Endometrial polyps

Clinical History

A 24-year-old female was being studied because she had primary infertility.

Imaging Findings

A 24-year-old female was being studied because she had primary infertility. She was referred to our department so that we could perform a hysterosalpingography on her. On doing this, it was found that she had a filling defect in the fundus of the uterine cavity near the left tuba, compatible with an endometrial polyp.

Discussion

Endometrial polyps are known to be among the most commonly occurring pathologic lesions of the uterine corpus. They are benign, nodular protrusions of the endometrial surface which consist of irregularly distributed endometrial glands and stroma. They generally consist of three components: (a) a stroma of focally or diffusely dense fibrous or smooth muscle tissue, (b) thick-walled vessels, and (c) endometrial glands. Cystic glandular hyperplasia within the polyp occurs are believed to occur most commonly. Endometrial polyps may occur with or without generalized endometrial hyperplasia, but polyps are a more common cause of abnormal endometrial thickening than the hyperplasia alone. At hysterosalpingography, endometrial polyps appear as smooth filling defects within the uterine cavity, and must be distinguished from air bubbles, leiomyomas, synechiae, and normal functional variants. Most of the polypoid lesions are attributed to endocrine changes. In recent years, sonohysterography has emerged as an excellent imaging option in evaluating endometrial polyps and submucosal fibroids. The typical appearance of an endometrial polyp at sonohysterography is a well-defined, homogeneous, polypoid lesion that is isoechoic to the endometrium with preservation of the endometrial-myometrial interface. There usually is a well-defined vascular pedicle within the stalk. In contrast to the transvaginal US demonstration of polyps, which may distort measurements of endometrial thickness if made before saline infusion, at sonohysterography the uninvolved single-layer endometrium appears normal in thickness and should be measured separately from the polyp. Some of the atypical features of polyps include cystic components, multiplicity, a broad base, and hypoechogenicity or heterogeneity. Occasionally, polyps can have a heterogeneous echotexture with multiple cysts. This complex appearance may indicate hemorrhage, infarction, or inflammation within the polyp. A small percentage of endometrial polyps may contain malignant foci or foci of endometrial hyperplasia.

Differential Diagnosis List

Final Diagnosis

Endometrial polyp

URL:	https://eurorad.org/case/5818
DOI:	10.1594/EURORAD/CASE.5818
ISSN:	1563-4086