Diagnosis of the endometrial polyp

Diagnosis of the endometrial polyp is today one of the most serious problems of gynecology. At first glance, it seems that it is quite easy to diagnose a polyp - with gynecological examination any gynecologist can identify it in appearance. It has a characteristic type of neoplasm, located on the stalk. It is one of the forms of growth of the endometrium, is attached to the uterus, gradually growing in its mucosa. Dimensions may vary, most often ranging from 1 to 10 mm, or more.

The most difficult is the differential diagnosis. There are many varieties of the polyp of the endometrium. It is also important to differentiate the malignant tumor from benign, exclude the likelihood of malignant degeneration of the polyp. You need to determine the size of the polyp, their multiplicity, or a single character, the presence of concomitant pathologies, such as inflammation, the infectious process. Sometimes there is a need for differentiation of the polyp from other similar neoplasms: hyperplasia, edenomyosis, cancer.

Laboratory diagnostics, analyzes

In order to make an accurate diagnosis, you need to pass a lot of tests. First of all, general clinical blood and urine tests are prescribed. On the detection of protein in the urine, it can be concluded that there are or are no inflammatory processes in the body, approximately determine their nature. Also, the presence of white blood cells in the urine can indicate the development of the inflammatory process.

By blood, too, you can determine an approximate picture of the pathology, develop a further survey plan. Thus, the number of red blood cells in the blood can have diagnostic value. Their reduction is often observed against the background of bleeding polyps, hidden bleeding, as well as in the presence of hidden inflammatory processes. Rise of erythrocytes can indicate the development of malignant process, as well as the likelihood of cancerous transformation of the polyp. With bleeding and intoxication, degenerative processes in polyps, a change in the morphological structure of erythrocytes can be observed. Thus, the basophilic granularity of erythrocytes is often a sign of bleeding polyps. In a chronic pathological process, signs of anemia as a consequence of prolonged bleeding or malignancy, a decrease in the amount of hematocrit may be observed. Such a picture can be observed against the background of injuries to polyps.

Informative may be the study of the leukocyte formula. An increase in the number of eosinophils indicates allergic processes, mucosal dystrophy. Can indicate the development of parasitic and hidden infections. Platelets indicate the condition of the circulatory system, the characteristics of blood clotting, can indicate latent bleeding and the presence of an active inflammatory process.

The decrease in the number of lymphocytes and leukocytes in the blood indicates the development of the oncological process. Since this may be a sign of immunodeficiency, it is also advisable to carry out an immunogram to clarify the diagnosis. It is from the results of this study that we can conclude how the polyp behaves, and what is the probability of its cancerous degeneration.

If there is a suspicion of cancer, the only way to confirm or disprove the diagnosis is a histological study. For this, a biopsy is performed, during which a biological material is collected for further investigation.

If a virus infection is suspected, a number of virologic, immunobiological and serological reactions are performed, which enable one to determine the degree of viral load, the species composition and the degree of virus activity. It is also possible to identify a latent infection that can be asymptomatic, causing numerous pathological processes in the body.

You may need an analysis for hormones, because it is the concentration of hormones in the body that determines the further growth of polyps. Activation of polyps growth occurs with the predominance of estrogens and a lack of progesterone. In this case, repeated formation of polyps after their removal can develop. If a hormonal imbalance is detected, corrective therapy is prescribed.

Scraping of the endometrial polyp

Scraping from the walls of the endometrium is a biological material that is necessary for further bacteriological examination. No special training is required. The doctor will do everything necessary during the gynecological examination. Special tools are used for sampling. The procedure is painless, administered within a few minutes. The only condition that must be observed is to exclude antibiotic therapy 14 days before the test, and also a few days before taking the material, do not use any antibacterial agents, especially local ones, do not douche, do not put candles.

Bacteriological examination may be required if there is a suspected infectious etiology of polyps, and if there is a suspicion of a violation of the vaginal microflora. For this, a standard bacteriological study is carried out, during which biological material is taken for the study. This is most often a smear or scraping from the mucous membrane of the vagina, which is taken by the doctor during gynecological examination.

Then, under laboratory conditions, the resulting material is sown to nutrient media and incubated under thermostat conditions for 3-5 days. Simultaneously, the smear under the microscope is evaluated, paying attention to the presence of additional inclusions, the nature of the microflora, the presence of epithelial cells. This can be a sign of an active inflammatory process.

Once the culture has grown, produce it by re-breeding on selective biological media. This is necessary in order to distinguish the pure culture of the pathogen and to identify it. If necessary, together with a bacteriological study, an antibiotic susceptibility test is performed, which makes it possible to select the optimal antimicrobial agent, which will have the greatest effect on the isolated pathogen. The necessary dosage of the drug is also determined.

If it is necessary to determine the nature of the microflora, an analysis is carried out for dysbiosis, or a special microbiological screening of the femoflore, which makes it possible to assess the state of the vaginal microbiocenosis. This study allows you to assess the qualitative and quantitative characteristics of microflora, to identify the total microbial number, to obtain a general idea of the structure, number and ratio of representatives obligate and facultative microflora, the percentage of opportunistic microorganisms.

You can also identify absolute pathogens, and determine their number. The standard analysis for dysbacteriosis is performed by bacteriological inoculation, the analysis for femoflor is performed by PCR. Each of their methods has its own shortcomings, as well as its advantages.

Endometrial Endometrial Biopsy

Biopsy is a procedure that is often performed when a cancer is suspected. It is quite simple, the main thing is to perform it carefully and professionally. In this case, using a special instrument, a piece of tumor (polyp) is sampled for further histological examination. It should be very carefully carried out the fence, so that a piece of tissue does not fall anywhere in the uterus and vagina. With a cancerous tumor, this can become a new site of tumor development (metastasis). Also, when collecting material, one should strive for minimal damage to the polyp, so as not to provoke its growth and malignant degeneration.

[1], [2], [3], [4], [5]

Histology of the endometrial polyp

Histological examination is performed on the material obtained during the biopsy. The analysis makes it possible to study the structure and dynamic processes occurring in tumor cells. According to the results, a conclusion is drawn about the nature of the tumor. First determine whether it is benign, or malignant. Also, according to the results, the character and direction of the further development of the neoplasm are predicted, tactics and treatment strategy are selected.

Has an important diagnostic value. Having determined the nature of the pathology, it is possible to select the optimal treatment in a timely manner, to reduce the likelihood of further progression of the disease. If adenomatous polyps are found, it is recommended that they be removed as soon as possible.

The essence of the study is that tissue samples are sown on a nutrient medium intended for growing tissue samples. Incubate in thermostat conditions from 10 days to 3 weeks, then do the reseeding on artificial nutrient media and incubate some more time.

Instrumental diagnostics

It is performed to visualize the polyp and to accurately identify it, since the palpations of the polyps practically do not lend themselves, and they are difficult to visualize in the mirrors. Only instrumental methods make it possible to accurately determine the localization, size, shape and nature of the polyp. This largely depends on the strategy and tactics of further treatment.

The main methods are ultrasound, which allows you to evaluate the processes in dynamics, to study the morphology of the polyp, its size and localization. The main signs of the formation of polyps are the expansion of the uterus, thickening of its inner layer, proliferation of the mucous membrane.

The coloscopy allows you to accurately examine, examine the polyp, and also determine the approximate cause of the pathology. You can detect inflammation, identify the infection process, hyperplasia. By colposcopy, the main channel of the cervix is examined. A gynecological mirror is used, which makes it possible to study the surface, appearance and structure of polyps.

Precisely determine the cause of the pathology can be in the course of hysteroscopy, in which the internal cavity of the uterus is examined, examine it. You can draw a biological material for further microscopic or histological examination. Also used X-ray examination with the introduction of contrast medium. Allows you to visualize the polyp, determine the structure, size, shape, location.

Magnetic resonance and computed tomography allows to obtain a complete clinical picture: to study the features of localization, development of the polyp, stage, degree of ingrowth. These are costly procedures that require a longer time for research, so they are used for suspected cancer. But these methods give the most complete picture.

The combination of several methods is also very informative. For example, hysteroscopy and ultrasound make it possible to comprehensively assess the polyp, to study both anatomical and morphological features in various projections.

Ultrasonography of the endometrium

Ultrasound makes it possible to visualize the polyp. There are two ways to conduct the study: the abdominal (external) and transvaginal (internal) method. Most often, endometrial polyps are diagnosed with abdominal ultrasound, since this method is designed to detect polyps localized inside the uterus.

Transvaginal method can give a lot of useful additional information. Usually, using ultrasound, large polyps larger than one centimeter are detected. Detection of smaller polyps requires special equipment, and this is a significant drawback of the method. Also with the help of ultrasound it is possible to calculate how quickly the polyp grows, to judge its susceptibility to malignancy.

Echoes of the endometrial polyp

The main indicator, which is evaluated in the diagnosis of polyps, is a change in M-echo, in which the anterior-posterior size of the uterine cavity is reflected. Its expansion can be observed during the menopause, which lasts more than 5 years (the norm). In pathology, in women of reproductive age, indicates the presence of any additional structure, regardless of whether it is a polyp, tumor, hyperplastic change in the mucosa or other layers of the uterus.

Typically, the polyp can be recognized by its characteristic appearance, in which a dense, outlined structure with a leg is visualized. Additional information, which will allow the final identification of the polyp, is Doppler ultrasound, which allows to determine the features of the blood flow in the vessels of the polyp. This makes it possible to accurately study the vascular bed of the polyp, which is completely independent. The introduction of a physiological solution into the uterine cavity makes it possible to examine the vessels in more detail and clearly.

[6], [7], [8]

Dimensions of endometrial polyps in the uterus

The minimum size of the polyp, which can be visualized using special methods - 1 mm. This is a small polyp. Polyps of medium size include polyps with a size of 5 to 7 millimeters. Large polyps are considered to be 1 cm in size and larger. They require removal.

Polyps can have different sizes. At an early stage polyps are visualized of sufficiently small sizes, reaching several millimeters (usually 1-3 mm). The detection of such polyps requires special equipment. With the help of ultrasound, such polyps are not found. Ultrasound can diagnose polyps larger than 1 cm.

Polyps with a size of 4 mm or more can be diagnosed during colposcopy. Polyps measuring 5-7 millimeters are considered average. They can be treated, can be deleted. Usually well suited for drug treatment, so do not rush to remove them. Polyps 8-9 mm in size practically do not give in to conservative therapy. If the size reaches 1 centimeter or more, it is necessary to remove it, these are large enough polyps. They are visualized by ultrasound.

[9], [10], [11], [12], [13], [14]

Multiple polyps of the endometrium

Polyps can be not only single, but also multiple. When there are multiple polyps, they diagnose pollinosis. This means that initially a single polyp was formed, which gradually began to undergo hyperplastic processes. Multiple can be mainly glandular or fibrous polyps, as they tend to proliferate rather than transform into a malignant tumor.

The polyp is fairly easy to recognize by its characteristic external features. Often occur in nulliparous, after 27 years of age, because there is a violation of the natural hormonal cycle. Multiple polyps can be easily detected either in the course of a conventional gynecological examination, or with the help of simple laboratory and instrumental methods. Among the main methods of treatment - can be called resection (remove the polyp, and his bed is cauterized).

Polymus of endometrium on MRI

Magnetic resonance therapy makes it possible to identify the polyp, to study its main characteristics, localization, and note the malignancy of tissues. It makes it possible to identify a cancerous tumor, and the probability of polyp transformation (the presence of atypical cells in them), as soon as possible, even at the stage of tumor formation. It is used for suspected cancer.

Differential diagnostics

The purpose of differential diagnosis is the need to differentiate the polyp from other tumors that have similar characteristics. Often it is necessary to differentiate the polyp from ovarian cysts, endometriosis, blood clots, uterine myomas, and cancerous tumors.

The cyst can be differentiated first of all in appearance and location. The cyst is usually located posterior and lateral to the uterus, while the polyp is located directly in the uterine cavity or on its neck. A characteristic feature of cysts are adhesions, which intensively cover the entire endometrium: the adhesive process covers the walls of the uterus, the neck. In polyps, an adhesive process is not observed.

The polyp is flat, has clearly outlined contours, is located on the stem. The walls of the cyst are unevenly thickened, the contours are uneven. A characteristic specific feature of the ovarian cyst is the effect of uniform darkening. The form of the cyst is often round, oval, polyp - absolutely of any shape.

In some cases, a woman may not even know that she has polyps, because they develop long and asymptomatically. Often found out accidentally, with a preventive examination. The cyst often causes a woman to see a doctor with complaints of pain in the lower abdomen. If the cyst has reached a sufficiently large size, it can press on adjacent organs, whereas polyps, even fairly large ones, may not manifest themselves in any way.

It is also often necessary to differentiate polyps from endometriosis. Endometriosis is a disease that is accompanied by a proliferation of endometrium and the formation of endometrial polyps. These are quite dangerous polyps, because they have changed their cellular structure and, in fact, represent a precancerous condition. Sometimes endometriosis is not accompanied by the formation of polyps. The main method of differential diagnosis is a histological and cytological study. During these studies, the structure of tissues and cells is studied. The detection of atypical cells indicates the development of endometriosis.

In most cases, the polyp is differentiated from a cancerous tumor. Sometimes this can be done without special studies, by visualization. So, the polyp can be recognized by a dense structure, the formation of the foot. Cancer is characterized by loose structure, loose fit of cells and the ability for unlimited growth. Polyps can not grow for a long time.

However, it must be borne in mind that only a histological study is a reliable and accurate confirmation of the diagnosis, during which a tissue sample obtained from a tumor is cultured and its properties are studied. By type of growth determine the type of tumor: benign or malignant. This allows you to make a final diagnosis: the polyp is a benign neoplasm.

In some cases, blood clots can be so similar to polyps that you have to resort to differential diagnosis. We need to carefully study the structure found: the polyp has the appearance of a neoplasm, with smooth, well-defined walls, is located on the stem.

The clot differs from the polyp in that it can be amorphous, often changing its shape. Often red, there may be a different consistency. In the middle of the clot is filled with various contents, which varies widely: from light mucus to hemorrhagic fluid. Can be fairly dense and thick, quite large.

Another formation from which it is necessary to differentiate the polyp is myoma. It has the appearance of nodes that have clear boundaries and even, slightly bumpy contours. The easiest way to differentiate is MRI. Myoma has a low intensity magnetic resonance signal with MRI. The signal is very similar to the signal of skeletal muscles.

[15], [16], [17], [18], [19], [20]

Is it possible to confuse the endometrial polyps?

The polyps of the endometrium can be confused with some other pathologies. But this does not happen often, because differential diagnosis makes it possible to exclude all other diseases and neoplasms that have similar symptoms and manifestations. You can get involved only at a primary examination, but to avoid such confusion there is a differential diagnosis. Theoretically, polyps can be caught with a cancer, cyst, myoma, endometriosis and blood clots.

Polyp of the endometrium and cancer

Polyps are pathological formations of the mucosa, protruding above its surface and associated with it by the foot or its base, represent single or multiple formations of irregular round or oval shape.

Also, the polyp can be recognized by a dense structure, the formation of the foot, whereas the cancer can be recognized by loose structure, loose fit of cells and the ability for unlimited growth.

Despite the fact that outwardly the cancer and polyps are easy to distinguish, this method of diagnosis should not be relied upon. Differentiate these two diseases only by histological examination. In this case, a targeted biopsy is performed, with the help of which a biological material (a piece of tumor) is taken for study in the laboratory. The essence of the study is to grow tissue culture from a sample on artificial nutrient media. Then the type of tumor is determined by the type of growth: benign or malignant.

It should also be taken into account that the polyp in the ovary can have atypical cells, which can eventually be malignant and regenerate into cancer. First, the endometrium grows, then the epithelial tissue is transformed. It acquires the capacity for unlimited growth, turns into a cancer tumor, the cells of which continue to uncontrollably share and multiply. The degeneration of polyps into cancer can occur under the influence of various factors, including as a result of his trauma.

Uterine fibroids and endometrial polyps

Myoma are very small in size: on average 0.3-0.4 cm. They are much smaller in size than polyps, and they also do not have a pedicel. Also, with magnetic resonance imaging, large uterine vessels, large nodes, are noticeable. The appearance of heterogeneous areas may indicate the process of transformation of fibroids into a cyst, or a profuse hemorrhage.

Also, it is possible to recognize fibroids by the well-being of a person. Polyps do not affect the well-being and do not cause any inconvenience to the person, whereas the fibroid manifests itself as a strong weakness and malaise, frequent inflammatory processes and the development of the infectious process. The main symptom is severe pain in the abdomen, menstruation is accompanied by severe blood loss. Also for a myoma is a feeling of pressure on internal organs, anemia, frequent urination. Sometimes the pain can give to the inguinal region and other areas.

Polyp of the endometrium and adenomyosis

Polyp is easy to recognize in appearance. The main method used to establish differential diagnosis is hysteroscopy. With the help of this method, you can notice differences - the endometrial polyp is located in the uterine membrane, adenomyosis affects the inner deep layers.

Uterine polyps and endometrial hyperplasia

Differential diagnosis of the endometrial polyp and endometrial hyperplasia is quite simple. When hyperplasia of the endometrium has the appearance of a protruding hyperplastic mucosa of the uterus, which, increasing in size, can extend far beyond the uterus, into the vagina. Polyps are strictly localized areas of the endometrium, which are located on the stem. For multiple endometriotic polyps, the formation of numerous nodules is characteristic.