Story of a Giant Endometrial Polyp in Asymptomatic Postmenopausal Female

Abstract

Endometrial polyps are localized overgrowth of endometrial glands and stoma through the uterine cavity. They are associated with postmenopausal bleeding, infertility and menorrhagia and are affected by unbalanced oestrogen therapy or increased frequency of tamoxifen exposure. We report a case of giant endometrial polyp in postmenopausal female without vaginal bleeding and hormone or drug use. A 65-year-old, postmenopausal female P3L2 with hypertension and Diabetes Mellitus (DM) came for routine health check-up. Her physical examination was normal. Pelvic examination uterus was multiparous sized, mid positioned and bilateral fornices were free. Patient was planned for hysteroscopic guided biopsy as her Ultrasonography (USG) showed endometrial thickness to be 12.3 mm. On hysteroscopy, there was hyperplastic endometrium with large endometrial polyp of size 8.5 cm. Polypectomy was done and the same was sent for histopathological evaluation. Report showed cystic hyperplasia without atypia. To summarize, postmenopausal female will not always present with symptoms and USG can also quite frequently miss the diagnosis, so proper evaluation is needed using hysteroscopy which is gold standard for diagnosis and treatment of endometrial polyp.

Keywords: Endometrial overgrowth; Hysteroscopic polyp excision; Uterine polyp.

[Table/Fig-1]:

Hysteroscopic finding showing dense adhesions being cut at cervical canal with help of scissors.

[Table/Fig-2]:

Giant polyp protruding from cervical canal.

[Table/Fig-3]:

Giant smooth walled polyp 8.5*1.5 cm.

[Table/Fig-4]:

Microscopically, glands of various sizes and irregular shapes are seen with cystic dilatation & epithelium is similar to proliferative type. (Images left to right)