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Endometrial polyps

Endometrial polyps develop due to proliferation of the glands of the basal layer of the endometrium on the leg, consisting of fibrous and smooth muscle tissue. Endometrial polyps are focal endometrial hyperplasia. Due to the fact that their structure contains stromal tissue (leg), it should not be identified with the polypoid form of glandular-cystic endometrial hyperplasia, and therefore the term "endometrial polyposis" does not accurately reflect the essence of the process and is considered unreasonable.

Endometrial polyps are found in 0.5-5.0% of gynecological patients aged 35-50 years, i.e. mainly in the reproductive period.

There are many classifications of endometrial polyps. More often they are divided into the following forms: glandular, glandular-fibrous and fibrous; glandular-fibrous with focal adenomatosis and adenomatous; malignant and angiomatous (E.M. Vikhlyaeva, B.I.Zheleznov, 1997).

Glandular polyps are characterized by the predominance of the glandular component over the stromal. The glands are located at an angle to each other in different directions with unequal lengths, lined with a proliferative type epithelium. In the stroma there are many cells, loose connective tissue with tangles of blood vessels in the base and leg.

Fibrous polyps contain more connective tissue with single glands lined with non-functioning epithelium. A small number of vessels with sclerotic walls are noted.

Glandular cystic polyps contain glands of various shapes and lengths and a stroma which at the base is denser and often fibrous. The glands are located unevenly in different directions with cystically stretched lumens covered with flattened epithelium. In polyps, proliferative glandular epithelium alternates with non-functioning. The vessels in them, as in other polyps, have sclerotic thickened walls and are arranged in the form of tangles in various places.

Adenomatous polyps are characterized by an abundance of diffusely distributed glandular tissue with intensive proliferation of the epithelium. Their malignant transformation, like other endometrial polyps, is rare (2-3%).

Polyps with focal adenomatosis have a morphological characteristic similar to glandular-fibrous polyps, but focal intense proliferation of glands with structural reorganization of the epithelium is observed in some of their sections. The glands have an irregular size and shape with papillary outgrowths in the lumens. The glandular epithelium of these polyps is characterized by cellular polymorphism, a violation of nuclear-cytoplasmic ratios, and often pathological mitoses. Occasionally squamous metaplasia occurs in the foci. Stroma - in the form of narrow layers of fibrous tissue. In the leg of the polyp are thick-walled blood vessels in the form of tangles.

An abundance of such vessels is characterized by angiomatous polyps. Endometrial polyps are more common in women of reproductive age. Glandular fibrous polyps are also observed in women in the perimenopausal period, but less often than in the reproductive one.

The pathogenesis of polyps is similar to the mechanism of development of glandular cystic hyperplasia. It is believed that the same hormonal disorders of a hereditary or acquired nature also contribute to the development of polyps.

A characteristic feature of many polyps is a tendency to relapse, which is not prevented by hormone therapy. It also confirms the "hormonal independence" of polyps.

It is suggested that the recurrence of polyps is more often associated with insufficiently thorough removal of them and usually occurs within the first year after their initial removal.

The clinical picture of polyps is characterized, as a rule, by various uterine bleeding.
In women of a young age and premenopausal period, they proceed according to the type of meno- and metrorrhagia. In some cases, there are so-called "contact bleeding."

In older women, postmenopausal women may experience a single or repeated scanty spotting from the uterus.

A pain symptom is a rare phenomenon that occurs in women with the development of necrotic changes in polyps, as well as with "born" polyps.

Often, endometrial polyps are asymptomatic, which is often characteristic of their fibrous and glandular-fibrous forms.

Diagnosis of polyps is based on anamnesis, which is especially characteristic for polyps of the first clinical pathogenetic variant. The data of the clinical picture, gynecological examination can only suspect the presence of polyps. The most important in their diagnosis belongs to special examination methods.

Radiologically in the presence of polyps, filling defects, serration of the contours with endometrial hyperplasia are detected. However, the contrast agent can often envelop polyps and they are not visible on the radiograph. Therefore, the x-ray method for the diagnosis of polyps is currently rarely used.

Echographic studies have a higher efficiency, the information content of which reaches 80-90% or more, especially when using vaginal sensors. More rarely, small polyps are detected by ultrasound, especially against the background of glandular cystic hyperplasia.

The most accurate method for diagnosing polyps is hysteroscopy. During its implementation, polyps are detected in the form of formations of a rounded or oblong shape, located more often in the region of the corners or the bottom of the uterus.

The final method for the diagnosis of polyps is a pathological study that reliably not only determines the presence of polyps, but also establishes their exact shape with possible complicated conditions (degeneration, decay, malignancy).

Treatment of endometrial polyps differs from that of endometrial hyperplasia. Surgical tactics in the treatment of polyps are widely recognized. In all cases, their complete removal with hysteroscopic control is indicated. Mandatory is the removal of the mucosa from all walls of the uterus and cervical canal. Subsequently, targeted monitoring of patients with endometrial polyps is shown in order to timely diagnose relapses. With relapses of polyps, targeted cryotherapy is recommended.

Hormone treatment is prescribed according to the same principles as with glandular cystic endometrial hyperplasia. Hormone therapy continues with endometrial polyps from 3 to 6-8 months with control studies (ultrasound, hysteroscopy).

It is possible to confine oneself to surgical removal without subsequent hormone therapy with fibrotic forms of polyps.

Identification of adenomatous polyps and polyps with focal adenomatosis is an indication for removal of the uterus with appendages in the perimenopausal period in women and for a thorough diagnosis with a biopsy of the state of the ovaries in young women.

Cryo-and laser effects on the area of ​​the removed polyp are considered an important measure in the prevention of relapse, they contribute to the normalization of the uterine receptor apparatus and immune status.

Prevention of endometrial polyps is the timely pathogenetic treatment of endometrial hyperplasia and the limitation of damaging and traumatic local effects on the uterus.
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Endometrial polyps

  1. Endometrial polyps
    Another cause of reproductive system dysfunctions may be endometrial polyps that impede embryo implantation and are a frequent cause of menstrual cycle changes. An endometrial polyp occurs as a result of focal growth of the uterine mucosa (endometrium). This formation grows from the wall of the uterus into its cavity and sometimes through the cervical canal reaches
  2. Endometrial polyps
    Definition of a concept. Endometrial polyps are the growths of individual sections of the mucous membrane of the uterine body (together with the underlying stroma). The term "polyp" has existed in medicine for a long time. For the first time to describe such growths, this term was used in the middle of the XVIII century. However, already in the writings of Hippocrates, one can find mention of polyps as a cause of infertility. Frequency. Literature Data
    In gynecological practice, a symptom complex of uterine lesions (endometritis-pyometra-complex) is distinguished, which develops within 2 months after estrus and is characterized by abundant vaginal discharge, an increase in the volume of the abdomen, polydipsia and polyuria. These signs are found in dogs of all breeds mainly at the age of 7-9 years, somewhat more often in nulliparous females. The presence of the listed
  4. Polyps
    Polyps of the cervix uteri are growths on the cervix (often in the walls of the cervical canal) in the form of a leg with a connective tissue skeleton (rod) covered with a multilayer flat or cylindrical epithelium with glandular structures in the thickness. There are simple (formed glandular or glandular-fibrous formations without proliferative changes) and adenomatous (formations with
  5. Polyps of the nose
    Polyps of the nose is one of the complications of year-round allergic rhinitis. Usually they are localized on the middle nasal concha, around the holes of the maxillary sinuses and ethmoid labyrinth. Polyps are observed in both allergic and infectious rhinitis. Polyps that occur with allergic rhinitis look like whitish or gray, shiny, gelatinous formations. Polyps in chronic
  6. Cervical Canal Polyps
    Seldom give significant bleeding, more often it is minor bleeding. Decidual polyp - the growth of decidual tissue, and its excess descends into the cervical canal. Such a polyp most often disappears by itself, or it can be removed by carefully unscrewing. A bleeding polyp should be removed, but without curettage of the uterine cavity, with hemostatic therapy, and preserving pregnancy
  7. Non-tumor polyps
    The vast majority of such formations that occur, in particular, in the colon, are sporadic, and the frequency of their development increases as a person ages. Non-tumor polyps (mostly hyperplastic) make up about 90% of all colon epithelial polyps and are found in more than 50% of people 60 years of age or older. Inflammatory (pseudo-) polyps,
  8. Fibroepithelial polyps.
    Fibroepithelial polyps are rare ureteral mucosal formations that can lead to obstruction. Similar changes can be detected at any level of the urinary tract, but in terms of the frequency of occurrence of fibroepithelial polyps, the ureters are in the first place, followed by the urethra, pelvis, bladder. In men, the predominant localization is
    - benign leg epithelial tumors growing from the mucous membrane. Classification of colon polyposis (according to V L. Rivkin, 1969) Group I. Polyps: a) single; b) group 1. Glandular and glandular-villous (adenomas and adenopapillomas); 2. Hyperplate (miliary). 3. Cystogranulating. 4. Rare non-epithelial polypoid formations. II group.
  10. Endometrial hyperplastic processes
    Hyperplastic processes of the endometrium, as well as other localizations, attract attention due to their progression to malignant growth. There is an unequivocal opinion about the high frequency of endometrial hyperplastic processes at perimenopausal age, as well as the high risk of their malignancy at this time. Less commonly, this pathology is observed in other age periods of a woman’s life and almost
  11. Endometrial precancer
    Precancer, or atypical endometrial hyperplasia. Atypical endometrial hyperplasia can develop in the basal, functional or both layers of the endometrium and is characterized by a more pronounced activity of the proliferative processes of the epithelium. The simultaneous development of atypical hyperplasia in the functional and basal layers of the endometrium is a prognostically unfavorable sign,
  12. P. POLYPES AND Tumors of the Large Intestine
    1. Benign polyps, polyposis and tumors. The etiology and pathogenesis, as well as tumors, in general, have not yet been sufficiently studied. Benign tumors (according to WHO, Geneva, 1981) are divided into three groups: 1). epithelial; 2). carpinoid; 3). non-epithelial tumors. Among the epithelial tumors of the colon, which make up the vast majority of all its tumors, distinguish
  13. Endometritis
    Acute endometritis. In recent years, a lot of data has been accumulated on the etiological structure of acute endometritis. Most often, it occurs after abortion, childbirth or diagnostic curettage of the uterus. The acute inflammatory process in the endometrium can be caused by a bacterial, viral, parasitic, fungal, mycoplasma, as well as protozoal and spirochete infection. Often observed
  14. Endometritis
    Endometritis - inflammation of the uterine mucosa (endometrium). An acute inflammatory process can be caused by a bacterial, viral, fungal, parasitic, mycoplasma, protozoal and spirochetal infection. Most often caused by a mixed aerobic-anaerobic association of several microorganisms. Most often, the muscular membrane of the uterus is involved in the inflammatory process with development
  15. Antineoplastic conditions of the endometrium
    Epidemiology. The results of demographic studies in recent years indicate an increased number of women who have crossed menopause. In this regard, in modern society there is a steadily growing interest in the problems of health and social adaptation of women of varying age. The growth rate of the incidence of RE is significantly higher than the growth rates of other malignant tumors
  16. Polyp of the nose. U-33.
    {foto25} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of laboratory parameters. 2. Improving the clinical symptoms of the disease (difficulty breathing, discharge from
  17. Endometritis
    Endometritis - inflammation of the mucous membrane and muscle (metroendometritis) of the uterine membranes. Depending on the characteristics of the pathogen, all endometritis is divided into specific and non-specific, and according to the clinical course - into acute, subacute and chronic. Under the influence of microbes and their toxins that enter the uterus, the mucous membrane hyperemic, swells, infiltrates with white blood cells, becomes covered with purulent plaque
  18. Endometritis
    Endometritis - inflammation of the uterine mucosa (endometrium). Most often occurs after complicated births, abortions, less often after diagnostic curettage of the uterine cavity, soundings and other intrauterine manipulations. An acute inflammatory process can be caused by a bacterial, viral, fungal, parasitic, mycoplasma, protozoal and spirochetal infection. Most often
  19. Polyps, cysts, and other benign changes in the cervix, vagina, and vulva
    This section describes polyps recognized by colposcopic examination, polypous changes, various cysts on the cervix, in the vagina and vulva. On the cervix, retention mucous cysts are most often formed. The mechanism of their formation is described in section 4.1.3. When the ectopia overlaps the squamous epithelium, mucus retention occurs and retention cysts form. Very rarely
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