Materiały źródłowe

• #1 Endometrial polyps: Pathogenesis, sequelae and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6501471/

  Endometrial polyps are overgrowths of endometrial glands that typically protrude into the uterine cavity. […] The pathogenesis and natural history of endometrial polyps are not very clear, exact cause of endometrial polyps is unknown, however, there are several theories proposed relating to the aetiology and pathogenesis of these lesions. They are believed to be related to oestrogen stimulation, this may be as a result of an increased concentration of oestrogen receptors (ERs), predominantly ER-alpha in polyp glandular cells compared with normal endometrium, and a decreased expression of progesterone receptors (PRs) A and B in polyps compared with normal endometrium. […] The balance between mitotic activity and apoptosis appears to play a role in regulating the development of normal endometrium during the menstrual cycle.

• #2 Endometrial Polyp – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557824/

  Endometrial polyps are localized overgrowths of the endometrial glands and stroma that protrude out of the endometrium. The definite etiology of endometrial polyps is unknown. However, endometrial polyps are associated with endometrial hyperplasia; therefore, unopposed estrogen is considered to be a risk factor. […] Other mechanisms that have been associated with the development of polyps include increased endometrial aromatase activity, TGF-beta, VEGF, BCL-2, and genetic factors. […] Endometrial abnormalities, including the development of polyps, are associated with chronic tamoxifen therapy and occur in 20% to 35% of females. […] A majority of polyps are benign; however, malignant transformation can occur in 0 to 13%. […] Malignancy in an endometrial polyp is related to a patients age and menopausal status. The prevalence of malignant endometrial polyps in symptomatic postmenopausal females is 4.47% compared with 1.51% in an asymptomatic postmenopausal female. […] Additional risk factors for malignant endometrial polyps include age greater than 60, large-sized polyps, menopause status, symptomatic bleeding, and polycystic ovarian syndrome.

• #3 Uterine polyps – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/uterine-polyps/symptoms-causes/syc-20378709

  Uterine polyps are growths attached to the inner wall of the uterus that expand into the uterus. Uterine polyps, also known as endometrial polyps, form as a result of cells in the lining of the uterus (endometrium) overgrowing. […] Hormonal factors appear to play a role. Uterine polyps are estrogen-sensitive, meaning they grow in response to estrogen in the body.

• #4 Uterine Polyps: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14683-uterine-polyps

  Uterine polyps form when theres an overgrowth of endometrial tissue. […] Researchers dont know why polyps form, but hormone levels may be a factor. Estrogen plays a role in causing the endometrium to thicken each month during your menstrual cycle. This thickening likely contributes to uterine polyp growth. Many risk factors for uterine polyps involve your body being exposed to high amounts of estrogen.

• #5 Uterine Polyps: Symptoms, Causes & Treatment Options – SehatHub

  https://sehathub.com/uterine-polyps

  Uterine or endometrial polyps are abnormal growths protruding from the inner lining of the uterine cavity. This abnormal growth contains glands, vessels, and stroma. […] The exact cause of uterine polyps is still unknown, but according to some research studies, it is believed to be related to estrogen stimulation, characterized by an increased concentration of estrogen receptors (ERs), particularly ER-alpha, in polyp glandular cells. This estrogen dominance, coupled with decreased expression of progesterone receptors (PRs), contributes to the development of these polyps in the inner lining of the uterus (endometrium). Additionally, abnormalities in cell survival and proliferation markers, chromosomal rearrangements, and the expression of specific genes like p63, aromatase P450, and SF-1 may also play a role in forming endometrial polyps. […] Uterine polyps can also develop due to genetic abnormalities, resulting in the monoclonal growth of altered endometrial cells. Monoclonal growth means that the polyps originate from a single abnormal cell or a small group of identical abnormal cells in the endometrium (inner lining of the uterus).

• #6 Uterine Polyps | Consultant360

  https://www.consultant360.com/clinical-updates/uterine-polyps

  The exact cause of uterine polyps remains uncertain, but several theories suggest that estrogen stimulation plays a significant role in their development. Polyps have been found to contain higher concentrations of estrogen receptors (ERs), specifically ER-alpha, and reduced progesterone receptors compared with normal endometrium, potentially causing abnormal growth and resistance to the natural shedding process seen in typical endometrial tissue. This hormonal imbalance may prevent polyp tissue from undergoing normal cyclical changes, contributing to its persistence. […] In addition to hormonal influences, abnormalities in cellular apoptosis (programmed cell death) and proliferation appear to be involved. Markers such as B-cell lymphoma-2 (Bcl-2), which inhibits apoptosis, and Ki67, which indicates cellular proliferation, are elevated in polyps, especially during the proliferative phase of the menstrual cycle. Increased Bcl-2 expression in polyps may lead to decreased cell death, allowing polyps to evade the normal shedding process. Furthermore, Ki67 expression is particularly high in the glandular epithelium of polyps, signifying increased cell growth, which is further elevated in women treated with tamoxifen, a drug with estrogen-like effects on the uterus that is commonly used in breast cancer treatment.

• #7 Pathology Outlines – Endometrial polyp

  https://www.pathologyoutlines.com/topic/uterusendopolyp.html

  Benign hyperplastic overgrowth of endometrial tissue that forms a localized projection into the endometrial cavity and is composed of a variable amount of glands and stroma […] May be related to hyperestrogenism, possibly originating as a localized hyperplasia of the endometrial basalis, secondary to hormonal influences […] Thought to represent a hyperplastic response of normal endometrial tissue, possibly originating as a localized hyperplasia of the endometrial basalis, secondary to unopposed estrogen […] Monoclonal stromal overgrowth with secondary induction of polyclonal benign glands […] Overexpression of endometrial aromatase suggests a role of this enzyme in pathogenesis […] Associated with tamoxifen therapy […] Long term consumption of phytoestrogens, produced by plants and found in abundance in spice, herbs and food, can lead to endometrial polyps […] Late menopause, hormone replacement therapy and obesity all increase risk […] In postmenopausal females, the presence of metabolic syndrome is a predictor.

• #8 Endometrial polyps – UpToDate

  https://www.uptodate.com/contents/endometrial-polyps/print

  Endometrial polyps are one of the most common etiologies of abnormal genital tract bleeding in both premenopausal and postmenopausal patients. […] The pathogenesis, diagnosis, and management of endometrial polyps are reviewed here. […] Several molecular mechanisms have been proposed to play a role in the development of endometrial polyps. These include monoclonal endometrial hyperplasia, overexpression of endometrial aromatase, somatic gene mutations, and age-related accumulation of low-frequency single nucleotide variants in oncogenes, including mutations in KRAS, PTEN, and TP53. […] Like uterine leiomyomas, polyps have characteristic cytogenetic rearrangements. Rearrangements in the high-mobility group family of transcription factors appear to play a pathogenic role.

• #9 Endometrial polyps: Pathogenesis, sequelae and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6501471/

  Cytogenetic studies have suggested that chromosomal abnormalities may have a role in the development of endometrial polyps. […] The risk factors for endometrial polyp formation include increased endogenous oestrogen and exogenous oestrogen administration. […] Endometrial polyp formation may be the result of localised chronic inflammation in the endometrium. […] The quantity of mast cells were found to be seven-fold higher in endometrial polyps compared with normal endometrium, and the majority of these mast cells were found to be activated. […] The difference in the expressions of growth factors may have an implication on the existence of two different kinds of endometrial polyps, one being hormonal dependent and the other of an inflammatory nature.

• #10 Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment

  https://www.imrpress.com/journal/CEOG/49/10/10.31083/j.ceog4910232/htm

  Monoclonal origin of EPs was first demonstrated by Jovanovic et al. on hysterectomy specimens from 22 women in 1996. However, the exact cause of EP is still unknown. Due to their histopathological heterogeneity, a multifactorial origin has been hypothesized. In particular, genetic, inflammatory, hormonal and iatrogenic factors are supposed to play some role in their origin. […] The importance of genetics in the pathogenesis of EP is emphasized by the models of Lynch or Cowden syndrome. These two genetic syndromes are associated with higher risk for EP, as well as for endometrial cancer. […] Abnormalities in chromosomes 6 and 12, such as chromosomal rearrangements (translocation), have been described in women with EP, resulting in altered endometrial pattern with the appearance of polypoid structures.

• #11 Uterine Polyps | Consultant360

  https://www.consultant360.com/clinical-updates/uterine-polyps

  Genetic factors also contribute to polyp formation. Chromosomal rearrangements in stromal cells have been identified, with abnormalities in specific regions such as 6p21-22, 12q13-15, and 7q22. Additional genetic markers, including p63, aromatase P450, and steroidogenic factor-1, have been linked to polyp development, indicating a complex interaction between hormonal and genetic factors in polyp formation. […] Inflammation is another potential factor in the pathogenesis of uterine polyps. Chronic localized inflammation may lead to the growth of new blood vessels and tissue expansion. Elevated levels of cyclooxygenase-2 (COX-2) and increased activated mast cells are commonly found in polyps, suggesting an inflammatory response that promotes angiogenesis and tissue proliferation. Angiogenic factors like vascular endothelial growth factor (VEGF) and transforming growth factor beta-1 (TGF beta-1) are also elevated in polyps, contributing to increased blood vessel density and fibrotic tissue, characteristic of these growths.

• #12 Endometrial polyps are non-neoplastic but harbor epithelial mutations in endometrial cancer drivers at low allelic frequencies | Modern Pathology

  https://www.nature.com/articles/s41379-022-01124-5

  The poorly understood link between EMP and endometrial cancer also raises questions about the status of EMPs as potential neoplasms driven by unknown genetic alterations. […] In this study, we took advantage of recent advances to revisit the molecular genetic origins of EMPs and their status as potential clonally-derived neoplasms. […] We conclude that mutations in canonical endometrial cancer drivers are common in EMPs, and that the overall spectrum resembles that of endometrial cancers. […] Our findings lead us to propose a model where age-related mutations and in particular cancer-causing mutations accumulate in EMPs. […] In this model, the mutations in endometrial cancer drivers are not the instigators driving the formation of the EMP, but rather accumulate as a function of age.

• #13 Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment

  https://www.imrpress.com/journal/CEOG/49/10/10.31083/j.ceog4910232/htm

  High levels of matrix metalloproteinase (MMPs), proteins involved in mechanisms of angiogenesis, migration, proliferation and cell death have been described in endometrial fluid of women with various uterine pathologies, including also EP (in addition to leiomyomas and adenomyosis). Recent studies and review showed increased risk of EP in women suffering from chronic endometritis. This data supports a potential inflammatory origin for some kinds of EP. […] The role of sexual hormones (estrogen, progesterone) in the pathogenesis of EP is currently subject of debate. Some Authors speculate that a greater expression of aromatase and sexual hormone receptors may be responsible for the stretching of the endometrial glands, stromal tissue and spiral arteries that confer their usual morphology. […] The impact of hormone replacement therapy on the development of EP is controversial, whilst the use of levonorgestrel-releasing intrauterine device seems to be protective.

• #14 Mendelian randomization analysis of the association between human blood cell traits and uterine polyps | Scientific Reports

  https://www.nature.com/articles/s41598-021-84851-0

  Human blood cells (HBCs) play essential roles in multiple biological processes but their roles in development of uterine polyps are unknown. […] Our findings suggested eosinophils might play important roles in the pathogenesis of EPs. […] A number of etiological theories have suggested an association between the pathogenesis of EPs and CPs and various factors, including estrogen overstimulation, chronic inflammation, and genetic predisposition. […] This indicates that HBCs might participate in important biological processes during the development of uterine polyps. […] Our study provided valuable information for screening novel biomarkers and understanding the pathophysiological mechanisms of EPs and CPs. […] We identified three eosinophil-related properties that were robustly associated with EPs, suggesting that eosinophils might play important roles in the pathogenesis of EPs.

• #15 Mendelian randomization analysis of the association between human blood cell traits and uterine polyps | Scientific Reports

  https://www.nature.com/articles/s41598-021-84851-0

  Our study together with previous studies indicated that eosinophils might be involved in EP pathogenesis. […] The present MR study found that decreased levels of eosinophils were causally associated with a higher risk of EPs. By identifying possible biomarkers for uterine polyps, our study provides novel insight into the pathogenesis of EPs.

• #16 Frontiers | Endometrial microbiota alteration in female patients with endometrial polyps based on 16S rRNA gene sequencing analysis

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2024.1351329/full

  The dynamic balance and stability of the genital tract microbiota are vital for maintaining women’s reproductive health. […] Our objective was to delineate the community structure and potential function of the endometrial microbiota in patients with EP and to further identify diagnostic indicators for EPs based on specific endometrial microbial ASVs. […] We hypothesize that abnormal uterine bleeding-induced alterations in the abundance and diversity of endometrial microbiota would essentially mirror the microbial characteristics associated with endometrial polyps. […] Specific species like Lactobacillus iners may act as opportunistic pathogens and can induce local inflammation or damage by affecting pathways including sphingolipid metabolism and apoptosis. […] The significant increase in pathways related to steroid hormone biosynthesis observed in EPs may also relate to local imbalances in estrogen and progesterone activities in the endometrium, which have been identified as crucial mechanisms in the development of EPs. […] Overall, our study revealed that significant endometrial microbial dysbiosis is linked to changes in specific metabolic pathways in patients with EPs. This suggests that alterations in endometrial microecology may play a pivotal role in disease development.

• #17 Uterine Polyps: Symptoms, Causes, Diagnosis and Treatment

  https://www.cancercenter.com/cancer-types/uterine-cancer/risk-factors/uterine-polyps

  Uterine polyps are abnormal growths that develop on the inner lining of the uterus, or endometrium. […] The exact cause of uterine polyps is unclear, though some have been linked to hormonal factors. Uterine polyps are estrogen-sensitive, meaning they grow in response to circulating estrogen. […] Scientists believe an overgrowth of this lining may lead to the formation of uterine polyps. […] An increased risk for developing uterine polyps may also be caused by other factors, such as obesity, high blood pressure (hypertension) and taking tamoxifen, a drug therapy for breast cancer. […] While most uterine polyps are benign, a small percentage may be precancerous or cancerous. […] A comprehensive mega analysis published in the European Journal of Obstetrics Gynecology and Reproductive Biology found that just 2.73 percent of polyps in women are cancerous.

• #18 Uterine Polyps: Symptoms, Causes, Diagnosis and Treatment

  https://www.cancercenter.com/cancer-types/uterine-cancer/risk-factors/uterine-polyps

  Although this percentage is relatively low, its important to note that any uterine polyp should be evaluated by a health care provider to rule out the possibility of cancer. […] Cancerous uterine polyps are rare. A pathologist will analyze the removed polyps, and if theyre cancerous, theyll determine whether all the cancer was removed. If remaining cancer is detected, further treatment, staging and evaluation may be required.

• #19 Effects of uterine polyps on embryo implantation in IVF cycles – MedCrave online

  https://medcraveonline.com/OGIJ/effects-of-uterine-polyps-on-embryo-implantation-in-ivf-cycles.html

  Embryo implantation requires healthy uterine endometrium for natural or assisted reproductive technology conception. […] Uterine or endometrial polyps are over growths of endometrial cells that extend into the uterine cavity. […] The results of this study indicated that the presence of endometrial polyps is a risk factor for infertility and failure of conception after in vitro fertilization. […] The endometrial polyp is an abnormal growth that contains glands, stroma and blood vessels outgrowing from the endometrium and occupies space small or large enough to fill the uterine cavity. […] Endometrial polyps have been found in about 25% of females with unexplained infertility. […] A study reported that the presence of endometrial polyps decreases the uterine receptivity thus resulting in lower implantation.

• #20 Endometrial Polyps | Radiology Key

  https://radiologykey.com/endometrial-polyps/

  Endometrial polyps are rare among women younger than 20 years of age. The incidence rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause. The prevalence of polyps can range from 10 to 24 % among women undergoing endometrial biopsy or hysterectomy to 8 to 36 % in postmenopausal women on tamoxifen therapy. Polyps in these women may be large (2 cm), multiple, or show molecular alterations. […] There are several theories on the molecular mechanisms playing a role in the development of endometrial polyps: monoclonal endometrial hyperplasia, gene mutations, overexpression of endometrial aromatase, and, like in leiomyomas, cytogenetic rearrangements and rearrangements in the HMG family of transcription factors. […] The exact mechanism by which endometrial polyps cause infertility is not known, but some proposed mechanisms are induction of an inflammatory process similar to an intrauterine device, mechanical interference with sperm and embryo transport, impairment of embryo implantation, or altered endometrial receptivity such as abnormalities in the expression of molecular markers such as HOXA 10 and HOXA 11.

• #21 Endometrial Polyps – Abnormal Bleeding – Causes of Infertility – Austin

  https://txfertility.com/female-infertility/endometrial-polyps/

  Endometrial or uterine polyps are very common in reproductive-age women and one of the most common causes of abnormal uterine bleeding, such as bleeding between periods. These polyps are an overgrowth of the inside lining of the uterus which is called the endometrium. Although endometrial polyps are almost always benign, it is possible that they can be premalignant or malignant. […] Endometrial polyps have been found to be associated with infertility. There is at least one good study that revealed that removal of the polyp increases the chances of conceiving. The study found that when a polyp was removed, the pregnancy rate was 63%. However, if the polyp was not removed at hysteroscopy, the pregnancy rate was only 28%. […] It has been speculated that a endometrial polyp may cause irritation of the lining of the uterus interfering with implantation of an embryo. These polyps can interfere with implantation, effectively preventing an embryo from attaching to the uterine wall. It is common for polyps to induce a chronic inflammatory response within the uterus, as the body mounts a reaction to try to destroy the polyp. This may be the mechanism by which polyps interfere with the establishment of a pregnancy.

• #22 Uterine Polyps: Symptoms, Causes, Treatment, and More

  https://www.healthline.com/health/womens-health/uterine-polyps

  Theres not a single known cause of uterine polyps, but its thought that high estrogen levels may play a role in their development. Obesity may also be a risk factor, due to higher amounts of estrogen released by body fat cells. […] Age may also play a role in the development of uterine polyps. These polyps are rare in women under the age of 20. However, the incidence peaks between ages 40 and 49. […] While the risk of developing uterine polyps decreases after menopause, when estrogen levels naturally drop, you may be at risk for these growths if you take tamoxifen therapy. In fact, its estimated that between 8 and 36 percent of postmenopausal women taking this therapy develop uterine polyps. […] The only way to treat uterine polyps is to remove them (polypectomy). Your doctor will send removed polyps to a laboratory for further analysis.

• #23 Endometrial polyp – Wikipedia

  https://en.wikipedia.org/wiki/Endometrial_polyp

  An endometrial polyp or uterine polyp is a mass in the inner lining of the uterus. […] No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen. […] Risk factors include obesity, high blood pressure and a history of cervical polyps. […] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps. […] The use of an intrauterine system containing levonorgestrel in women taking tamoxifen may reduce the incidence of polyps.

• #24 TOP 10 FACTS: Uterine Polyps By Dr. Michele Couri, MD, FACOG, ABIHM | Couri Center

  https://www.couricenter.com/articles/top-10-facts-uterine-polyps-by-dr-michele-couri-md-facog-abihm/

  Uterine polyps are abnormal but very common growths inside the uterine cavity. They arise from the uterine lining (endometrium) and are typically benign. A small percentage of uterine polyps may contain atypical or malignant cells. […] The exact cause of uterine polyps is unknown; however, their growth can be stimulated by estrogen as they do contain estrogen and progesterone receptors. Medications such as Tamoxifen and hormone replacement therapy may increase the risk of polyp formation. Other risk factors include obesity and localized higher levels of inflammation within the uterine cavity. Genetic factors play a role in uterine polyp formation as well.

• #25 Polyps in Uterus: Symptoms, Infertility, Causes & Treatment – Tua Saúde

  https://www.tuasaude.com/en/polyps-in-uterus/

  Polyps in the uterus are more common in perimenopausal or menopausal women with hypertension, obesity and/or polycystic ovarian syndrome, and in women who use tamoxifen or take hormone replacement therapy with high doses of estrogen. […] Most uterine polyps are benign lesions that rarely turn into cancer. However, this can happen in some cases, especially in menopausal women and over 60 years old who have large polyps that present with symptoms. […] Therefore, regular monitoring and optimal treatment of polyps as guided a gynecologist is essential to reduce the risk for cancer.

• #26

  https://www.ejgo.net/articles/10.12892/ejgo340101

  Subsequently to a review of the physiology of the endometrium, the onsetting of endometrial polyps was suggested through estrogen-related and non-estrogen related ways; the two ways can overlap. […] The most implied factors in the development of endometrial polyps are linked with one of these or both ways.

• #27 Uterine Polyps | Consultant360

  https://www.consultant360.com/clinical-updates/uterine-polyps

  These findings suggest that uterine polyps may arise from hormonal, genetic, and inflammatory factors. The interaction of these factors may lead to two distinct types of polyps: those driven by hormonal imbalances and those resulting from inflammation. This dual nature could explain variations in symptoms, recurrence rates, and potential implications for fertility and cancer risk.

• #28 Pathogenesis mechanisms of endometrial polyps in women of reproductive age: a literature review – Orazov – Gynecology

  https://journals.rcsi.science/2079-5831/article/view/109662

  Endometrial polyp (EP) is a frequent incidental finding during hysteroscopy in asymptomatic patients. To date, the pathogenesis of EPs has not been fully disclosed, which challenges the primary and secondary prevention of EPs and their targeted therapy. […] Analysis of the literature data allowed us to conclude that ES pathogenesis most likely involves several mechanisms, both estrogen-mediated (hyperestrogenism, including related to impaired progesterone reception and deficiency) and non-hormonal (inflammatory, immune, genetic factors, neoangiogenesis). Hormonal and non-hormonal factors disturb normal cyclic changes of the endometrium during the menstrual cycle, alter the balance and dynamics of proliferation and apoptosis, and initiate neoangiogenesis that serves as a resolving mechanism of polyposis formation, persistence of ES, and their recurrence after surgical removal. […] The objective of our study was to analyze and summarize the scientific data available on the mechanisms of ES pathogenesis in women of reproductive age.

• #29

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/giant_endometrial_polyp_in_a_post_menopausal.93.aspx

  Endometrial polyps (EPs) result from the overgrowth of endometrial glands and stroma. […] The exact pathogenesis of polyps remains unclear. […] A systematic semi-quantitative review showed that endometrial polyps arise mostly because of oestrogen hypersensitivity in some endometrial areas, caused by a hyper-activation of the beta-oestrogen receptor (ER) on the alpha receptor (ER). Other risk factors for endometrial polyps are aging, BLC-2 expression, obesity, tamoxifen intake, unbalanced oestrogen therapy, and imbalance between oestrogen and progestins. […] Phytoestrogens are plant-derived phytochemicals that are functionally and structurally similar to 17-estradiol (isoflavones) or synthetic estrogens such as diethylstilboestrol (lignins). […] The consumption of PE-rich diet might be the possible cause of giant endometrial polyp. Further studies need to be conducted to add more evidence to this. […] This case highlights the importance of considering dietary influences in giant endometrial polyp formation and emphasizes the need for further research to clear up the mechanisms behind the association between phytoestrogen intake and giant endometrial polyps.

• #30

  https://www.pioneerpublisher.com/crms/article/view/499

  Endometrial polyps (EPs) are common gynecological diseases among women of childbearing age. […] This article aims to review the epidemiology, pathological histology, and pathogenesis of endometrial polyps to reveal their mechanisms and characteristics more accurately and guide further clinical research and treatment.

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