Age dependent association of endometrial polyps with increased risk of cancer involvement

Abstract

BACKGROUND: Endometrial polyps (EMPs) are commonly encountered in routine surgical pathology practice, but opinions differ on whether they are intrinsically a marker for concurrent or subsequent malignancy. The objectives of the present study are 1) to investigate the age-group in which EMP are most commonly encountered 2) to document the age-group in which EMP are most commonly associated with malignancies 3) To investigate whether the age of diagnosis of the various carcinoma subtypes in EMPs is congruent with published data on similar malignancies arising in non-polypoid endometrium and 4) To investigate whether the histologic subtype distribution of malignancies associated with EMPs are similar or different from the distribution of malignancies arising from non-polypoid endometrium based on published data. PATIENTS AND METHODS: All cases of EMPs were retrieved from the files of Yale-New Haven Hospital for the period 1986-1995. The patients were divided into 5 age groups: Each group was further subclassified based on an association (or lack thereof) of EMPs with endometrial carcinoma. Chi-square test was used to compare the proportion of malignancy associated EMPs between the age groups. RESULTS: We identified 513 EMPs, of which 209 (41%) were from biopsy specimens and 304 (59%) from hysterectomy specimens. Sixty six (13%) of all EMPs were malignant. The 66 malignant EMPs included 58 endometrioid, 6 serous, 1 carcinosarcoma, and 1 clear cell carcinoma. In age group >35, only 1(2.5%) of 40 EMPs was associated with endometrial malignancy. In contrast, 37(32%) of 115 EMPs were associated with malignancy in the age group > 65. The frequency of malignant EMPs increased with age and reached statistical significance in the age group >65 (p < 0.001). The most common histologic type of malignancy was endometrioid adenocarcinoma. CONCLUSIONS: EMPs show statistically significant age dependent association with malignant tumor involvement. Careful search for malignancy, particularly in women with multiple risk factors is advised in daily practice. Additional studies are needed to address the histological features and immunohistochemical profiles in the context of association between endometrioid and high-grade endometrial carcinoma and endometrial polyps.

Figure 1

Frequency of occurrence of benign endometrial polyps by age group. The frequency of occurrence of EMPs at the time of diagnosis peaked in the age group 46–55 years (29%), followed by 36–45 (27%), 56–65 (18%) and >65 years (17%). The incidence of EMPs in the age group 25–35 years was significantly lower (9%).

Figure 2

Frequency of occurrence of malignant endometrial polyps by age group. In age group 25–35 years, only 2.5% of the EMPs were associated with endometrial malignancy. In contrast, in the age group >65 years, 32% of the EMPs were associated with malignancy.

Figure 3

Distribution of benign and malignant endometrial polyps by age group Although the incidence of EMPs at the time of diagnosis in the age group > 65 years was among the lowest, the incidence of malignancy associated EMPs was the highest.

Figure 4

Benign and malignant endometrial polyps by age group