.5% vs. 45.5%, P=0.72), biochemical pregnancy loss (13.5% vs. 15.7% vs. 20.0%, P=0.86), clinical pregnancy loss (25.0% vs. 31.4% vs. 30.0%, P=0.77), and live birth (27.1% vs. 26.2% vs. 22.7%, P=0.91) during the subsequent IVF cycle. Conclusion Women with previously failed IVF and abnormal endometrial histopathology treated with curettage had the same outcome in the subsequent IVF cycle as women with normal endometrial histopathology.
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Akış S, Kıran G, Göçmen A. The clinical importance of polyp size measurement through two-dimensional saline infusion sonohysterography prior to hysteroscopic resection in predicting premalignant and malignant endometrial lesions. Int J Gynaecol Obstet 2021; 157:582-587. [PMID: 34510415 DOI: 10.1002/ijgo.13925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the clinical importance of endometrial polyp size measured using saline infusion sonohysterography (SIS) before performing a hysteroscopic resection in predicting premalignant/malignant lesions. METHODS A retrospective observational study analysis was conducted of 365 patients, who underwent SIS, in a reference hospital. The longest plane of the polyp size was taken as base. Polyps were classified as benign, premalignant, or malignant. RESULTS The rates of premalignant and malignant lesions were 7.4% and 0.9%, respectively. The mean polyp size was 17.7 ± 0.5 mm in benign patients and 23.7 ± 1.8 mm in premalignant/malignant individuals (P < 0.001). In the group of polyps that were 0-10, 10-20, 20-30, and >30 mm, premalignancy/malignancy rates were 0.0%, 4.8%, 13.3%, and 18.8%, respectively. The cut-off value for polyp size to be able to predict lesions was calculated as 22.5 mm (sensitivity: 63%, specificity: 80%) on receiver operating characteristics curve analysis (P = 0.001, area under the curve 0.732). The power of the study was calculated as 90.86%. CONCLUSION During the female reproductive years, endometrial polyps smaller than 10 mm, as measured in SIS, can be followed. However, when the polyp size is 22.5 mm or more, especially in postmenopausal women, treatment should be planned.
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Affiliation(s)
- Serkan Akış
- Department of Gynecologic Oncology, University of Health Sciences, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Gürkan Kıran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Ahmet Göçmen
- Department of Obstetrics and Gynecology, Medicana Ataşehir Hospital, Istanbul, Turkey
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Namazov A, Gemer O, Ben-Arie A, Israeli O, Bart O, Saphier O, Mahler N, Kapustian V, Silberstein T. Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:912-915. [DOI: 10.1016/j.jogc.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/28/2018] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
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Polo JF, Puentes LO, Falla NF, Mendoza J, Parra Medina R. Prevalencia de carcinoma en pólipos endometriales resecados por histeroscopia. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La prevalencia de pólipos endometriales (PE) es alrededor de 24% en la población femenina general y entre 10 y 30% en aquellas con hemorragia uterina anormal. Son lesiones de crecimiento rápido que pueden transformarse en una neoplasia maligna. Objetivo: determinar la frecuencia de cáncer endometrial en pacientes con PE diagnosticados por histeroscopia. Metodología: serie de casos retrospectivos atendidos en el Hospital de San José, Bogotá, Colombia, de 2005 a 2014. Resultados: se analizaron en total 408 historias clínicas de pacientes con diagnóstico histopatológico de PE, 10 (2.4%) presentaron patología premaligna y 9 (2,2%) lesión maligna confirmada por microscopía (endometrioides 6, seroso papilar 2 y carcinosarcoma 1). Todas las pacientes con patología maligna tenían más de 60 años y estaban en posmenopausia. Cuatro eran nulíparas, ninguna consumía tamoxifeno ni medicamentos hormonales Conclusión: la prevalencia de carcinomas endometriales en PE diagnosticados a través de histeroscopia en mujeres posmenopáusicas fue de 7.7%. Estos datos son similares a los reportados en la literatura, por lo que recomendamos la implementación de histeroscopia para el tratamiento de todos los PE y su riguroso estudio histopatológico.
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Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med 2019; 7:2050312119848247. [PMID: 31105939 PMCID: PMC6501471 DOI: 10.1177/2050312119848247] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/10/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Njume Peter Nijkang
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Lyndal Anderson
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Robert Markham
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Frank Manconi
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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The risk of malignancy in uterine polyps: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 237:48-56. [PMID: 31009859 DOI: 10.1016/j.ejogrb.2019.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/04/2019] [Accepted: 04/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endometrial polyps are a common condition. The risk of malignancy has often led to an overtreatment with high health care costs and huge psychological distress. OBJECTIVE We conducted a systematic review and a meta-analysis in order to estimate the prevalence of premalignant and malignant lesions in women undergoing hysteroscopic polypectomy. DATA SOURCE We developed the search using PubMed/MEDLINE and EMBASE databases to identify papers published between 2000- January 2019. The research strategy used on Pubmed was: ("polyps" (MESH) OR "endometrial polyp*") AND ("malignancy" OR "cancer" OR "histopathology" OR "hysteroscopy" OR "ultrasound", OR "sonohysterography"). The same search was modified for EMBASE. STUDY ELIGIBILITY We included all observational retrospective and prospective studies and studies were selected for the review if they met following inclusion criteria: pre-operative diagnosis of benign-looking endometrial polyps at ultrasound examination or at hysteroscopy, excision of endometrial polyps via surgical hysteroscopy, histopathological diagnosis of benign polyps, or hyperplasia without atypia, or premalignancy (atypical hyperplasia) or malignancy (endometrial cancer). Moreover, studies were included if number or percentage of subjects with and without malignancy was provided and if they reported data about menopausal and/or bleeding status. We excluded data presented exclusively as abstracts in national and international meetings, or case report or review articles that did not include original data and papers published in other than English language. Our primary outcome was the prevalence of endometrial premalignant or malignant polyps in the total series, among premenopausal and postmenopausal women and among women with or without abnormal bleeding and then in subgroup analysis according to study design, diagnostic method, study region and calendar year of publication. RESULTS A total of 51 studies reporting data on 35,345 women were included in this review. The prevalence of malignant polyps was 2.73% (95% CI 2.57-2.91) with very high heterogeneity among studies. The rates were lower for premenopausal women (1.12%) than post-menopausal ones (4.93%) and the difference was statistically significant (chi-square = 397.21. p < .0001). The risk of malignancy was higher among symptomatic (5.14%) than asymptomatic ones (1.89%) (chi-square = 133.13 p < .001). We observed higher rate of malignant polyps in prospective studies. In the meta-analysis selecting 10 prospective studies the random pooled estimate was 5.88 (95% CI: 4.06-7.97) with heterogeneity among studies (heterogeneity chi square = 17.55 P = .025) whereas in retrospective studies the random pooled estimate was 2.94 (95% CI:2.24-3.71) with high heterogeneity among studies (P < .001). This finding can be due to more strict diagnostic criteria in prospective studies. CONCLUSION Symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps increased the risk of malignancy. This finding could be an useful evidence to select patients who need to undergo hysteroscopic resection of endometrial polyps and women to whom, instead, an expectant management can be offer.
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Recurrent endometrial polyps – influencing factors and treatment. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.23.1.2019.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abrão F, Modotti WP, Spadoto-Dias D, Bueloni-Dias FN, Leite NJ, Peres GF, Elias LV, Domingues MAC, Dias R. Concomitant p53 and PTEN immunoexpression to predict the risk of malignancy in endometrial polyps. Medicine (Baltimore) 2018; 97:e12304. [PMID: 30235677 PMCID: PMC6160221 DOI: 10.1097/md.0000000000012304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this retrospective cross-sectional study was to assess the usefulness of phosphase and tensin homolog deleted on chromosome 10 (PTEN) and p53 protein immunoexpression in predicting the risk of malignancy in endometrial polyps. The study was conducted at tertiary public hospital, university teaching center, and private practice clinic.A total of 159 patients with endometrial polyps who underwent hysteroscopic polypectomy between January 2010 to December 2014 were included. p53 and PTEN immunoexpression were assessed in histologic endometrial polyp samples. Patients were allocated into 2 groups: group A, endometrial polyps without atypia (120), and group B, endometrial polyps with atypia (39), which were subdivided into A1 (80) and B1 (21) = p53-/PTEN+ immunostaining; A2 (20) and B2 (11) = p53+/PTEN+; A3 (14) and B3 (4) = p53+/PTEN-; A4 (6) and B4 (3) = p53-/PTEN-.There was no significant difference between groups regarding clinical and epidemiologic parameters, except for age. Neoplasia incidence within groups was higher when at least 1 marker was abnormally stained (in group A, P = .0089, odds ratio [OR] = 13.94 [1.62; 120.27]; in group B, P = .0255, OR 12.73 [1.38; 117.27]). Overall neoplasia incidence was higher in group B than in group A (20.5% vs 5.8%; P = .0113). Malignant neoplasia was found more frequently in patients with p53+ (P = .0006, OR = 7.67 [2.30; 25.54]) and PTEN- (P = .0043; OR = 5.43 [1.77; 16.61]).Immunohistochemical analysis using p53 and PTEN as markers, either alone or concomitantly, can be useful to predict malignant transformation in cases of endometrial polyps.
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Affiliation(s)
- Féres Abrão
- Department of Gynecology and Obstetrics of Hospital Beneficente Unimar - HBU, University of Marília - UNIMAR Medical School, Marília
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Sasaki LMP, Andrade KRC, Figueiredo ACMG, Wanderley MDS, Pereira MG. Factors Associated with Malignancy in Hysteroscopically Resected Endometrial Polyps: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 25:777-785. [DOI: 10.1016/j.jmig.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
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N o 249-Épaississement endométrial asymptomatique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e378-e390. [DOI: 10.1016/j.jogc.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Wolfman W. No. 249-Asymptomatic Endometrial Thickening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e367-e377. [DOI: 10.1016/j.jogc.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ghoubara A, Sundar S, Ewies AAA. Predictors of malignancy in endometrial polyps: study of 421 women with postmenopausal bleeding. Climacteric 2017; 21:82-87. [DOI: 10.1080/13697137.2017.1410783] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Ghoubara
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Obstetrics and Gynecology Department, Aswan University, Aswan, Egypt
- Pan Birmingham Gynecological Cancer Center, Birmingham City Hospital, Birmingham, UK
| | - S. Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynecological Cancer Center, Birmingham City Hospital, Birmingham, UK
| | - A. A. A. Ewies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynecological Cancer Center, Birmingham City Hospital, Birmingham, UK
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Cho HW, Koo YJ, Hong JH, Lee JK. Clinical indications for hysteroscopic removal of uterine masses: Time, age at diagnosis, and mass size. J Obstet Gynaecol Res 2017; 43:1751-1757. [PMID: 28816389 DOI: 10.1111/jog.13447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 05/12/2017] [Accepted: 06/10/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to investigate clinical factors associated with abnormal pathologies of uterine masses resected via hysteroscopy. METHODS Women who underwent hysteroscopic surgery for presumptive diagnoses of abnormal endometrial or endocervical masses, such as polyps or leiomyomas on ultrasonography, between January 2012 and April 2015, were enrolled. Clinical and pathologic data were retrospectively reviewed. RESULTS Among 189 patients, pathologic diagnoses of the uterine mass were abnormal in 172 (91.0%) cases, including polyps in 119 (63.0%), leiomyomas in 49 (26.0%), endometrial hyperplasia in two (1.0%), and endometrial cancer in two (1.0%). Seventeen (9.0%) women who underwent hysteroscopic removal showed unremarkable results on pathology, and the most common finding among them was the proliferative phase of the normal endometrium. Women aged over 40 years with uterine masses and a time since last menstrual period of over 15 days are four times more likely to be diagnosed with neoplastic masses than others (odds ratio [OR], 4.39, 95% confidence interval [CI], 1.33-14.48 and OR, 4.22, 95%CI, 1.35-13.21, respectively); those with masses over 1.5 cm in size are three times more likely to be neoplastic than others (OR, 3.08, 95%CI, 1.04-9.12). CONCLUSION Large mass size, longer time after last menstrual period, and older age are risk factors for abnormal histologies of uterine masses resected via hysteroscopy. Clinicians should take particular care when contemplating hysteroscopic removal for women younger than 40 years, and those with masses of <1.5 cm in size in the proliferative phase of the endometrium to avoid an unnecessary surgery.
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Affiliation(s)
- Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jin-Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Republic of Korea
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Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P): What is the relationship, how are they diagnosed and how are they treated? Best Pract Res Clin Obstet Gynaecol 2017; 40:89-104. [DOI: 10.1016/j.bpobgyn.2016.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/23/2016] [Indexed: 12/11/2022]
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20
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Yela DA, Ribeiro CM, Benetti-Pinto CL. Malignancy Risk in Brazilian Women with Endometrial Polyps. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniela Angerame Yela
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina Machado Ribeiro
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cristina Laguna Benetti-Pinto
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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21
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Systemic hypertension and diabetes mellitus as predictors of malignancy among women with endometrial polyps: a meta-analysis of observational studies. Menopause 2016; 23:691-7. [DOI: 10.1097/gme.0000000000000602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Clark TJ, Middleton LJ, Cooper NA, Diwakar L, Denny E, Smith P, Gennard L, Stobert L, Roberts TE, Cheed V, Bingham T, Jowett S, Brettell E, Connor M, Jones SE, Daniels JP. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technol Assess 2016; 19:1-194. [PMID: 26240949 DOI: 10.3310/hta19610] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. OBJECTIVES To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. DESIGN A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. SETTING Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. PARTICIPANTS Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. INTERVENTIONS We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. MAIN OUTCOME MEASURES The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. RESULTS At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively. CONCLUSIONS When treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower. TRIAL REGISTRATION Current Controlled Trials ISRCTN 65868569. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- T Justin Clark
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK.,School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Natalie Am Cooper
- Women's Health Research Unit, The Blizard Institute, Queen Mary University of London, London, UK
| | - Lavanya Diwakar
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elaine Denny
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Edgbaston, Birmingham, UK
| | - Paul Smith
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK.,School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Gennard
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Lynda Stobert
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Edgbaston, Birmingham, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Versha Cheed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Tracey Bingham
- Birmingham Women's Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mary Connor
- Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Sian E Jones
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jane P Daniels
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Ciavattini A, DI Giuseppe J, Clemente N, Moriconi L, Carpini GD, Montik N, Mazzanti L. Thickness of preperitoneal fat as a predictor of malignancy in overweight and obese women with endometrial polyps. Oncol Lett 2016; 11:2278-2282. [PMID: 26998162 DOI: 10.3892/ol.2016.4186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 10/27/2015] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to determine the association between the thickness of preperitoneal fat (PFT), utilized as an indicator of visceral fat deposition, and the risk of premalignant and malignant changes of endometrial polyps (EPs) in overweight and obese women. Overweight and obese women who had undergone diagnostic outpatient hysteroscopy and subsequent endometrial polypectomy between January 2010 and May 2013 were analyzed. Each patient underwent a transabdominal ultrasound for the purpose of measuring the thickness of preperitoneal fat. A total of 146 overweight or obese women were analyzed. The overall incidence of malignant or premalignant lesions was 8.2%. Notably, 5 patients (3.4%) received a histopathological diagnosis of complex hyperplasia with atypia, while polyps harboring carcinoma were diagnosed in 7 cases (4.8%). A significantly increased PFT was observed in women exhibiting preneoplastic and neoplastic lesions, compared with women with benign EPs (mean ± SD, 23.2±3.7 vs. 15.9±8.3; P<0.01). Patient age of >60 years was significantly associated with malignant progression of EPs, while body mass index, menopausal status, arterial hypertension, diabetes, abnormal uterine bleeding, hormone replacement therapy and tamoxifen treatment demonstrated no significant association with the development of preneoplastic and neoplastic lesions of the endometrium. In a multivariate analysis, only PFT maintained a significant correlation with the diagnosis of preneoplastic and neoplastic lesions on EPs (odds ratio, 1.14; 95% confidence interval, 1.04-1.26). Ultrasound evaluation of PFT in overweight and obese women may be useful for the identification of a particularly high-risk subgroup of women. Therefore, regardless of symptoms or additional clinical variables, these particularly high-risk women require appropriate counseling and prompt surgical removal of EPs.
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Affiliation(s)
- Andrea Ciavattini
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Jacopo DI Giuseppe
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Nicolò Clemente
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Lorenzo Moriconi
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Giovanni Delli Carpini
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Nina Montik
- Gynecological Section, Women's Health Sciences Department, Polytechnic University of Marche, Ancona I-60123, Italy
| | - Laura Mazzanti
- Biochemistry Section, Department of Clinical Sciences, Polytechnic University of Marche, Ancona I-60123, Italy
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Elfayomy AK, Soliman BS. Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women. J Obstet Gynaecol India 2015; 65:186-92. [PMID: 26085741 PMCID: PMC4464569 DOI: 10.1007/s13224-014-0576-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. METHODS One hundred and fifty women aged 29-52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. RESULTS Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p < 0.001; OR 4.61; CI 1.9-27), polyp volume >10 ml (p < 0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume >10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. CONCLUSION Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume ≤10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.
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Affiliation(s)
- Amr K. Elfayomy
- />Department of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- />Department of Obstetrics & Gynecology, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Badeea S Soliman
- />Department of Obstetrics & Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Naaman Y, Diment J, Perlman S, Oustinov N, Vaisbuch E, Ben-Arie A. Can malignant potential of endometrial polyps be determined by incorporating the endometrial intraepithelial neoplasia (EIN) classification? Gynecol Oncol 2015; 136:254-7. [DOI: 10.1016/j.ygyno.2014.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/07/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022]
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26
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Gambadauro P, Martínez-Maestre MÁ, Schneider J, Torrejón R. Endometrial polyp or neoplasia? A case–control study in women with polyps at ultrasound. Climacteric 2014; 18:399-404. [DOI: 10.3109/13697137.2014.967673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ricciardi E, Vecchione A, Marci R, Schimberni M, Frega A, Maniglio P, Caserta D, Moscarini M. Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases. Eur J Obstet Gynecol Reprod Biol 2014; 183:121-4. [PMID: 25461364 DOI: 10.1016/j.ejogrb.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/28/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To assess the prevalence of polyps carrying a malignancy and match association between clinical factors and oncologic progression. STUDY DESIGN A retrospective study (Canadian Task Force classification II-3) at a university hospital in Rome, Italy. We retrospectively analyzed data from 1027 women consecutively treated for endometrial polyps at our center in the period 2002-2011. The association of malignancy with hormonal status, tamoxifen, hypertension, symptoms, diabetes mellitus, obesity, and hormonal replacement therapy in pre- and post-menopausal women was assessed. RESULTS Mean age was 45.8±10.8 years. Benign polyps accounted for 95.8% of the total, pre-malignant for 2.67%, malignant for 1.54%. Our data showed that post-menopausal and older women (>60y) with endometrial polyps have a higher risk of developing a related endometrial cancer (OR: 3.05, 95% CI [1.54, 6.19], p<0.001 and OR: 2.8, 95% CI [1.38, 5.56], p≤0.003. Also we observed that women with AUB in the post-menopausal period displayed a risk of malignancy (OR: 31.1, 95% CI [10.3,111], p value <0.001). CONCLUSION Special attention should be drawn to symptomatic post-menopausal patients that appear to be at higher risk of malignancy. Symptomatic pre-menopausal women and asymptomatic post-menopausal women with polyps may be a group with intermediate-risk. These patients should undergo an individualized management plan, balancing both risks and benefits of surgical intervention after discussion with the patient.
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Affiliation(s)
- Enzo Ricciardi
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy; Department of Obstetrics and Gynecology, Universitätsklinikum Freiburg, Freiburg i.Br., Germany.
| | - Andrea Vecchione
- Department of Pathology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Roberto Marci
- Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Mauro Schimberni
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Frega
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Maniglio
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Donatella Caserta
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Moscarini
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Gambadauro P, Martínez-Maestre MÁ, Schneider J, Torrejón R. Malignant and premalignant changes in the endometrium of women with an ultrasound diagnosis of endometrial polyp. J OBSTET GYNAECOL 2014; 34:611-5. [PMID: 24832109 DOI: 10.3109/01443615.2014.916255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The association between polyps and endometrial cancer is under debate. The main objectives of this study were to study the frequency and the characteristics of malignant and premalignant endometrial changes in women with endometrial polyp at ultrasound. The study population consisted of 1,390 consecutive patients that were referred to office hysteroscopy because of the ultrasonographic diagnosis of endometrial polyps. A total of 16 cases of endometrial neoplasia were diagnosed (1.15%). The frequencies of atypia and cancer in our population were 0.14% and 1.01%, respectively. All patients, except one, were postmenopausal (93.8%). All had undergone the initial ultrasonographic assessment because of symptoms (bleeding in the 93.8%). The neoplasia was not confined to the polyp in 75% of the cases. Nine cases had a lower risk disease (56.25%; atypical hyperplasia or endometrial cancer stage IA-G1,2), while seven had a higher risk cancer (43.75%; ≥ stage IA-G3). Patients with a higher risk disease were found to be significantly younger, and their polyps were smaller, albeit non-significantly. In spite of the common practice to refer all women with an ultrasound diagnosis of polyp to hysteroscopy, our data show how the prevalence of endometrial neoplasia in these patients is low (1.15%). Moreover, the malignancy is not confined to a polyp in most of the cases.
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Lenci MA, Nascimento VALD, Grandini AB, Fahmy WM, Depes DDB, Baracat FF, Lopes RGC. Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy. EINSTEIN-SAO PAULO 2014; 12:16-21. [PMID: 24728240 PMCID: PMC4898233 DOI: 10.1590/s1679-45082014ao2764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 12/04/2013] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods: The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results: Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion: Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.
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Affiliation(s)
| | | | - Ana Beatriz Grandini
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, Brazil
| | - Walid Makin Fahmy
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, Brazil
| | | | - Fausto Farah Baracat
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, 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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El-Hamarneh T, Hey-Cunningham AJ, Berbic M, Al-Jefout M, Fraser IS, Black K. Cellular immune environment in endometrial polyps. Fertil Steril 2013; 100:1364-72. [PMID: 23931965 DOI: 10.1016/j.fertnstert.2013.06.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To investigate the immune environment of endometrial polyps (EPs). DESIGN Prospective case-control study. SETTING Teaching hospital and university research laboratory. PATIENT(S) Reproductive-age women undergoing hysteroscopy dilation and curettage for benign indications. Samples were collected from women with (n = 23) and without (n = 40) EPs. INTERVENTION(S) Endometrial samples were immunohistochemically stained with antibodies against mast cells (MCs) and regulatory T cells (Tregs). MAIN OUTCOME MEASURE(S) Tryptase+, chymase+, and c-Kit+ MCs and Foxp3+ Tregs were quantified in EPs and polyp-adjacent, polyp-distant, and control endometrium. RESULT(S) Densities of all MC types were highly significantly increased in EPs compared with adjacent, distant, and control endometrium. Chymase+ and c-Kit+ MCs were increased in density in adjacent compared with control endometrium. c-Kit+ MCs were also increased in distant compared with control endometrium. Foxp3+ Treg density was increased in EPs compared with distant and control endometrium and decreased in distant compared with control endometrium. CONCLUSION(S) This study provides novel insights into localized disturbances in the cellular immune environment within EPs consistent with EPs being inflammatory lesions associated with MC overactivity. Tregs are likely to be recruited to EPs in an attempt to suppress the inflammatory process due to the greatly increased presence of MCs. These immunologic disturbances are likely to be involved in the causation of abnormal bleeding and infertility in premenopausal women with EPs, and their role in the pathophysiology requires further research.
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Affiliation(s)
- Tania El-Hamarneh
- Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, New South Wales, Australia
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Hassa H, Korkmazer E, Tokgöz VY, Öge T. Independent risk factors for endometrial polyps: diabetes, hypertension, and obesity. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mohammed A, Bayo A, Rizwan A. Malignant Potential of Endometrial Polyps: A retrospective study. Qatar Med J 2012. [DOI: 10.5339/qmj.2012.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To estimate the potential risk of malignancy in endometrial polyps and to investigate the possible clinical risk factors. Clinical, sonographic, hysteroscopic and pathological data were reviewed of 337 women with pathologically confirmed endometrial polyps diagnosed in Qatar between 2000 and 2010. The polyps were benign in 95.6% of cases, pre-malignant in 2.3%, and malignant in 2.1 % of cases. Advanced age, menopausal status and vaginal bleeding were strongly associated with atypical hyperplasia and cancer. There appeared to be no association between the risk of malignancy and other clinical risk factors.
Conclusions: There is a small risk of malignancy in endometrial polyps, mainly in post-menopausal patients of advanced age with symptomatic vaginal bleeding. In these circumstances, endometrial polyps should be managed aggressively as potential cancer and removalfor histology is mandatory.
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Affiliation(s)
- A.B. Mohammed
- Obstetrics and Gynecology Department, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Al. Bayo
- Obstetrics and Gynecology Department, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A. Rizwan
- Obstetrics and Gynecology Department, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
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Menzies R, Wallace S, Ennis M, Bennett A, Jacobson M, Yip G, Wolfman W. Significance of abnormal sonographic findings in postmenopausal women with and without bleeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:944-51. [PMID: 21923992 DOI: 10.1016/s1701-2163(16)35020-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We sought to determine the incidence of cancer and to compare pathologic outcomes in bleeding and non-bleeding postmenopausal patients who underwent hysteroscopy. METHODS We conducted a retrospective chart review of 294 postmenopausal women with abnormal uterine bleeding and 142 postmenopausal women without symptoms who underwent hysteroscopy. An 11 mm cut-off for asymptomatic women was applied to determine whether this endometrial thickness threshold would differentiate women with and without endometrial cancer in the asymptomatic group. RESULTS In symptomatic patients, 14 were found to have endometrial cancer and 10 were found to have endometrial hyperplasia. In the asymptomatic group, two women (1.4%) were found to have endometrial cancer with average thickness 17.5 mm, and one (0.71%) was found to have endometrial hyperplasia. Logistic regression models showed the risk of a bleeding patient developing endometrial cancer at an endometrial thickness of 4 mm was the same as the risk in a non-bleeding patient at a thickness of 15 mm. CONCLUSION Asymptomatic postmenopausal women have a low risk of having significant endometrial pathology. Cancer was approximately four times more prevalent in women with bleeding than in women with no bleeding.
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Affiliation(s)
- Rebecca Menzies
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
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Van Den Bosch T, Van Schoubroeck D, Luts J, Bignardi T, Condous G, Epstein E, Leone FP, Testa AC, Valentin L, Van Huffel S, Bourne T, Timmerman D. Effect of gel-instillation sonography on Doppler ultrasound findings in endometrial polyps. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:355-359. [PMID: 21557371 DOI: 10.1002/uog.9043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Saline infusion sonohysterography has been reported to suppress the color signal within the endometrium at color or power Doppler evaluation. The aim of this study was to evaluate if gel-instillation sonography (GIS) affects the power Doppler signal in patients with endometrial polyps. METHODS Ultrasound volumes of the uterus, obtained by three-dimensional ultrasound imaging of 25 women with histologically confirmed endometrial polyps, were assessed offline by six gynecologists with a special interest in gynecological ultrasound. Each woman contributed four volumes: one gray-scale volume and one power Doppler volume before GIS, and one gray-scale volume and one power Doppler volume at GIS. Power Doppler features before and after gel infusion were compared. RESULTS At unenhanced ultrasound a pedicle artery was seen in 27-46% of cases, whereas, after gel infusion the examiners reported a pedicle artery in 30-46% of cases (Exact McNemar's test P-values ranged from 0.50 to 1.00). The level of agreement between unenhanced ultrasound and GIS ranged from 59 to 91% (Cohen's kappa values ranged from 0.17 to 0.79). There was no tendency for a pedicle artery to be identified less often at GIS than before gel instillation. CONCLUSION Gel infusion does not affect the power Doppler signal in patients with endometrial polyps.
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Affiliation(s)
- T Van Den Bosch
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
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Wethington SL, Herzog TJ, Burke WM, Sun X, Lerner JP, Lewin SN, Wright JD. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol 2011; 18:3819-23. [PMID: 21701931 DOI: 10.1245/s10434-011-1815-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endometrial polyps commonly affect premenopausal and postmenopausal women and carry a small risk of cancer. Consensus guidelines to direct the management of women with endometrial polyps are lacking. We examined the risk of malignancy in symptomatic and asymptomatic women with endometrial polyps. METHODS Institutional databases were analyzed to identify women with pathologically confirmed endometrial polyps diagnosed from 2002 to 2007. Demographic, clinical, and pathologic outcomes were reviewed. The most significant pathologic diagnosis was recorded for each subject. Endometrial hyperplasia and cancer were characterized as arising in the polyp or the adjacent endometrium. Factors associated with atypical hyperplasia and cancer were analyzed. RESULTS A total of 1011 women with endometrial polyps were identified. On pathology review, 964 (95.4%) polyps were reported as benign, 13 (1.3%) as hyperplasia without atypia, 5 (0.5%) as hyperplasia with atypia, and 13 (1.3%) as endometrial cancer. The only clinical or demographic factor associated with atypical hyperplasia and cancer was menopausal status (P = .02). Among premenopausal women the risk of cancer or atypical hyperplasia was 0.9% in patients without bleeding and 1.0% in women with bleeding. In postmenopausal women cancer or atypical hyperplasia was found in 1.9% of patients without bleeding and in 3.8% of women with bleeding. CONCLUSIONS The risk of endometrial cancer in women with endometrial polyps is 1.3%, while cancers confined to a polyp were found in only 0.3%. The risk is greatest in postmenopausal women with vaginal bleeding.
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Affiliation(s)
- Stephanie L Wethington
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Wolfman W, Leyland N, Heywood M, Singh SS, Rittenberg DA, Soucy R, Allaire C, Awadalla A, Best C, Dunn S, Leroux N, Potestio F, Senikas V, Wallace S, Menzies R. Asymptomatic endometrial thickening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:990-9. [PMID: 21176311 DOI: 10.1016/s1701-2163(16)34690-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To formulate clinical recommendations for the assessment of endometrial thickening when it is found on ultrasound in a postmenopausal patient without bleeding. OUTCOMES Ensure that women with asymptomatic thickening and endometrial polyps found on ultrasound are managed appropriately. EVIDENCE Published literature was retrieved through searches of English language articles from the EMBASE, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1970 to 2009, using appropriate controlled vocabulary (e.g., "asymptomatic endometrial thickness," "endometrial cancer," "postmenopausal bleeding," "transvaginal ultrasonography," "endometrial biopsy" and "endometrial polyp"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to April 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The level of evidence was determined according to the criteria established by the Canadian Task Force on Preventative Health Care (Table). Recommendations are ranked according to this method. BENEFITS, HARMS, AND COSTS It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complication. It is also expected to decrease the cost to the health system by eliminating unnecessary interventions.
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Wolfman W, Leyland N, Wolfman W, Heywood M, Singh SS, Rittenberg DA, Soucy R, Allaire C, Awadalla A, Best C, Dunn S, Leroux N, Potestio F, Senikas V. Épaississement endométrial asymptomatique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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